Diarrhoea, Constipation, Worm Infestation, Haemorrhoids Flashcards
What do the following cause, diarrhoea or constipation: calcium, magnesium, aluminium, bismuth subsalicylate
Constipation: calcium, aluminium, bismuth subsalicylate
Diarrhoea: magnesium
Do hypotensive drugs cause diarrhoea or constipation (e.g. ACEi, BB, CCB like verapamil, diuretics like thiazides)?
Constipation
Types of fibre, examples and how they work?
- soluble fibre (oats, psyllium fibre, beans, citrus fruits, laxatives): dissolves in water to form a gel like substance in the colon
- insoluble fibre (beans, nuts, leafy vegetables): increases stool bulk, retention of stool water & rate of transit of stool thru the intestine -> increase frequency of defecation
Should you refer if someone has constipation for >7 days
Yes
What is preferred and to avoid for constipation during pregnancy?
Preferred: bulk-forming laxative
Avoid: stimulant
Classification of diarrhoea?
- acute (<14D)
- persistent (>14D)
- chronic (>4w)
What are the 2 main viruses that cause diarrhoea?
Rotavirus, norovirus
What are some bacteria that can cause diarrhoea?
Staphylococcus, Campylobacter, Salmonella, shigella, pathogenic E coli, Bacillus cereus, Listeria monocytogenes
How is bacterial diarrhoea spread?
Food-borne
How is viral diarrhoea spread?
Faecal oral route (rotavirus), contact (norovirus)
What is recommended and not recommended to treat bacterial diarrhoea?
Recommended: fluid replacement
Not recommended: antibiotics
Which strains of probiotics can help with diarrhoea?
Lactobacillus rhamnosus, Saccharomyces boulardii
What Chinese supplement has been used for diarrhoea?
Po Chai pills
What are the types of laxatives? and forensic classification
- bulk forming: GSL
- lubricant: GSL
- saline: GSL for enema, P-only for oral
- hyperosmotic: GSL
- stimulant: GSL
- chloride channel activators: POM
What are the types of laxatives and examples?
- bulk forming: psyllium aka Fybogel
- lubricant: liquid paraffin
- saline: Fleet
- hyperosmotic: glycerin supp & enemas (glycerol, sato minica glycerin gel), macrogol (folax), lactulose (duphalac)
- stimulant: sennosides (Senna, EX-LAX), bisacodyl (dulcolax)
- chloride channel activators: lubiprostone
Onset of effect of laxatives?
- bulk forming: 12-24h, up to 72h
- lubricant: 6-8h
- saline: 30min-3h after PO, 2-5min after PR
- hyperosmotic: 24-48h after PO, 15-60min after PR
- stimulant: 6-12h after PO, 15-60min after PR
- chloride channel activators: within 24h
Which laxatives requires adequate water intake for them to work?
Bulk-forming, hyperosmotic
How do saline laxatives work?
Presence of non-absorbable cations and anions in small intestines increases intraluminal pressure -> exert stimulus that increase intestinal motility
Minimum age for using Macrogol, Fybogel, liquid paraffin, lactulose, glycerin, Senna, bisacodyl, lubiprostone
Macrogol: 8 years
Fybogel: 6 years
Liquid paraffin, Senna: 12 years
Lactulose & glycerin: <1y
Bisacodyl: 4 years (PO & PR)
Lubiprostone: adults
What should be avoided if patient has intestinal obstruction?
Bulk-forming, stimulant
What are Po Chai Pills used for?
Diarrhoea, vomiting, motion sickness, indigestion
What can be used for diarrhoea? and examples and forensic classification
- probiotics (Lactoel Forte) GSL
- Po Chai pills GSL
- adsorbents: activated charcoal (ultracarbon, norit), smecta, kaolin (kaomix) GSL
- ORS
- anti-motility agents: loperamide (Imodium), diphenoxylate/atropine (dhamotil, lomotil) P-only
- anti-secretory agents: racecadotril (Hidrasec) POM
Minimum age for smecta, activated charcoal, lactoel forte, loperamide, diphenoxylate/atropine, racecadotril?
Smecta: 2 years
Activated charcoal: can use in children
Lactoel forte: can use in infants
Loperamide: 6 years
Dhamotil: 12 years
Racecadotril: 3 months
Dose of loperamide? and max dose
> 12y: 4mg initially, then 2mg after every loose stool, max 16mg/day
Dose of diphenoxylate/atropine? and max dose
> 12y: 2 tab QDS, max 8 tab/day
What is the purpose of atropine in dhamotil?
Discourage abuse of diphenoxylate (opioid agonist) thru anticholinergic side effects
How are pinworm infestations spread?
- Faecal-oral (directly by hand or indirectly through contaminated bed sheets or clothing)
- inhalation of airborne eggs -> swallow
- retro infection: pinworm hatches on anal verge and renters host
How are pinworm and roundworm infestations spread?
Faecal-oral (infected pets pass faeces into soil/sand/plant -> human go touch)
How are tapeworm infestations spread?
Ingestion of raw or undercooked beef/pork
How are hookworm infestations spread?
Penetrate unprotected skin -> contact with contaminated soil or sand
Symptoms of pinworm infestations?
Perianal itch at night (lay eggs at night)
Should patients shower or use bathtub to wash anal area during pinworm infestation?
Shower
Bathtub risk reinfection from bath water
Treatment option for worm infestations? MOA? Forensic classification?
Albendazole (P-only): destroy microtubules in intestinal and tegmental cells of intestinal helminths
How should albendazole be administered and why?
Localised GIT infections: empty stomach
Systemic infections: with meals (esp high-fat) -> increase absorption
Albendazole SE?
Common: HA, dizzy, N/V/D, abd pain
Rare: rash, agranulocytosis, bone marrow suppression, hepatitis, acute liver & renal failure
Dose and duration of albendazole?
> 2y: 400mg (1 tablet)
1-2y: 200mg (half tablet)
Duration: 1 day (can repeat in 2 weeks)
How long to space apart adsorbents from other medications?
2h
Treatment options for haemorrhoids? MOA? Forensic classification?
- Diosmin 450mg + Hesperidia 50mg (Daflon, Diosper) (GSL): reduce swelling, inflammation & pain by increasing venous distensibility & venous stasis, normalise capillary permeability and reinforce capillary resistance
- Piles Ointment (GSL): anti-inflammatory, antibacterial, anti-hemorrhoidal properties
- Preparation H Clear Gel/Ointment (GSL): temporarily shrinks swollen haemorrhoids tissue, provide relief from pain, itch & discomfort
- Yunnan Baiyao Haemorrhoidal Ointment (GSL): resolve stasis, stop bleeding, disperse swelling
- Proctosedyl Ointment (exemption): local anaesthetic, steroid (hydrocortisone), broad spectrum antibiotic (neomycin B sulfate), improve capillary permeability (esculin)
- Proctosdyl suppository (exemption): local anaesthetic, steroid (hydrocortisone)
Definition of constipation? Using what criteria?
Rome criteria: functional constipation ≥3m with ≥2 sx
- straining (25% of the time)
- hard stools (25% of the time)
- incomplete evacuation (25% of the time)
- ≤2 bowel movements/week
Definition of diarrhoea?
> 3 unformed stools in 24h
