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Constipation and Diarrhoea Flashcards

1
Q

Which 2 serious underlying conditions can cause constipation?

A
  • Hypothyroidism
  • Hypokalaemia
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2
Q

Which 2 serious underlying conditions can cause diarrhoea?

A
  • Ulcerative Colitis
  • Crohn’s disease
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3
Q

True or False: Constipation and Diarrhoea can both be drug induced.

A

True

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4
Q

What is the definition of constipation?

A

Difficult passage of hard or infrequent stools.
-> Usually twice a week or less.

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5
Q

What are some common causes of constipation and explain them?

A
  • Diet - Low fibre intake, dairy products
  • IBS - alternate between constipation and diarrhoea
  • Poor Bowel Habit - resisting urge to go toilet
  • Laxative abuse - intestines become reliant and lose natural bowel movement
  • Travelling - changing lifestyle and diet
  • Pregnancy - pressure on womb, hormonal changes
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6
Q

Acute constipation can last for how long?

A

< 4 weeks

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7
Q

Chronic constipation usually lasts for how long?

A

> 3 months

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8
Q

Primary disturbance of bowel function in constipation is usually due to what?

A
  • Diet (low fibre intake)
  • Lifestyle factors (Lack of mobility)
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9
Q

Secondary constipation can be a result of what?

A
  • Treatment (opioids and anti hypertensive drugs)
  • Diseases (Hypothyroidism, Parkinson disease, Colon cancer)
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10
Q

How do diuretics cause constipation? Give an example of a diuretic.

A

Increase in urination -> loss of fluids -> hardening of stools
Furosemide

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11
Q

What is faecal impaction?

A

Hardened stools get stuck in the large intestine (colon) making it difficult to pass stools.

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12
Q

What can faecal impaction lead to?

A

Intestinal wall ulcerations and perforations
Bleeding -> infections

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13
Q

What is the diagnosis of constipation usually based on?

A
  • Changes in toilet frequency
  • Rectal examination (colonoscopy)
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14
Q

Give some red flags of constipation.

A
  • Unexpected weight loss
  • Blood in faeces
  • Abdominal masses
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15
Q

How does colonoscopy work in constipation?

A

Camera inserted through rectum to have a look at colon.
-> Faeces have to be cleared to see

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16
Q

What are some diagnostic tests in constipation?

A
  • Blood tests
  • Scans
  • Endoscope
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17
Q

Further tests of constipation can lead to which underlying health conditions?

A
  • Hormone disorders
  • Bowel blockage
  • GI disorders
  • Current medications
  • Emotional state
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18
Q

What is used to help patient describe what their stools look like?

A

The Bristol Stools Chart

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19
Q

What lifestyle advice would you give a patient with constipation?

A
  • Diet - Fruit and veg, whole grains and fibre intake.
  • Increase fluid intake
  • Increase physical activity
  • Regularly going to toilet
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20
Q

What pharmacological treatment is given in constipation?

A

Laxatives

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21
Q

Laxatives are given in indications where..?

A

The patient has faecal impaction, illness, pregnancy, poor diet.

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22
Q

What are the different types of laxatives?

A
  • Bulk-forming laxatives
  • Stimulant
  • Osmotic
  • Faecal softners
  • Pro-stimulatory
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23
Q

What is the role of laxatives?

A
  • Increase volume and soften faeces
  • Increase bowel movement
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24
Q

What is the bulk-forming laxatives? Give an example.

A
  • Non-absorbable cellulose-like material that resemble dietary fibre
    -> Fybogel
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25
How does a bulk forming laxative help in constipation?
Hydrate in the presence of water and swell to form a soft mass.
26
Give some main drugs in bulk-forming agents.
- Ispaghula - Methylcellulose - Stericulia
27
How do osmotic laxatives work?
Increase salt concentration in bowels, causing fluid to move into bowels by osmosis.
28
What are some of the main drugs in osmotic laxatives?
Inorganic salts -> Magnesium salts, Lactulose, Lacitol, Polyethylene Glycol, Sorbitol
29
When are phosphate enemas used?
Prior to surgery or sigmoidoscopy -> work within 30 minutes
30
In which patients should osmotic laxatives not be used in?
Patients with renal insufficiency.
31
How do faecal softeners work?
They are surfactants. They reduce the surface tension of the oil-water interface, allowing water to penetrate the faeces.
32
Give an example of a faecal softener.
Docusate sodium
33
What is an example of a Pro-Secretory?
Lubiprostone
34
What is lubiprostone?
Fatty acid derived from prostaglandin E1
35
How does lubiprostone work?
1. Activates chloride ions on GI epithelial cells 2. Pump chloride ions into the bowels 3. Allows the movement of water into the bowels
36
How do stimulant laxatives work?
They stimulate colonic nerves causing bowel movement. -> can increase water and electrolyte transfer into lower gut.
37
Which drugs are used to stimulate colonic nerves only?
Senna
38
Which drugs are used to stimulate colonic and rectal nerves?
Bisacodyl and sodium picosulphate
39
What side effect can be caused when using stimulant laxatives in severe forms of constipation?
Abdominal cramps
40
Why do you have to be careful giving stimulant laxatives in patients with pregnancy?
They can cause uterine contractions.
41
Which drug is found in senna?
Anthraquinones.
42
How is senna used as a stimulant laxative?
1. Anthraquinone increases secretions and irritates the mucosa 2. This cause muscle contractions 3. Peristalsis
43
How does senna stimulate colonic motor function?
Release of neurotransmitters from mucosal cells.
44
What is the last laxative used when all other laxatives don't work?
Prokinetic laxatives
45
What is an example of a prokinetic laxative and how does it work?
Prucalopride - Serotonin (5HT4) receptor agonist, which stimulates intestinal motility. - ACh also released which activates nerve cells in GI
46
What does 5HT stand for?
Serotonin - 5-Hydroxytryptamine
47
What is the definition of diarrhoea?
Passage of loose or watery stools
48
What is diarrhoea most likely caused by?
Viral and Bacterial infections
49
What other condition is diarrhoea associated with?
IBS
50
What should be taken in consideration if a patient has diarrhoea?
- Recent travel - Food eaten - Drugs use (antibiotics) - Dehydration
51
What is gastroenteritis?
Food poisoning
52
What does iatrogenic effect mean?
Overuse and harm caused by drugs
53
What is the 2 treatments of diarrhoea?
- Maintenance of fluid and electrolytes balance - use of anti-diarrhoeal agents
54
True or false:Acute infective diarrhoea and traveller’s diarrhoea require oral rehydration sachets?
False. Usually self-limiting.
55
What is the best thing to take for fluid and electrolytes balance loss?
Fruit juice as it contains glucose, Na+ and K+. -> important to maintain fluid intake
56
Oral rehydration sachets are best for which group of patients?
Young children and the elderly
57
How does the mu opioid receptor help in diarrhoea?
It slows down bowel movements
58
What happens when a opioid binds to a mu opioid receptor?
- Mu opioid receptor activated - G-protein coupled receptor -> G-protein dissociates - Triggers cAMP production - Alter calcium influx - Inhibits ACh release
59
Drug activation of the Mu opioid receptor leads to what?
- Analgesia - Euphoria - Dependence - Respiratory depression - Decreased digestive tract motility
60
Give an example of an opioid used in diarrhoea.
Loperamide -> Imodium
61
What are the benefits of using loperamide in diarrhoea?
- Reduces peristalsis - Increases transit time - Enhance water and electrolyte reabsorption - Reduces gut secretions
62
Are there any side effects of using loperamide?
Increased use can cause CNS depression -> low chance of crossing blood-brain barrier
63
What other receptor can loperamide bind to and what effect does this cause?
Delta receptor -> decreases intestinal secretions
64
Antibiotic associated diarrhoea is commonly caused by what?
Clostridioides difficile
65
Complications of CDI can lead to...?
Pseudomembraneous colitis, perforation of the colon, sepsis and death
66
Can you use loperamide in antibiotic asssociated diarrhoea?
NO!
67
Why do you have to be careful when using antibiotics in diarrhoea?
It can kill the good bacteria and allow the bad bacteria to damage the walls of the intestines.

PHA223 (10 decks)

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