Clinical Presentation

Most patients diagnosed with SO dysfunction have undergone prior cholecystectomy, but SO dysfunction may exist with an intact gallbladder and biliary tree. It is important to remember that symptoms of SO dysfunction can mimic those of gallbladder dysfunction, and the diagnosis should not be made until after the patient has had a cholecystec-tomy or after proper investigations have ruled out the presence of gallbladder dysfunction. In postcholecystectomy pain, the patient often has temporary improvement of their pain following cholecystectomy, but pain similar in character and location to the pain experienced before chole-cystectomy often returns. The pattern of pain is variable, with patients experiencing episodes of pain occurring infrequently, lasting several hours, to patients whose pain frequency and severity increases to a chronic baseline pain syndrome with intermittent acute attacks. The pain relationship to food intake is also variable, with some patients noting the onset of pain 1 to 3 hours postprandially. Other patients note no relationship to food ingestion. The ROME II diagnostic criteria were developed to better characterize the pain associated with SO dysfunction (Table 134-1). The physical examination between episodes of pain is often normal, but patients may have nonspecific abdominal tenderness. Elevations of liver associated enzymes or pancreatic enzymes during episodes of pain, are noted in < 50% of patients.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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