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| | __NOTOC__ |
| | '''For patient information click [[Abdominal distension (patient information)|here]]''' |
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| {{Infobox_Disease | | | {{Infobox_Disease | |
| | Name = {{PAGENAME}} | | | Name = {{PAGENAME}} |
| | Image = Bowel obstruction.jpg | | | Image = Bowel obstruction.jpg |
| | Caption =
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| | DiseasesDB = 30819
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| | ICD10 = {{ICD10|R|14||r|10}}, {{ICD10|R|19|0|r|10}}
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| | ICD9 = {{ICD9|787.3}}, {{ICD9|789.3}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus =
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| | eMedicineSubj =
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| | eMedicineTopic =
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| | MeshID =
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| }} | | }} |
| {{Search infobox}}
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| {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; {{MUT}}
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| ==Overview==
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| * '''Abdominal distension''' must be evaluated carefully and systematically. The first concern is to rule out a serious diagnosis such as [[abdominal aneurysm]].
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| * Importance of evaluation:
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| :* To rule out serious diagnoses
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| :* To evaluate mundane diagnoses
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| :*:* [[Overeating]]
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| :*:* [[Swallowing air]]
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| * Attention to history and physical examination is important to formulate plan of diagnosis
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| ==Causes in Alphabetical Order==
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| '''Abdominal distension''' (or "distended abdomen") can be a sign of many other conditions, including:In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| * [[Abdominal abscess]]
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| * [[Abdominal aneurysm]]
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| * [[Abdominal trauma]] with intra-abdominal [[bleeding]]
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| * [[Acanthocytosis]]
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| * [[Acute appendicitis]]
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| * [[Air swallowing]] (nervous habit)
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| * [[Ascites]]
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| *:* [[Congestive Heart Failure]]
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| :* [[Hypoalbuminemia]] (e.g. [[malnutrition]], [[liver failure]])
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| :* [[Metastatic cancer]] (e.g., colon, ovarian)
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| :* [[Nephrotic syndrome]]
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| :* [[Portal hypertension]] (e.g. [[cirrhosis]])
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| * [[Biliary Atresia]]
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| * [[Blind loop syndrome]]
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| * [[Chylous ascites]]
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| * [[Cirrhosis]]
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| * [[Colonic pseudo-obstruction]] ([[Ogilvie's Syndrome]])
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| * [[Colonic volvulus]]
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| * [[Congenital hepatic porphyria]]
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| * [[Congenital megacolon]]
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| * Congenital short bowel
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| * [[Congenital tuberculosis]]
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| * [[Constipation]]
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| * [[Diverticulitis]]
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| * End stage [[liver failure]]
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| * Functional gas/[[constipation]]
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| * Gas/bloat syndrome
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| * [[Granulosa cell tumor]] of the [[ovary]]
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| * [[Heart failure]]
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| * [[Helminthiasis]]
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| * Hepatorenal [[tyrosinemia]]
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| * [[Hirschsprung disease]]
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| * [[Hypothyroidism]]
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| * Idiopathic sclerosing mesenteritis
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| * [[Ileus]]
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| * [[Infectious diarrhea]]
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| * [[Irritable bowel syndrome]]
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| * Jirásek-Zuelzer-Wilson syndrome
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| * [[Lactose intolerance]]
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| * [[Large bowel obstruction]]
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| * [[Leukemia]]
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| * [[Lymphoma]]
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| * [[Meconium]] plug syndrome
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| * [[Metastatic cancer]] (e.g., colon, ovarian)
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| * [[Necrotizing enterocolitis]]
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| * Neonatal [[sepsis]]
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| * [[Nephrotic syndrome]]
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| * [[Obesity]]
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| * [[Ovarian hyperstimulation syndrome]] [[OHSS]]
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| * [[Ovarian cancer]]
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| * [[Ovarian cyst]]
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| * [[Overeating]]
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| * [[Pancreatitis]] and complications (pseudocyst)
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| * [[Paralytic ileus]]
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| * Peritoneal bleeding
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| * [[Peritonitis]]
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| * [[Polycystic Liver Disease]]
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| * [[Pregnancy]]
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| * [[Premenstrual syndrome]]
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| * Sclerosing mesenteritis
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| * [[Small bowel obstruction]]
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| * Smith's disease
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| * [[Spontaneous bacterial peritonitis]] (SBP)
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| * Stalker-Chitayat syndrome
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| * [[Toxic megacolon]]
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| * [[Trauma]]
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| * [[Umbilical hernia]] or [[ventral hernia]]
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| * Urethral obstruction sequence
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| * Urorectal septum malformation sequence
