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Competency > Diarrhoea, Constipation, Worm Infestation, Haemorrhoids > Flashcards

Diarrhoea, Constipation, Worm Infestation, Haemorrhoids Flashcards

1
Q

What do the following cause, diarrhoea or constipation: calcium, magnesium, aluminium, bismuth subsalicylate

A

Constipation: calcium, aluminium, bismuth subsalicylate
Diarrhoea: magnesium

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2
Q

Do hypotensive drugs cause diarrhoea or constipation (e.g. ACEi, BB, CCB like verapamil, diuretics like thiazides)?

A

Constipation

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3
Q

Types of fibre, examples and how they work?

A
  • 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
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4
Q

Should you refer if someone has constipation for >7 days

A

Yes

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5
Q

What is preferred and to avoid for constipation during pregnancy?

A

Preferred: bulk-forming laxative
Avoid: stimulant

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6
Q

Classification of diarrhoea?

A
  • acute (<14D)
  • persistent (>14D)
  • chronic (>4w)
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7
Q

What are the 2 main viruses that cause diarrhoea?

A

Rotavirus, norovirus

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8
Q

What are some bacteria that can cause diarrhoea?

A

Staphylococcus, Campylobacter, Salmonella, shigella, pathogenic E coli, Bacillus cereus, Listeria monocytogenes

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9
Q

How is bacterial diarrhoea spread?

A

Food-borne

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10
Q

How is viral diarrhoea spread?

A

Faecal oral route (rotavirus), contact (norovirus)

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11
Q

What is recommended and not recommended to treat bacterial diarrhoea?

A

Recommended: fluid replacement
Not recommended: antibiotics

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12
Q

Which strains of probiotics can help with diarrhoea?

A

Lactobacillus rhamnosus, Saccharomyces boulardii

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13
Q

What Chinese supplement has been used for diarrhoea?

A

Po Chai pills

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14
Q

What are the types of laxatives? and forensic classification

A
  • bulk forming: GSL
  • lubricant: GSL
  • saline: GSL for enema, P-only for oral
  • hyperosmotic: GSL
  • stimulant: GSL
  • chloride channel activators: POM
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15
Q

What are the types of laxatives and examples?

A
  • 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
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16
Q

Onset of effect of laxatives?

A
  • 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
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17
Q

Which laxatives requires adequate water intake for them to work?

A

Bulk-forming, hyperosmotic

18
Q

How do saline laxatives work?

A

Presence of non-absorbable cations and anions in small intestines increases intraluminal pressure -> exert stimulus that increase intestinal motility

19
Q

Minimum age for using Macrogol, Fybogel, liquid paraffin, lactulose, glycerin, Senna, bisacodyl, lubiprostone

A

Macrogol: 8 years
Fybogel: 6 years
Liquid paraffin, Senna: 12 years
Lactulose & glycerin: <1y
Bisacodyl: 4 years (PO & PR)
Lubiprostone: adults

20
Q

What should be avoided if patient has intestinal obstruction?

A

Bulk-forming, stimulant

21
Q

What are Po Chai Pills used for?

A

Diarrhoea, vomiting, motion sickness, indigestion

22
Q

What can be used for diarrhoea? and examples and forensic classification

A
  • 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
23
Q

Minimum age for smecta, activated charcoal, lactoel forte, loperamide, diphenoxylate/atropine, racecadotril?

A

Smecta: 2 years
Activated charcoal: can use in children
Lactoel forte: can use in infants
Loperamide: 6 years
Dhamotil: 12 years
Racecadotril: 3 months

24
Q

Dose of loperamide? and max dose

A

> 12y: 4mg initially, then 2mg after every loose stool, max 16mg/day

25
Q

Dose of diphenoxylate/atropine? and max dose

A

> 12y: 2 tab QDS, max 8 tab/day

26
Q

What is the purpose of atropine in dhamotil?

A

Discourage abuse of diphenoxylate (opioid agonist) thru anticholinergic side effects

27
Q

How are pinworm infestations spread?

A
  • 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
28
Q

How are pinworm and roundworm infestations spread?

A

Faecal-oral (infected pets pass faeces into soil/sand/plant -> human go touch)

29
Q

How are tapeworm infestations spread?

A

Ingestion of raw or undercooked beef/pork

30
Q

How are hookworm infestations spread?

A

Penetrate unprotected skin -> contact with contaminated soil or sand

31
Q

Symptoms of pinworm infestations?

A

Perianal itch at night (lay eggs at night)

32
Q

Should patients shower or use bathtub to wash anal area during pinworm infestation?

A

Shower
Bathtub risk reinfection from bath water

33
Q

Treatment option for worm infestations? MOA? Forensic classification?

A

Albendazole (P-only): destroy microtubules in intestinal and tegmental cells of intestinal helminths

34
Q

How should albendazole be administered and why?

A

Localised GIT infections: empty stomach
Systemic infections: with meals (esp high-fat) -> increase absorption

35
Q

Albendazole SE?

A

Common: HA, dizzy, N/V/D, abd pain
Rare: rash, agranulocytosis, bone marrow suppression, hepatitis, acute liver & renal failure

36
Q

Dose and duration of albendazole?

A

> 2y: 400mg (1 tablet)
1-2y: 200mg (half tablet)
Duration: 1 day (can repeat in 2 weeks)

37
Q

How long to space apart adsorbents from other medications?

A

2h

38
Q

Treatment options for haemorrhoids? MOA? Forensic classification?

A
  • 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)
39
Q

Definition of constipation? Using what criteria?

A

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

40
Q

Definition of diarrhoea?

A

> 3 unformed stools in 24h

Competency (28 decks)

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