GIT

Question 1

what is flatulence?, how is the gas made?

Answer 1

It is passing gas from the digestive system out.
▪ Gas collects in two main ways:
✓ Swallowing air while you eat or drink.
✓ Breaking down food.

Question 2

what herbs do we use as carminatives?

Answer 2

fennel,anise,caraway

Question 3

what is fennel

Answer 3

from the dried ripe fruit of (Foeniculum vulgare)
contains 2-6% volatile oil, which consis
ts mainly of fenchones and anethole.

Question 4

what is anise

Answer 4

from the dried ripe fruit of (pimpinella anisum)
1.5-3.5% volatile oil, which con
sists mainly of (70%–90%) anethole, methyl ch
avicol , p-methoxyphenol acetone

Question 5

what is caraway

Answer 5

from the dried ripe fruit of (cuarum carvi)
Caraway fruits contain 2-7% volatile oil, which
consists mainly of carvone (50-60%) and
limonene

Question 6

give an example of a carminative product

Answer 6

bioD-gas (fennel 200, anise 150, caraway 150)

Question 7

what are nausea and vomiting

Answer 7

Nausea and vomiting are common symptoms that can be
caused by numerous conditions, including motion
sickness, pregnancy (morning sickness), fumes or smoke,
anxiety, chemotherapeutic agents, food poising and
general anesthetic agents.
▪ Stimuli giving rise to nausea and vomiting originate from
visceral, vestibular, and chemoreceptor trigger zone
inputs which are mediated by serotonin, dopamine,
histamine, and acetylcholine.

Question 8

what are the two categories of anti nausea and vomiting drugs

Answer 8

✓ agents directed at suppressing nausea and preventing
vomiting (antiemetic) which typically act centrally.
✓ agents directed at modulating gastrointestinal motility
(prokinetic).

Question 9

ginger is?

Answer 9

Scientific name: Zingiber officinale.
▪ Part used: rhizome.
▪ Constituents: sesquiterpene oils (zingiberene), phenols
(gingerols and shogaols).
▪ Mechanism of action:
✓ Acts directly at the gastric level and not on the central
nervous system.
✓ Ginger decreases emesis through 5-HT3 antagonism.

safe in pregnancy and can be used in adjuvant chemotherapy

▪ Adverse effects:
▪ Heartburn, nausea, diarrhea was reported in two studies in
groups of patients with heavy menstrual bleeding and after
elective cesarean section.
▪ Drug interaction:
▪ Ginger may increase the risk of bleeding in patients taking
warfarin and heparin, anti-platelet drugs.
▪ Ginger promotes the flow of gastric acid. Hence it should not be
taken by those who take H-2 receptor blockers or PPIs.

Contraindication
▪ Do not use in those with gallstones due to its cholagogue effect.
▪ Dose:
▪ There is no consensus agreement on the correct dosage of ginger,
most clinical studies recommend a safe daily dose of 1000 mg

Question 10

products containing ginger

Answer 10

bioemesis 500mg and ginger 400mg

Question 11

what is dyspepsia

Answer 11

Is also known as indigestion. The term describes
discomfort or pain in the upper abdomen.
▪ Dyspepsia is closely associated with eating habits and
are very common complaints.
▪ Patients describe the symptoms as nausea, pain and
cramps, distension, heartburn and the ‘inability to digest
food’
, often experienced after rich meals.
▪ The condition is treated either with: cholagogues,
choloretics or with bitter stimulants.

Question 12

what is a Cholagogue , choleritics and bitter stimulants

Answer 12

Cholagogue agent that stimulates the flow of bile
into the duodenum (i.e. promotes emptying of the
gallbladder and bile ducts).
▪ A choleretic is an agent that stimulate the production of
bile by the liver.
should not be used in cases
of bile duct obstruction or cholestatic jaundice.

bitter stimulants act directly on the mucosa of the upper
part of the GI tract and especially of the bitter receptors
on the tongue, stimulating the secretion of saliva and
gastric juices and influencing the secretion of gastrin.

Question 13

what are the different MOA of bitter stimulants

Answer 13

cephalic vagal reflex: oral bitter receptors, more saliva

local reflex: oral and GIT bitter receptors more digestion

hyperameia: better blood flow

Question 14

what is Dandelion (anti dyspepsia)

Answer 14

Scientific name: Taraxacum officinale.
▪ Part used: root.
▪ Constituents: sesquiterpenes lactones and triterpene:
taraxasterol.
▪ Mechanism: increase bile production.

