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Constipation

Clinical Classification of Functional Constipation Category Features Physiologic and Imaging Test Results Normal-transit constipation Incomplete evacuation; abdominal pain may be present but not predominant feature Normal; may show excessive stool in colon Slow-transit constipation Infrequent stools (e.g., ≤ 1/week), lack of urge to defecate, poor response to fiber and laxatives, generalized symptoms (e.g., malaise, fatigue); more prevalent in young women Delay in colonic transit [e.g., retention…

Diarrhea

Overview Diarrhea is a symptom experienced by nearly everyone, generally considered an increase in the volume, fluidity, &/or frequency of stools. Most episodes are transient and self-limited or self-treated with nonprescription medications. However, diarrhea may be persistent or complicated by pain, fever, rectal bleeding, or other factors that bring patients to medical attention. Chronic diarrhea may affect ~ 5% of people in industrialized countries, and acute…

Nausea and Vomiting

Overview Nausea and vomiting are experienced by almost everyone, and most episodes and causes are self-limited, rarely coming to medical attention. Patients are often aware of the common causes, such as acute viral infections, "travelers" nausea and diarrhea, or the after effects of excessive alcohol consumption, and self-medicate or wait for the symptoms to pass. Other episodes are sufficiently severe or atypical that patients seek medical…

Abdominal Pain

Overview The evaluation of the adult patient with abdominal pain is often challenging for the primary care, specialist, or emergency physician. While occasional abdominal pain is experienced by almost all adults and is usually self-limited, it can herald serious disorders, demanding immediate diagnosis and treatment. Much has been written about the clinical evaluation of acute abdominal pain and will be covered here only briefly, allowing us…

Pancreatic Ductal Carcinoma

KEY FACTS Imaging Multiplanar, multiphasic CT or MR CT : Poorly marginated, hypodense mass with tendency to infiltrate posteriorly into retroperitoneum Strong tendency to obstruct pancreatic and common bile ducts, with abrupt ductal cutoff at site of obstruction Pancreatic parenchymal atrophy upstream from mass Soft tissue infiltration to involve adjacent vessels and organs (e.g., duodenum, bowel, stomach, and adrenals) Most common sites of distant metastatic disease…

Groove Pancreatitis

KEY FACTS Terminology Synonym: Cystic dystrophy of duodenal wall Chronic segmental pancreatitis in groove between duodenum and pancreatic head Distal common bile duct (CBD) traverses posterior aspect of groove You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Acute Pancreatitis and Complications

KEY FACTS Imaging Interstitial edematous pancreatitis (IEP) (70-80% of cases): Normal enhancement of pancreas without necrosis Pancreas typically enlarged and edematous Peripancreatic fat stranding, edema, and free fluid Mild edematous pancreatitis can appear normal on CT Necrotizing pancreatitis (NP) (20-30% of cases): Areas of nonenhancing parenchymal necrosis May necrose pancreatic duct as well Necrosis usually develops within 3-4 days after symptom onset Complications Infected pancreatic necrosis…