Approach to the Patient with Constipation

Rao, Satish S.C.; Camilleri, Michael

doi:10.1002/9781118512074.ch42

Cited by 9 publications

(9 citation statements)

References 252 publications

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“…From the previous results, the joint probability distribution for the spin parameter indicates that, with 90% confidence, −0.13 ≤ a * ≤ 0.27. Hence, if the assumption that the inner radius of the disc is at the ISCO in observation N5 is correct, IGR J17091 contains a low-spin or retrograde BH, consistent with what Rao & Vadawale (2012) suggested.…”

Section: The Spin Parameter Of Igr J17091supporting

confidence: 80%

“…When there is no reflection component, one can also estimate the inclination angle from other spectral components. For instance, King et al (2012), Capitanio et al (2012) and Rao & Vadawale (2012) analysed data of IGR J17091 during its 2011 outburst and obtained a high inclination angle, up to ∼70 • . Xu et al (2017) speculated that this discrepancy is the result of a warped accretion disc and suggested that the low inclination angle was either the orbital inclination, or somewhere in between the orbital and the inner disc inclination angle.…”

Section: The Reflection Component In Igr J17091mentioning

confidence: 99%

“…Using simultaneous RXTE and XMM-Newton observations, Rao & Vadawale (2012) reported a phase-resolved spectroscopic study of IGR J17091 in the heartbeat state during the 2011 outburst of the source. By fitting the continuum, they obtained an inclination angle i 50 • and a spin parameter a * < 0.2, suggesting that IGR J17091 has a low, or even negative, spin parameter.…”

Section: The Spin Parameter Of Igr J17091mentioning

confidence: 99%

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The reflection component in the average and heartbeat spectra of the black hole candidate IGR J17091-3642 during the 2016 outburst

Wang

Méndez

Altamirano

et al. 2018

Monthly Notices of the Royal Astronomical Society

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We present simultaneous NuSTAR and Swift observations of the black hole transient IGR J17091-3642 during its 2016 outburst. By jointly fitting six NuSTAR and four Swift spectra, we found that during this outburst the source evolves from the hard to the hard/soft intermediate and back to the hard state, similar to the 2011 outburst. Unlike in the previous outburst, in this case we observed both a broad emission and an moderately broad absorption line in our observations. Our fits favour an accretion disc with an inclination angle of ∼45 • with respect to the line of sight and a high iron abundance of 3.5 ± 0.3 in units of the solar abundance. We also observed heartbeat variability in one NuSTAR observation. We fitted the phase-resolved spectra of this observation and found that the reflected emission varies independently from the direct emission, whereas in the fits to the average spectra these two quantities are strongly correlated. Assuming that in IGR J17091-3642 the inner radius of the disc both in the average and the phase-resolved spectra is located at the radius of the innermost stable circular orbit, with 90% confidence the spin parameter of the black hole in this system is −0.13 ≤ a * ≤ 0.27.

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Section: The Spin Parameter Of Igr J17091supporting

confidence: 80%

Section: The Reflection Component In Igr J17091mentioning

confidence: 99%

Section: The Spin Parameter Of Igr J17091mentioning

confidence: 99%

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The reflection component in the average and heartbeat spectra of the black hole candidate IGR J17091-3642 during the 2016 outburst

Wang

Méndez

Altamirano

et al. 2018

Monthly Notices of the Royal Astronomical Society

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“…As part of a detailed physical exam, abdominal and digital rectal examination (with consideration of in-office anoscopic evaluation in selected patients) should be performed at the time of discussion of the patient’s presenting symptoms to help begin to elucidate the cause of chronic constipation [ 29 ]. Explaining the purpose and nature of the digital rectal examination to patients with chronic constipation is recommended, as well as the relevance of anorectal anatomy as it relates to defecation and stool evacuation.…”

Section: Diagnosing Constipation In a Primary Care Settingmentioning

confidence: 99%

Diagnosing Constipation Spectrum Disorders in a Primary Care Setting

Heidelbaugh

Andino

Pineles

et al. 2021

JCM

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Understanding pathophysiological causes of constipation is worthwhile in directing therapy and improving symptoms. This review aims to identify and fill gaps in the understanding of the pathophysiology of constipation, understand its prevalence, review diagnostic tools available to primary care physicians (PCPs), and highlight patients’ expectations for the management of this common spectrum of disorders. Literature searches conducted via PubMed included terms related to constipation, diagnosis, and patient perceptions. Case studies were developed to highlight the differences between patients who may be appropriately managed in the primary care setting and those requiring specialty consultation. Myriad pathophysiological factors may contribute to constipation, including stool consistency, altered intestinal motility, gut microbiome, anorectal abnormalities, as well as behavioral and psychological factors. Common diagnoses of “primary constipation” include slow-transit constipation, defecation disorders, irritable bowel syndrome with constipation, and chronic idiopathic constipation. A detailed medical history should be conducted to exclude alarm features and PCPs should be familiar with pathophysiological factors that cause constipation, available diagnostic tools, alarm signs, and the various classification criteria for constipation subtypes in order to diagnose and treat patients accordingly. PCPs should understand when a referral to a gastroenterologist, anorectal specialist, pelvic floor physical therapist, and/or mental health specialist is appropriate.

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“…Several hypotheses have been proposed in order to explain the faintness of the IGR J17091-3624 "Heartbeat". For example, Capitanio et al 2011 speculate that the lower luminosity of IGR J17091-3624 could also be ascribed to the spectral deformation effects due to the high inclination angle that is favored by the data [13,4,25]. In fact a study, reported by Cunningham (1975), claims that when a Kerr BH is seen at a high inclination angle (cosi < 0.25, i >75deg), the source appears significantly fainter (up to a factor that depends on the BH spin and mass but can reach about an order of magnitude less) with respect to the system observed face-on.…”

Section: The 2011 Outburst a Special Casementioning

confidence: 99%

IGR J17091-3624: a GRS 1915-105 like source as seen by INTEGRAL and Swift

Capitanio¹,

Delsanto²,

Bozzo³

et al. 2013

Proceedings of an INTEGRAL View of the High-Energy Sky (The First 10 Years) - 9th INTEGRAL Workshop and Celebration of the 10t

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We present here the main characteristics of the BHC IGR J17091-3624 outbursts occurred several times since 1994. Since 2003, the source has been extensively observed by INTEGRAL and Swift. In particular, we report results on the last 2011 outburst that showed a rare variability behaviour observed before only in the galactic BH GRS 1915+105 but at a different level of flux.Several hypotheses have been proposed in order to explain this particular behaviour. They are all discussed here, in the light of their apparent contradiction. Finally, based on all available informations, we attempt to give an overall view of this enigmatic source and we speculate on the evolutionary state of the binary system. An INTEGRAL view of the high-energy sky (the first 10 years) -9th INTEGRAL Workshop and celebration of the 10th anniversary of the launch

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Approach to the Patient with Constipation

Cited by 9 publications

References 252 publications

The reflection component in the average and heartbeat spectra of the black hole candidate IGR J17091-3642 during the 2016 outburst

The reflection component in the average and heartbeat spectra of the black hole candidate IGR J17091-3642 during the 2016 outburst

Diagnosing Constipation Spectrum Disorders in a Primary Care Setting

IGR J17091-3624: a GRS 1915-105 like source as seen by INTEGRAL and Swift

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