Autonomic neuropathy

Alternative names:

neuropathy - autonomic

Symptoms:

• abdomen, swollen
• heat intolerance, induced by exercise
• nausea after eating
• vomiting of undigested food
• early satiety (feeling full after only a few bites)
• unintentional weight loss of more than 5% of body weight
• male impotence
• diarrhea
• constipation
• dizziness that occurs when standing up
• urinary incontinence (overflow incontinence)
• difficulty beginning to urinate
• feeling of incomplete bladder emptying

Signs and tests:

Inspection of the abdomen may show distention, and listening to the abdomen with a stethoscope (auscultation) may show abnormal sounds indicating decreased gastric motility. An eye examination may show sluggish pupil reaction. Examination by touch or tapping (palpation and percussion) may indicate a distended bladder. Blood pressure examination may show a fall in blood pressure upon standing up (postural hypotension). Occasionally, other symptoms may indicate disturbed functioning of the autonomic nervous system, including high blood pressure, rapid or slow heart rate, irregular heart rhythms, excessive sweating (hyperhidrosis), difficulty swallowing, or other symptoms.

• An upper GI (gastrointestinal) with small bowel series may show decreased motility, delayed emptying of the stomach, or other abnormalities and may be used to rule out physical obstruction as a cause of vomiting or other GI symptoms.
• An EGD (esophagogastroduodenoscopy) is used to rule out physical obstruction as a cause of GI symptoms.
• An isotope study may indicate gastroparesis (decreased gastric motility).
• A VCUG (voiding cystourethrogram) or other tests of bladder function may show a flaccid bladder (inability of the bladder to contract to cause emptying).

Other tests for autonomic neuropathy are guided by the suspected cause of the disorder, as suggested by the history, symptoms presented, and pattern of symptom development.