SOD is an important consideration in the examination of patients with PCS, and is thought to be the cause of pain in up to 14% of these patients. It manifests as pancreatic or biliary pain, or a combination thereof, and in some patients, may present as pancreatitis or cholestasis. We recognize the following two separate entities within this disorder:

1. SO stenosis is an anatomic abnormality that may have resulted from prior inflammatory processes leading to fibrosis (eg, pancreatitis, passage of stones, operative trauma, etc). It is associated with elevated basal sphincter pressures and a lack of manometric response to smooth muscle relaxants.

2. SO dyskinesia is a functional disorder of the SO resulting in intermittent biliary and/or pancreatic obstruction also associated with elevated sphincter pressure but with a manometric response to smooth muscle relaxants. The etiology is unknown, and may be related to local hormonal or neurologic disturbance.

Abdominal pain is the major symptom. Pain is epigastric to right upper quadrant in location, may be severe, lasts from 30 minutes to several hours, and may radiate to the back or right shoulder, and it may be accompanied by nausea and vomiting. The pain may begin from weeks to several years after a cholecystectomy. Alternatively, in a subset of patients, SOD is suspected upon continued biliary pain, not relieved by prior cholecystectomy. Moreover, pain is refractory to medications for acid suppression or IBS. Fever, chills, and jaundice are rare.

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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