Constipation and chronic diarrhea - management and treatment Flashcards
what is the definition of of diarrhea ?
increase in the volume of stool and the frequency of bowel movements is also increased
it is present if one of the following criteria is fulfilled
frequent defecation of more than 3 times in 24hrs
altered stool consistency where the water content is more than 75 percent
increase in stool quantity moe than 200-250g per day
what is important when taking he medical history in diarrhoea patients ?
the frequency and size of each bowel movement
small and frequent bowel movements indicate what ?
left colon or rectal disease
voluminous stool usually indicate what ?
small bowel and right colon disease
if diarrhoea does not interrupts sleeping pattern what does this suggest ?
absence of nocturnal diarrhea indicates functional bowel disease
what is the definition of acute diarrhoea ?
ongoing for less than 14 days
what is the etiology of diarrhoea ?
travelling
food consumption of tainted and spoilt food , improper heating
secretory diarrhoea - staphylococcus, eccoli , cholera (acute) rotavirus (acute) colchicine medication (secretory diarrhoea)
medications:
antacids ,
laxatives (osmotic diarrhea - lactulose , citrate of magnesia , maldigestion of milk) ,
pancreatic insufficiency , billary disease chrons disease , celiac disease surgical resection scleroderma (diarrhoea secondary to malabsorption )
inflammatory bowel disease - chrons disease,
ulcerative colitis
enteric infections - shigella , salmonella , campylobacter , yersina
(exudative diarrhoea)
hyperthyroidism
hypokalaemia
irritable bowel syndrome -
what is the classification of pathophysiological mechanism for diarrhoea
diarrhoea secondary to mucosal transport or secretory dysfunction (occurs independent of dietary intake and does not subside with fasting)
osmotic diarrhoea - ceases with fasting
diarrhoea secondary to malabsorption
exudative diarrhoea - diseases associated with large quantities of inflammatory exudate such as pus , blood and proteinaceous materials
diarrhoea secondary to altered bowel movement - when bowel movement decreases it encourages bacterial overgrowth and bile salt beconjugation diarrhoea is then th direct result of fat malabortioon and increased colonic secretion
significant increase in bowel movement can deliver excessive large volumes of stool to colon and the maximum absorptive capacity of the colon which is 4l is exceeded , and the bowel is emptied before the adequate absorption
what is the definition of persistent diarrhoea ?
diarrhoea has persisted for more than 14 days which rules out any of the toxin and infectious diarrhoea
which infections result as chronic diarrhoea ?
giardiasis
amebiasis
what is the definition of chronic diarrhoea ?
lasting more than 30 days
what are some anti diarrhoea drugs ?
loperamide
loperamide is contraindicated in ?
fever or blood in stool
what are the diagnosis for diarrhoea ?
stool microscopy
dark field microscopy fro cholera
stool cultures
ELISA fro rotavirus
immunoassays ad bioassays for ecoli strains
what is the treatment for diarrhoea ?
ringer lactate solution iv infusion or fluids given under nasogastric gastric tube
what is the definition of constipition
infrequent difficult passage of stool with sensation of incomplete bowel emptying
constipation can be classified according to what ?
acute - sudden onset resolving within 3 months
chronic - persists longer than 3 months
constipitaion is classified into what?
primary - functional
unidentifiable disorder or side effect of medication.
Mostly due to poor diet and insufficient exercise and not good hydration and low in fibre
secondary - constipitaion due to medical disorder such as structural abnormality or medication
what is the normal bowl movements frequency ?
1-3 bowl movements per day
what is fecal impaction ?
accumulation of hard stool usually in the rectum that cannot be passed because of its size and consistency
what is a megacolon ?
constipation carried out to the extreme , hugely dilated atonic colon containing a lot of stool
what is the pathophysiology of constipation
motility disorder
hyper motility
hypotonia
where is stool normally stored ?
in the sigmoid and not the rectum
what gives us the sensation to emptying ?
when the stool is passed from the sigmoid to the rectum it passes these afferent stimulus which indicates us to defecate
what is the etiology of constipation
not enough hydration
not enough fibre
sigmoid spasms, so content is held proximally to the sigmoid
decrease propulsive activity - intrinsic muscle =scleroderma ,
neurological disorder,
anticholinergic antidepressants ,
laxatives- eventually giving atonic colon,
calcium channel blockers
opiates
suppression of normal defecation through external anal sphincter
depression
decreased physical activity
hypothyroidism
anatomical changes in colon - colorectal carcinoma , stricture
acute change of bowl movements especially after 40 indicate what ?
neoplasm
what is the subclassifications of chronic constipation ?
elder: well established laxative habit
young :often female constipated because of lifestyle - does not spontaneously defectae in the morning and skipping breakfast
junk food or salad low in fibre such as lettuce
why is the constipation in megacolon ?
the colon musculature is hypotonic , allowing he fecal accumilations
how can we differentiate a megacolon from hirschpung disease (congenitally acquired megacolon)
rectal examination: the rectum is empty despite huge accumulation of stool in the sigmoid
in acquired megacolon the rectum is foll of stool
ganglion cell biopsy
rectosphincteric manometry
fluoroscopy
what are better treatments other than laxatives due to their dependency and therefore desensitisation
enema
suppositories
why is enema and suppository better than laxatives ?
they only stimulate the rectosigmoid or rectum rather than the entire colon
fibre therapy - increase stool bulk , increasing colonic contractions
psyllium products / methycellulose artificial forms of bran
lactulose not digested and enters the colon and broken down by the bacteria creating an osmotic load stimulate colonic emptying
what is the criteria that needs to be met for definitive diagnosis of constipation
rome 3 diagnostc criteria , atleast two of the symptoms has occurred in the past 6 months over 12 week period
what are the factors in the rome 3 diagnostic criteria for constipation ?
less than 3 times a week stool passage
hard lumpy stool
incomplete defectaion sensation
manual anuveing to empty bowl
straining during attempt to defecate
sensation of anorectal obstruction
