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DPP-4 inhibition on top of angiotensin receptor blockade offers a new therapeutic approach for diabetic nephropathy
Surgery [34] [36] Indication: intractable slow-transit constipation refractory to conservative management Procedures Total abdominal colectomy with ileorectal anastomosis: preferred procedure for isolated refractory slow-transit constipation Fecal diversion (e.g., ileostomy): considered for intractable constipation refractory to other treatments Fecal impaction Etiology [37] Risk factors Inadequate fluid intake (e.g., limited access to fluids or reduced thirst perception) Reduced renal concentrating ability Immobility Associated conditions Chronic constipation Anatomical abnormalities (e.g., anorectal malformations, postsurgical changes) Motility disorders (e.g., Chagas disease, systemic sclerosis) Medications (e.g., anticholinergics, serotonin antagonists, chronic laxative use) Clinical features Inability to defecate for days or weeks Normal or hypoactive bowel sounds [38] Distended, tympanitic abdomen DRE: hard, impacted stools distending the rectum Tenesmus Fecal impaction may manifest with diarrhea (paradoxical diarrhea) because of overflow fecal incontinence
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