Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40

850 Intestinal Flukes Intestinal Motor Disorders

causing a myocarditis, or the brain, causing focal problems. In the

absence of these complications, prognosis for all 3 flukes is good.

Intestinal Motor Disorders.............................

GEORGE TRIADAFILOPOULOS, MD

history & physical

■Chronic intestinal pseudo-obstruction: syndrome that suggests

mechanical bowel obstruction in the absence of anatomic obstruc-

tion

Risk Factors

■Neuropathic damage:

➣Amyloidosis, diabetes mellitus, multiple sclerosis, collagen vas-

cular disease and paraneoplastic syndromes

■Neurological intestinal dysfunction:

➣Brainstem tumors, cerebrovascular accidents, spinal cord injury,

Parkinson’s disease or autonomic system degeneration

➣Drugs: anticholinergics, antidepressants, calcium channel blo-

ckers, and alpha-2 adrenergic agonists

■Early neuropathic damage but later myopathy:

➣Scleroderma

Symptoms

■Acute, recurrent, or chronic nausea and vomiting

■Abdominal distension and pain

■Constipation or diarrhea

■Early satiety, anorexia, and weight loss

■Occasionally urinary symptoms, such frequency and incontinence

Physical Signs

■Abdominal distention

■Succussion splash

■Clinical signs suggestive of collagen vascular or neuromuscular dis-

ease

tests

Basic Tests

■Serum electrolytes and albumin: hypokalemia and metabolic acido-

sis or alkalosis due to diarrhea or vomiting

■Hypoalbuminemia: suggests malnutrition