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6.08 Gas Pain and Constipation


Presentation

Excruciating, bloating, sharp, crampy, migratory abdominal pain may double the patient over, but last only a few seconds and is relieved by bowel movement and passing flatus. It may be related to loud bowel sounds (borborygmi) but not to position, eating, or other causes, and is not accompanied by other symptoms, such as nausea, vomiting, diarrhea, urinary urgency, et cetera. Rarely are patients awakened with nocturnal symptoms. The physical examination is also benign, with no tenderness, masses, organomegaly, or other abnormalities, and the patient does not appear ill between the episodes of abdominl pain. Bowel sounds may become loud during each episode of cramps.

What to do:

What not to do:

Discussion

While a patient may swallow excessive air in response to anxiety, an increased rate of "empty" swallowing may also accompany a number of gastrointestinal abnormalities including hiatal hernia and chronic cholecystitis. Heartburn increases salivation and therefore the frequency of swallowing. In addition to air swallowing. intraluminal gas-producing bacteria provide the other major mechanism for causing excess intestinal gas. Some patients may be helped by advising them to reduce or eliminate their intake of foods that contain non-absorbable carbohydrates such as beans, broccoli, cauliflower and cabbage. Alternatively, they can be instructed to take Beano food enzyme tablets with these healthful foods.

Colic attacks usually start when an infant is 7 to 10 days old and increase in frequency for the next one to two months. they do not just happen suddenly one night when the infant is six or eight weeks old. In that situation, look for some other acute problem such as corneal abrasion, incarcerated hernia or digital hair tourniquet in an infant who is irritable or feeding poorly with no previous problems. Constipation is one of the most common causes of pediatric abdominal pain. After a digital rectal examination, a glycerin suppository in infants or a single cleansing enema in children may provide rapid symptomatic relief.


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD