Diarrhoea

Question 1

mainstay of treatment

Answer 1

ORS (Oral Rehydration Salt)

Question 2

add on drugs

Answer 2

antimotility
antisecretory
adsorbant
probiotics
prebiotics

Question 3

standard WHO ors formula

Answer 3

Na+ - 90mM
K+ - 20mM
Cl- - 80mM
citrate - 10mM
glucose - 111mM

total-311mOsm/l

based on diarrhoea due to cholera

Question 4

new ORS formula

Answer 4

Na+ - 75mM
K+ - 20mM
Cl- - 65mM
citrate - 10mM
glucose - 75mM

total-245mOsm/l

based on ETEC diarrhoea

Question 5

zinc supplementation in diarrhoea

Answer 5

0-6 months: 10mg Zn/day
6 months-5 yrs: 20mg Zn/day

zinc reduces diarrhoea and increases growth or absorptive power of intestinal cells

Question 6

Antimotility

Answer 6

opioids - Loperamide (DOC for diarrhoea) , Diphenoxylate

5HT3 antagonists - Alosetron - diarrhoea in IBS in females only

Question 7

antisecretory

Answer 7

Octreotide - doc for secretory diarrhoea in carcinoid syndrome, VIPoma, HIV, cancer

Crofelemer - inhibits CFTR transporter which decrease chloride secretion, new drug for HIV induced diarrhoea

Clonidine - alpha 2A agonist - decreases chloride secretion and is used in treatment of diabetic diarrhoea

Question 8

Adsorbant

Answer 8

used in IBS

Bulk laxatives - only drugs for diarrhoea and constipation
Psyillum
Ispagula

bile acid binders - Cholestyramine

Question 9

Prebiotics

Answer 9

(stimulates colonic bacterial growth)

bulk laxatives

Question 10

probiotics

Answer 10

good or symbiotic colonic bacteria

Bifidobacterium
Lactobacillus
Fusarium
Streptomyces (fungus)

use: given for treatment of antibiotics associated diarrhoea

Question 11

Irritable bowel syndrome

Answer 11

predominant symptom:

constipation: bulk laxatives -> osmotic laxatives -> chloride secretors -> prokinetics

diarrhoea: antimotility drug (Loperamide is doc) -> Adsorbant -> Alosetron in females

abdominal pain: antispasmodics -> tricyclics antidepressants

gas/bloating: Probiotics -> Rifaximin