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PHAR 1054 > Bowel disorders > Flashcards

Bowel disorders Flashcards

1
Q

0

Outline constipation as a bowel disorders

A
  • A change in bowel habit that results in no stools being passed for at least three days
  • Slower bowel transit allows more water to be reabsorbed from faecal matter
  • Stools become hard and difficult to pass
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2
Q

Outline what causes constipation

A
  • Low fluid intake/ dehydration
  • Lack of fibre
  • Lack of exercise
  • Changes in diet
  • Pregnancy
  • Medication
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3
Q

Outline signs and symptoms of contstipation

A
  • Difficulty passing stools
  • Pain when passing stools
  • Hard/solid stools are more hard and solid
  • Bloating or abdominal discomfort
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4
Q

Outline when to refer for constipation 1

A
  • Children under 12
  • Blood or mucus in stools
  • Significant change in bowel habit
  • Unexplained weight loss
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5
Q

Outline when to refer for constipation 2

A
  • Long duration or symptoms (more than 1 week)
  • Presence of pain, bloating and nausea
  • OTC medication failure
  • Prescribed medication known to cause constipation
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6
Q

Outline 1 type of treatment for constipation

A

Stimulant laxatives which stimulate nerve endings in the
bowel to promote the movement of the stools
- Usually effective in 8-12 hours;
- Suitable for short term use only

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7
Q

Outline the recommended dose for stimulat laxatives

A

Dulcolax 5mg tablets (bisacodyl)
* ONE to TWO tablets before bedtime
Dulcolax Adult Pico Liquid (sodium picosulphate 5mg/5mL)
* ONE to TWO 5mL spoonfuls before bedtime
Senokot 7.5mg tablets (Senna fruit)
* ONE to TWO tablets before bedtime
Senokot Max strength (Senna fruit)
* ONE 15mg tablet before bedtime

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8
Q

Outline concerns with stimulant laxatives

A
  • Not for regular use
  • Not for long term use
  • Can affect bowel tone
  • Often misused
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9
Q

Outline a 2nd treatment for constipation

A
  • Bulk forming laxatives which contain natural fibre and
    increase the mass of the stools,
    encouraging the intestine to
    move faster(HOLD WATER IN STOOLS)
  • Usually effective in 24-36 hours;
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10
Q

Outline the recommended dose for bulk forming laxatives

A

Fybogel Hi-fibre (ispaghula husk)
* Take one sachet in the morning and one in the evening.
* Take at least two hours before going to bed
Other bulk forming laxatives include Methylcellulose

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11
Q

Outline concerns with bulk forming laxatives

A

Taste and texture are challenging
* not suitable for patients with impaction, obstruction or atonic bowel
* Not for use in patients with alternating bowel habit
* Not suitable for patients with difficulty swallowing
* Has been known to cause rashes and itching to some patients

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12
Q

Outline a 3rd treatment for constipation

A
  • Osmotic laxatives which increase the
    amount of water in the large
    bowel
  • Increase stool volume prompting
    a bowel movement
  • Usually takes 24-48 hours to
    work
  • e.g. Movicol and Lactulose
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13
Q

Outline the recommended dose for osmotic laxatives

A

Movicol Sachets (Macrogol 3350, Sodium chloride, Sodium bicarbonate, Potassium chloride)
* 1-3 sachets daily in divided doses
Lactulose Oral Solution (Lactulose 3.3g/5ml).
* 15-45ml either once daily or split in two divided doses

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14
Q

Outline concers with osmotic laxatives

A
  • Cost
  • Taste
  • Bulky
  • Can cause diarrhoea if misused
    HOWEVER SAFE FOR PREGNANCY
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15
Q

Outline a 4th treatment option for constipation

A
  • Faecal Softeners act by adding water to faecal
    matter, their other mode of action appears to be reducing surface
    tension
  • Glycerin appears to have some softening effect
  • Oil based softeners appear to primarily have a lubricating effect
  • Making them easier to pass
  • E.g docusate sodium, glycerin, paraffin
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16
Q

Outline the recommended dose for faecal softeners

A

Docusate Docusate sodium 100mg capsules
Take 1 capsule 3 times a day , increase to 5 times a day if necessary
* Glycerol (4g glycerol suppository)
* One to be inserted rectally as required
* Liquid Paraffin
* Two to six 5mL spoonfuls when required

17
Q

Outline concerns of faecal softeners

A

Docusate Sodium
* Takes a few days to work
* Can cause nausea, diarrhoea, cramps and rashes/itching
Glycerol
* requires rectal insertion, not popular
* Can cause cramps, irritation and wind
Liquid paraffin
* is potentially dangerous, can cause pneumonia if inhaled
* Causes vitamin deficiency with repeated use

18
Q

Outline lifestyle advice for constipation

A
  • Drink plenty of fluids
  • Increase dietary fibre intake
  • Improve toilet routine
  • Increase exercise or activity
19
Q

Outline diarrhoea as a bwoel disorder

A
  • An increase in bowel movements involving loose or watery stools
  • When the lining of the large intestine becomes inflamed, insufficient fluid is removed from the food in the intestine.
  • Stools then become looser/liquid-like when they are excreted from
    the body
  • Can lead to dehydration
20
Q

Outline what causes diarrhoea

A
  • Bacterial or viral infections (gastroenteritis)
  • Dietary changes
  • Food allergies and food poisoning
  • Alcohol in excess
  • Poor hand hygiene (faecal-oral route)
  • IBS
21
Q

Outline signs and symptoms of diarrhoea

A
  • Increased frequency of stools
  • Loose or liquid-like stools
  • Abdominal cramps
  • Bloating
  • Nausea and vomiting
  • Increased urgency to pass stools
  • Flatulence
22
Q

Outline when to refer for diarrhoea

A
  • Children under 12
  • 1 day duration in under 1s
  • 2 days duration in under 3s and elderly
  • Symptoms persisting for 3 days or more in others or recurrent
  • If patient shows signs of dehydration
  • Diarrhoea accompanied by fever or severe nausea and vomiting
  • Anyone returning from holiday abroad
  • Blood in stools
23
Q

Outline 1 treatment option for diarrhoea

A

Rehydration Salts
* Replaces lost fluids and
electrolytes (salts)
* Reduces risk of severe
dehydration
* Dehydration is a significant risk
in babies and children
* E.g dioralyte

24
Q

Outline the recommended dose for dioralyte

A

Dioralyte sachets
* One to be taken immediately in approximately 200mL of water and drink
immediately
* To be taken after every loose motion (Poo!)

Dioralyte Relief sachets (Pre-Cooked Rice Powder 6G, Sodium Citrate 580Mg, Sodium Chloride
350Mg And Potassium Chloride 300Mg.)
* One sachet after each loose motion (watery stool) up to a maximum of 5
sachets per day for 3-4 days.

25
Q

Outline concerns with rehydration salts

A
  • Managing patient expectations
  • Taste
  • Requirement to reconstitute as instructed
  • Young children still need to see a doctor
26
Q

Outline a 2nd treatment option for diarrohea

A
  • Antidiarrhoeals or Antimotility Agents which stop stools from being passed by
    slowing bowel movement and
    allowing fluids to be reabsorbed
  • Very effective treatment but not
    without risk
  • E.g. loperamide, kaolin and
    morphine
27
Q

Outline the recommended dose for antidiarrhoeals

A

Imodium (Loperamide 2mg capsule)
* Take 2 capsules to start treatment. Take 1 capsule after each loose bowel
movement, up to a maximum of 6 capsules per day.

Imodium Plus
* Take TWO caplets immediately. Then take one caplet after each loose bowel
movement.

Kaolin and Morphine
* Shake the bottle, Mix 2 teaspoons (10ml) of the medicine in water and
consume. Repeat this dose up to 3 times a day if required.

28
Q

Outline concerns of antidiarrhoeals

A
  • May simply delay seeking medical advice
  • may hide symptoms of infection
  • Not suitable for children under 12
  • Kaolin and morphine has a potential for abuse
29
Q

Outline lifestyle advice for diarrhoea

A
  • Stay at home and get plenty of rest
  • Stay off school/work until you have not had diarrhoea for at least 2
    days to reduce spread of bacterial infection
  • Small frequent sips of fluids (water/squash)
  • Eat when you are able to
  • Effective handwashing would have the most significant impact
30
Q

Outline Irritable bowel syndrom as a bowel disorder

A
  • Common long term bowel condition that affects bowel function with
    associated symptoms and pain which is intermittent.
  • It affects up to 20% of the population.
  • Common in women but cause unknown
31
Q

Outline what causes IBS

A

MaAIN SYMPTOMS
* Abdominal pain
* Abdominal distension
* Disturbed bowel habit

OTHER SYMPTOMPS
* Nausea
* Lethargy
* Urinary symptoms

32
Q

Outline when to refer for IBS

A
  • Children
  • Older people with recent onset
  • Pregnancy
  • Blood in stools
  • Unexplained weight loss
  • Unresponsive to treatment
  • Not previously diagnosed
33
Q

Outline a treatment option for IBS

A
  • Antispasmodics which work on smooth muscle within
    the gastrointestinal tract to relax
    muscle and reduce pain from
    spasm
  • side effects are relatively rare
  • E.g. peppermint oil, mebeverine
  • hyoscine
34
Q

Outline the recommended dose for Antispasmodics

A

Colpermin (peppermint oil 0.2% capsules)
* One capsule three times a day. This dosage may be increased to two
capsules three times a day if discomfort is severe.

Buscopan (hyoscine 10mg tablets)
* The recommended starting dose is 1 tablet three times daily; this can
be increased up to 2 tablets four times daily if necessary.

Colofac IBS (mebeverine 135mg tablets)
* One tablet three times a day, preferably 20 minutes before meals.

35
Q

Outline safety concerns of antispasmodics

A
  • Only work for spasm symptoms no direct effect on bowel movement symptoms
  • Require diagnosis first so some patients may be disappointed
  • Colpermin not suitable for nut allergy suffers
  • Can cause skin reactions and swelling
  • Hyoscine can also cause dry mouth and allergic response
  • No children
36
Q

Outline lifestyle advice for IBS

A
  • Relaxation techniques might be beneficial
  • Some alternative therapies might also be of benefit.
  • Following a low fat, low sugar, high fibre diet
  • Adding bran to the diet
  • Avoid certain sweeteners
  • Identifying aggravating factors
  • Some patients benefit from a reduction in caffeine intake

PHAR 1054 (20 decks)

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