Question 15

What is IBS

Answer 15

▪ It is a common, functional disorder.
▪ It is characterized by recurrent abdominal discomfort
and pain associated with altered bowel movements with
no identifiable structural abnormalities or biochemical
pathologies.

Causes:
✓ Changes in gut microbiota.
✓ Autonomic dysfunction .
✓ Psychological factors: anxiety.

Signs and symptoms:
✓ Lower abdominal pain.
✓ Abdominal bloating.
✓ Diarrhea.
✓ Constipation.
✓ Passage of mucous.

Question 16

peppermint Oil (IBS)

Answer 16

▪ Scientific name: Mentha piperita.
▪ Part used: leaves.
▪ Composition of the oil: menthol, menthyl acetate ,
and menthone.
▪ Mechanism of action:
▪ The studies have proposed that the mechanism for the
carminative action is peppermint’s ability to reduce the
tonus of the esophageal sphincter.
▪ It acts as smooth muscle relaxant (Ca2+ antagonistic
effects).
Drug interaction:
▪ Peppermint oil capsules appear to increase the
bioavailability of felodipine.
▪ Warning:
▪ Patients with gastroesophageal reflux (heartburn) should
avoid peppermint because heartburn may increase.

Question 17

what is gastritis

Answer 17

Gastritis: is the inflammation of the lining of the stomach.
▪ It may occur as a short episode or may be of a long duration.
▪ Symptoms of gastritis:
▪ May be asymptomatic.
▪ Upper abdominal pain (most common symptom), nausea
and vomiting, bloating, loss of appetite, heartburn.
Common causes of gastritis:
▪ Infection with Helicobacter pylori
▪ Use of NSAIDs.
▪ Less common causes include alcohol, smoking,
autoimmune problems and Crohn’s disease.
▪ and its preparations and licorice root preparations

Question 18

how to treat gastritis

Answer 18

▪ The main phytomedicines in use today for gastritis relief are
chamomile and licorice root.
▪ Alginate and other mucilages.
▪ Most pharmaceuticals for mild gastric inflammation contain
a mixture of:
✓ an emollient, to line and soothe the mucosa (e.g. alginate).
✓ an antacid.
✓ and a carminative such as peppermint or anise oil.

Question 19

what are alginates? (gastrits)

Answer 19

Alginate, or alginic acid, is an anionic polysaccharide
distributed widely in the cell walls of brown algae.
▪ Alginate binds with water to form a viscous gum and acts as
a protective coating over the walls of the stomach and
esophagus.

example gaviscon

Question 20

chamomile (gastritis)

Answer 20

▪ Scientific name: Matricaria chamomilla.
▪ Part used: flowers.
▪ Composition: bisabolol (sesquiterpene), apigenin
(flavonoid), matricin (terpenoid), and chamazulene.
▪ Pharmacopeial grade chamomile must contain no less
than 0.4% of volatile oil and no less than 0.3% of
apigenin.
▪ Mechanism of action:
▪ Anti-inflammatory effect: apigenin may be an
anti-inflammatory constituent.
▪ It inhibits phospholipase A, cyclo-oxygenase, and
lipooxygenase.
▪ The volatile oil components, chamazulene and α-bisabolol,
have also demonstrated anti-inflammatory action by
interfering with 5-lipooxygenase and cyclo-oxygenase
production

alternative for nsaid induced ulcers (instead of omeprazole)

Question 21

what is diarrhea

Answer 21

Diarrhea is an increased frequency and decreased consistency of
fecal discharge as compared with an individual’s normal bowel
pattern.
▪ Increased fluidity and volume of stool.
▪ Increased frequency (3 or more per day).
▪ Usually self limiting lasting no more than 48 hrs.
▪ Diarrhea of sudden onset and short duration is very common,
especially in children. It normally requires no detailed
investigation or treatment, as long as the loss of electrolytes is
kept under control.
Chronic serious cases of diarrhea caused by more virulent
pathogens are still a major health threat to the population of poor
tropical and subtropical areas.
▪ The WHO has estimated that approximately 5 million deaths are
due to diarrhea annually (2.5million in children under 5 years).