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| * Valvular dysplasia of the child
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| * [[Variegate porphyria]]
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| * [[Weight gain]]
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| * Wolman syndrome
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| Other:
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| Pseudomyxoma peritonei
| | {{Abdominal distension}} |
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| Clostridium Difficile
| | {{CMG}}; {{AE}} {{CZ}}; {{MUT}} |
| Ascites
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| Hookworm
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| Drowning
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| Pelvic Masses
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| Ileus
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| Pseudocyesis
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| Pulmonary hypertension
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| Volvulus
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| Eosinophilic gastroenteritis
| | {{SK}} Distended abdomen; abdominal swelling; swelling in the abdomen; swollen belly |
| Ulcerative colitis
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| Strongyloidiasis
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| Toxic megacolon
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| Soiling
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| Bloating
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| Necrotizing enterocolitis
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| Intestinal pseudoobstruction
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| Cardiac tamponade
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| Enteritis
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| Jugular venous pressure
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| Ischemic colitis
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| SSRI discontinuation syndrome
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| Bowel obstruction
| | == [[Abdominal distension overview|Overview]] == |
| Autonomic dysreflexia
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| Islet cell transplantation
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| Infectious hematopoietic necrosis virus
| | == [[Abdominal distension pathophysiology|Pathophysiology]] == |
| Cordyceps
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| Ovarian hyperstimulation syndrome
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| Necrotising enterocolitis
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| Distension
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| ===Causes of Abdominal Distension by Organ System=== | | == [[Abdominal distension causes|Causes]] == |
| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
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| [[Abdominal aneurysm]], | |
| [[Congestive Heart Failure]],
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| [[Heart failure]],
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| |-
| | == [[Abdominal distension differential diagnosis|Differentiating Abdominal Distension from other Diseases]] == |
| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Congenital'''
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| |bgcolor="Beige"|
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| [[Congenital hepatic porphyria]], | |
| [[Congenital megacolon]],
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| Congenital short bowel,
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| [[Congenital tuberculosis]],
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| [[Hirschsprung's disease]],
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| Jirásek-Zuelzer-Wilson syndrome,
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| [[Meconium]] plug syndrome,
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|
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| |-
| | == [[Abdominal distension epidemiology and demographics|Epidemiology and Demographics]] == |
| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"|
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| [[Ovarian hyperstimulation syndrome]] [[OHSS]], | |
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|
| |-
| | == [[Abdominal distension risk factors|Risk Factors]] == |
| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"|
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| [[Hypothyroidism]], | |
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| |-
| | == [[Abdominal distension natural history, complications and prognosis|Natural History, Complications and Prognosis ]] == |
| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"|
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| [[Abdominal abscess]], | |
| [[Acute appendicitis]],
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| [[Ascites]],
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| [[Biliary Atresia]],
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| [[Cirrhosis]],
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| [[Colonic volvulus]],
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| [[Constipation]],
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| [[Diverticulitis]],
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| Idiopathic sclerosing mesenteritis,
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| [[Ileus]],
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| [[Large bowel obstruction]],
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| [[Necrotizing enterocolitis]],
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| [[Pancreatitis]] and complications (pseudocyst),
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| Peritoneal bleeding,
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| [[Peritonitis]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"|
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| [[Polycystic Liver Disease]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"|
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| [[Acanthocytosis]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"|
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| [[Blind loop syndrome]],
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| [[Colonic pseudo-obstruction]] ([[Ogilvie's Syndrome]]),
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"|
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| [[Helminthiasis]],
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| [[Toxic megacolon]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"|
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| [[Acute intermittent porphyria]],
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| Hepatorenal tyrosinemia]],
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| [[Lactose intolerance]],
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| [[Overeating]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"|
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| [[Ovarian cancer]],
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| [[Pregnancy]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"|
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| [[Granulosa cell tumor]] of the [[ovary]],
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| [[Leukemia]],
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| [[Lymphoma]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"|
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| [[Nephrotic syndrome]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"|
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| [[Abdominal trauma]] with intra-abdominal [[bleeding]],
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"|
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| Air swallowing (nervous habit),
