Diarrhoea, Constipation, Coeliac disease, IBS Flashcards
How is diarrhoea categorized?
acute (<14 days), persistent (>14 days <28) & chronic (>28 days)
Acute diarrhoea is not infectious. True or false?
false, usually infectious
Acute diarrhoea is usually self-limiting in 3 days. True or false?
True
What are the 4 mechanisms that cause diarrhoea?
- increased osmotic load in gut lumen
- increase in secretion of fluid and electrolytes into intestine and reduced absorption
- inflammation of intestinal lining caused by inflammation of intestinal mucosal cells will result in fluid and blood loss
- increased intestinal motility
What is the primary aim of diarrhoea treatment?
To prevent dehydration
How does Loperamide work?
Increases salt and water reabsorption by decreasing motility of gut longitudinal and circular muscles
Loperamide is an OTC medicine that can be given to children. True or false?
False, OTC but not for children
Loperamide is a synthetic opioid but has no opiate activity at therapeutic doses. True or false?
True
If symptoms of overdose of loperamide occur, what drug is given?
Naloxone
Other than loperamide and oral rehydration therapy, what is available for treatment of diarrhoea?
Antispasmodics, morphine, Diphenoxylate, antibiotics, adsorbents
What does ORT generally contain?
sodium and potassium to replace essential ions, citrate/bicarbonate for acidosis, glucose or another carbohydrate
What are the characteristics of an ORT solution?
should enhance absorption of water and electrolytes, replace electrolyte deficit, contain agent to reverse acidosis, be slightly hypo-osmolar to prevent osmotic diarrhoea, be simple to use, readily available, palatable
Loperamide and antispasmodics can be used for treatment of acute diarrhoea in young children. True or false?
False, neither can be used in young children
Acute diarrhoea that is infectious is caused by a virus. True or false?
true, eg Norovirus, rotavirus
Traveller’s diarrhoea is usually caused by a virus. True or false?
False, usually by a bacteria e.g. E.coli, 10% of cases are viral
What advice should be given to prevent travellers’ diarrhoea?
hand washing with soap, avoid drinking local water, avoid ice cubes, dairy products, ice cream, salad, eat fresh foods, avoid fish and shellfish
What are some causes of chronic diarrhoea?
IBS, IBD, malabsorption syndromes, metabolic diseases and laxative abuse
What questions should you ask a patient concerning their chronic diarrhoea?
medication, recent travel, stool frequency, onset, duration, food, nature, occurrence
What drug is used adjunct to oral rehydration therapy in children aged 3 months and over?
Racecadotril
What does racecadotril do?
– It is an enkephalinase inhibitor. It reduces hypersecretion of water and electrolytes into the intestinal lumen. Given orally
The rotavirus is a live vaccine given IV. True or false?
false, given orally
The rotavirus vaccine should be started in children over 15 weeks old, given in two divided doses. True or false?
false, should not be started in children over 15 weeks
What is the recommended schedule for rotavirus vaccine?
The first dose at 2 months of age (must be given between 6 weeks-15 weeks). The second dose 3 months of age
What are the warning signs of diarrhoea for referral?
symptoms for more than 1 week, babies/young children, signs of dehydration, diarrhoea accompanied by fever, stools are bloody or black, severe abdominal or rectal pain
What causes pseudomembranous colitis?
Overgrowth of C.diff and release of toxin
How is pseudomembranous colitis managed?
stop antibiotics, Fluid and electrolyte replacement, Isolation strategies, environmental control and hand hygiene
How is C.diff treated?
– Oral Metronidazole or oral Vancomycin / but some other treatments include, probiotics, faecal microbiota transplant, IV immunoglobulin
Risk factors for CDI
Use of broad spectrum ABs, hospitalisation, age, acid suppressing drugs like PPIs, co-morbidities
Alcohol gel kills C.diff spores. True or false?
False
Which drug classes should be avoided in the management of C.diff?
Quinolones, Cephalosporins, Clindamycin
What is the dietary advice for someone who is constipated?
Increase fluid intake 2L/day and increase fibre
What are some symptoms of constipation?
abdominal pain and distension, nausea, pain when passing stool, bloating, cramping
What drugs can cause constipation?
antacids, antihypertensives, antidepressants, Antimuscarinics, Antiparkinsonian meds, opioid analgesics & iron
What are the types of constipation?
functional – no known cause & secondary – caused by a particular condition or medicine
What are some red flags for constipation?
unexplained weight loss, rectal bleeding, family history of colon cancer or IBD, signs of obstruction
What are the aims of constipation treatment?
restore normal stool frequency, achieve regular and comfortable defaecation, avoid laxative dependence, relieve discomfort
- Name the 6 causes of constipation
Lifestyle Diet and fluid Mechanical - tumours, strictures etc. Systemic affecting motility - pregnancy, hypercalcaemia Neurological - paralysis Drugs - opiates, diuretics, CCBs
Type 1 and 2 of the Bristol stool chart indicate diarrhoea. True or false?
false, indicate constipation
What are the treatment options for constipation?
Bulking agents e.g. dietary fibre, isphaghula, methyl cellulose, Stimulants e.g. senna, bisacodyl, Osmotic laxatives, faecal softening laxatives
How do bulking agents work in relieving constipation?
They increase faecal mass and so stimulate peristalsis
Laxatives should be offered to any patients starting on opiates. What are some other reasons for use of laxatives?
Post MI - to prevent strain, Expulsion of parasites after anthelmintic, treatment, Prior to surgery, Prior to certain X-ray procedures, In liver failure
How do stimulants relieve constipation?
Increase intestinal motility - but should be avoided in intestinal obstruction
How do osmotic agents relieve constipation?
Increase the amount of water in the large bowel, either by drawing fluid from the body into the bowel or by retaining the fluid they were administered with
Glycerol is a softening agent that is used orally to relieve constipation. True or false?
false, for rectal use only
Name a stimulant that is used for treatment of constipation
Senna
Name an osmotic agent that is used to treat constipation
Lactulose
Name a softening agent used to treat constipation
Glycerol, Docusate, Liquid paraffin
What are some complications of constipation?
faecal impaction, haemorrhoids, rectal prolapse, anal fissures
What is coeliac disease?
an autoimmune condition affecting the small intestine, caused by genetic predisposition or an environmental trigger, body’s immune system attacks itself when gluten is ingested
What are the symptoms of coeliac disease?
some asymptomatic but some: headaches, diarrhoea, abdominal pain, lethargy
What are some complications of coeliac disease?
Long term malabsorption and osteoporosis, refractory coeliac disease, ulcerative jejunitis, autoimmune disease
What is IBS?
A disorder which affects the large intestine
What treatment is available for IBS?
dietary changes, exercise, antispasmodics, laxatives, anti-diarrhoeal and probiotics
What are antispasmodics?
smooth muscle relaxants which help with cramping pain
What are the effects of Coeliac disease on the small intestine?
Villous atrophy
Hyperplasia of intestinal crypts
Increase in lymphocytes
What are some possible long-term consequences of untreated CD?
Osteoporosis, Hodgkin lymphoma, infertility
Which drug commonly causes constipation?
Promethazine
Which laxative should be avoided in pregnancy and why
Senna as stimulant laxatives can induce uterine contractions