Question 22

what is the first line in the treatment of diarrhea

Answer 22

First line treatment of diarrhea is oral rehydration therapy
(regardless of the etiology) using sugar-salt solutions, often with
added starch (found as pharmaceutical preparation and sold as
OTC).
▪ Homemade solutions consisting of half a small spoon of salt and
six level small spoons of sugar dissolved in one liter of safe
water.
Mechanism of action: the polysaccharides of rice grains are
hydrolyzed in the GI tract; the resulting sugars are absorbed
because the co-transport of sugar and Na from the GI lumen into
the cells and mucosa is unaffected.
▪ Rice suspensions thus actively shift the balance of Na towards
the mucosal side, enhance the absorption of water and provide
the body with energy, and the efficacy of rice starch has been
demonstrated in several clinical studies.

Question 23

tannins in diarrhea

Answer 23

Tannins are astringent, polymeric polyphenols, and are found
widely in plant drugs. They have a significant effect on the
bowel in case of diarrhea.
▪ Mechanism of action: tannins bind to surface proteins of
inflamed membranes, tighten and contract human tissue, and
inhibit absorption of toxic viral or bacterial products. The result
is fluid retention (restricted secretion of water into the lumen of
the intestinal tract) that can quickly stop diarrhea and reduce any
bleeding (accompanying diarrhea).
▪ Tannins cause proteins to be deposited on the epithelial surface,
forming a stable, coherent membrane.
▪ Protective film that would hinder the absorption of toxins, blunt
the action of local irritants and normalize hyperperistalsis.

Question 24

tea in diarrhea

Answer 24

Scientific name: Camellia sinensis.
▪ Part used: leaves.
▪ Constituents: catechins (3-10%), flavonols (6-8%),
xanthine alkaloids.
Drug-herb interaction:
✓ Reduced absorption of iron.
Contraindications: avoid in kidney disorders, heart disorders,
why?
▪ Side-effects: nervous system stimulation( anxiety, nervousness
..etc)
below 200–300 mg as a safe dosage for pregnant health (not more
than five cups daily of tea) .
✓ Sleep disorders in some infants (lactation).

Question 25

what is constipation

Answer 25

▪ Constipation is defined as difficult or infrequent passage of
stool, at times associated with straining or a feeling of
incomplete defecation.
▪ Causes: inappropriate diet, insufficient fluid intake, insufficient
fiber intake, lack of physical activity, malignant disease, drugs.
▪ Diagnosis: if the frequency of bowel movements is less than
once in 2 or 3 days.
▪ Alternating diarrhea and constipation is a symptom of irritable
bowel syndrome.

Question 26

what are the categorizes of anti constipation herbs

Answer 26

✓ Bulk forming laxative: act mainly via physicochemical effects
within the bowel lumen.
✓ Stimulant laxative (purgatives), which act directly on the mucos
a of the GI tract

Question 27

what are bulk forming laxatives

Answer 27

Are the most commonly recommended initial treatments
for constipation.
▪ Bulk-forming laxatives may work as quickly as 12 hours
after use or take as long as 3 days to be effective.
▪ They contain a high percentage of fiber and are often rich
in polysaccharides (mucilage), which swell in the GI tract
and produce lubrication.

They influence the composition of food material in
the GI tract, especially via the colonic bacteria, which are
provided with nutrients for proliferation.
▪ This in turn influences the composition of the GI flora and
the metabolism of the food in the tract (including an
increase in gas, or flatus).
▪ Preparations of bulk-forming laxatives are always taken
with plenty of water.

They are not absorbed from the intestines into the body
and are safe for long-term use. They are also safe for
elderly patients to use.
▪ Bulk laxatives are considered safe during pregnancy.
▪ Contraindications:
✓ Bedridden patients and those with altered cognition.
✓ Bowel obstruction, and stenotic lesions of the GIT
contraindicate the use of bulk-forming laxatives
✓ Can they be taken with loperamide? no

Question 28

linseed (bulk forming laxatives)

Answer 28

▪ Scientific name: Linum usitatissimum.
▪ Part used: the ripe seeds.
▪ The seed must be ground so that it can absorb fluid and
swell.
▪ Constituents: mucilages.
▪ Dose: 3-6 capsules, each containing 1,000 mg oil.
▪ Drug-herb interaction:
✓ It may be reduced absorption of oral drugs, such as
antibiotics ..etc, if administered concomitantly with linseed.
✓ This is due to adsorption of drugs on the polysaccharide
mucilage.
✓ For this reason it should be taken 0.5 – 1 hr after taking ot
her drugs.