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| Functional gas/constipation,
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| Gas/bloat syndrome,
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| [[Obesity]],
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| [[Umbilical hernia]] or [[ventral hernia]],
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| |-
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| |}
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| ==Diagnosis==
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| === History ===
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| * [[Diarrhea]]
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| * [[Weight gain]]
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| * Duration
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| * Flatus
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| * [[Reflux]]
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| * Last bowel movement
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| * Last [[menstrual period]]
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| * Sexual history
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| * Presence of [[fever]]
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| * Constitutional symptoms
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| === Physical Examination ===
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| * In women, pelvic exam
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| * Fluid wave
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| * Signs:
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| *:* [[Cirrhosis]]
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| *:* [[Portal hypertension]]
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| ==== Abdomen ====
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| * Abdominal exam
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| *:* Masses
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| *:* Palpitation for hernias
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| * Abdominal tenderness
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| === Laboratory Findings ===
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| * [[Complete blood count]] ([[CBC]])
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| * [[Stool culture]]s
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| * [[Pregnancy test]]
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| * [[Erythrocyte sedimentation rate]] ([[ESR]])
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| * Liver workup ([[liver function test]]s, [[biopsy]], [[hepatitis]] panel)
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| === MRI and CT ===
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| * Pelvic and abdominal [[CT scan]]s could reveal:
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| *:* [[Cirrhosis]]
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| *:* Ovarian masses
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| *:* [[Pseudocyst]]s
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| *:* [[Aneurysm]]s
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| === Echocardiography or Ultrasound ===
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| * Pelvic and abdominal ultrasound may reveal:
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| *:* Ovarian mass
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| *:* [[Pregnancy]]
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| *:* [[Ascites]]
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| *:* [[Liver disease]]
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| === Other Imaging Findings ===
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| * KUB x-rays ([[kidney]], [[ureter]], [[bladder]])
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| *:* Could reveal [[paralytic ileus]], [[constipation]], [[air swallowing]], [[bowel obstruction]]
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| === Other Diagnostic Studies ===
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| * [[Biopsy]] for masses/tumors
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| * [[Endoscopy]] (lower gastrointestinal) may be performed to rule out any organic pathology before [[irritable bowel syndrome]] can be diagnosed.
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| * [[Paracentesis]] may provide symptomatic relief and is diagnostic for [[spontaneous bacterial peritonitis]] (SBP) and malignant [[ascites]].
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| | == Diagnosis == |
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| | [[Abdominal distension history and symptoms|History and Symptoms]] | [[Abdominal distension physical examination|Physical Examination]] | [[Abdominal distension laboratory findings|Laboratory Findings]] | [[Abdominal distension x ray|X Ray]] | [[Abdominal distension CT|CT]] | [[Abdominal distension MRI|MRI]] | [[Abdominal distension ultrasound|Ultrasound]] | [[Abdominal distension other imaging findings|Other Imaging Findings]] | [[Abdominal distension other diagnostic studies|Other Diagnostic Studies]] |
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| == Treatment == | | == Treatment == |
| * For [[malabsorption]], reduce milk intake and change diet
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| * For [[bowel obstruction]], [[pancreatitis]] (for example), [[nasogastric tube]] decompression and bowel rest (when indicated)
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| * For swallowing air, awareness is key:
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| *:* Sip hot beverages
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| *:* Avoid carbonated beverages
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| *:* Chew gum/suck on candies
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| *:* Eat slowly
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| *:* Drink through a straw
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| * Treatment of underlying [[liver disease]]s (management of complications)
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| * Increase dietary fiber, reduce stress, and [[antispasmodic]]s for [[irritable bowel syndrome]]
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| === Acute Pharmacotherapies ===
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| * For [[constipation]], [[laxative]]s
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| * For [[spontaneous bacterial peritonitis]] (SBP), [[antibiotic]]s
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| == Surgery and Device Based Therapy ==
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| * Referral for [[hernia]]s (if and when appropriate)
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| ==References==
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| {{reflist|2}}
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| ==See also==
| | [[Abdominal distension medical therapy|Medical Therapy]] | [[Abdominal distension surgery|Surgery]] | [[Abdominal distension primary prevention|Primary Prevention]] | [[Abdominal distension cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Abdominal distension future or investigational therapies|Future or Investigational Therapies]] |
| * [[Gastric distension]]
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| * [[Bloating]]
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| {{WikiDoc Help Menu}} | | == Case Studies == |
| {{WikiDoc Sources}} | | [[Abdominal distension case study one|Case #1]] |
| | {{WH}} |
| | {{WS}} |
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| [[Category:Digestive disease symptoms]] | | [[Category:Digestive disease symptoms]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| | [[Category:Symptoms]] |
| [[Category:Physical examination]] | | [[Category:Physical examination]] |
| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