Question 29

barn ( balk forming laxatives)

Answer 29

Scientific name: Triticum aestivum.
▪ Part used: outer layer of wheat kernel.
▪ Constituents: 46% of non-starch polysaccharides.
▪ Caution: should not be used in patients with gluten-
induced enteropathies

Question 30

psyllium (balk forming laxatives)

Answer 30

High in fiber.
▪ Contain 10 to 30% mucilage (polysaccharides).
▪ Studies have shown that psyllium fiber is more effective
than lactulose and other laxatives, and causes more frequent
and bulkier bowel movements. It has also been documented
to result in a lower incidence of adverse effects.

Question 31

what are stimulant laxatives

Answer 31

▪ Stimulant laxatives increase motor activity of the bowels
by directly stimulating the nerve plexus in the intestinal
wall, causing increased movement and the stimulation of
local reflexes, (chloride channel).
▪ Stimulant laxatives should only be used when osmotic
laxatives have been ineffective, or in preparation for rectal
or bowel examinations.
Results occur in 6 to 10 hours.

Question 32

senna (stimulant laxative)

Answer 32

▪ Scientific name: Cassia senna.
▪ Part used: leaves.
▪ Constituents: dianthrone glycosides, particularly
sennosides A, B, C, and D.
▪ Mechanism: senna is a stimulant laxative that acts
directly on the intestinal mucosa.
▪ The laxative effect is due to: increase peristalsis of the
colon, reducing transit time and, consequently, reducing the
re-absorption of water from the colon.

Adverse effects:
✓ Abdominal pain, flatulence, nausea, bloating, changes in
heart rhythm.
✓ Electrolyte disturbances (e.g., hypokalemia).
✓ Renal excretion of the compounds may cause abnormal
coloration of the urine (yellowish brown that turns red with
increasing pH).

Another drawback includes their tendency to promote
overemptying and reduction of spontaneous bowel function,
thus leading to development of the so-called laxative habit.
For this reason, chronic use of stimulant laxatives should be
discouraged and use beyond one week should be avoided.
▪ Rebound constipation.

Melanotic pigmentation of the colonic mucosa (melanosis
coli) has been observed. This is reversible and thought to be
benign.
▪ In recent years, evidence has been reported that several
anthraquinones are mutagenic in the Ames test. Some have
been found to induce genotoxic effects in cultured
mammalian cells and to behave as possible tumor promoter.

Drug-herb interaction:
✓ Because of the loss of potassium (hypokalemia), the
effect of digitalis cardiac glycosides may be potentiated.
✓ Laxative activity of senna can aggravate loss of potassium
associated with use of thiazide diuretics and licorice root.
✓oral drugs absorption less

Contraindication:
✓ Intestinal obstruction, stomach inflammation and intestinal
inflammatory diseases, such as irritable bowel, ulcerative
colitis, and Crohn’s disease.
✓ Children under age of 10 or 12 due to water and
electrolyte loss.
✓ Pregnancy and nursing mothers.

Dose:
✓ Adults and children over 10 years: standardized daily dose
equivalent to 10- 30 mg sennosides (calculated as sennoside
B).Dose:

Question 33

liver diseases

Answer 33

Hepatoprotective medicines and dietary supplements are
used as additional treatment for toxic liver damages, acute
and chronic viral hepatitis, cirrhosis, and other liver disease.
▪ Hepatoprotectives are remedies which help to reduce the
damage caused to the liver from hepatic stressors and
diseases.
▪ Herbs can be assumed to have a hepatoprotective effect if
they can maintain liver cell function and help accelerate
healing.

Question 34

milk thistle (liver disease)

Answer 34

Scientific name: Silybum marianum.
▪ Part used: seeds.
▪ Constituent: a flavolignan known as silymarin:
▪ Silybin A, B.
▪ Isosilybin A , B.
▪ Silychristin.
▪ Silydianin.

Anti‐inflammatory and immuno‐modulation activity:
✓ A number of studies have shown that silymarin exerts
anti‐inflammatory action via suppression of the release of
cytokines such as tumor necrosis factor‐α (TNF‐α),
adhesion molecules, suppression of nuclear factor kappa
(NF‐κB) and 5‐lipoxygenase pathway.

Enhanced protein synthesis:
✓ Regeneration of liver cells is necessary for the hepatic
recovery from acute or chronic injury.
✓ Silybin have been shown to stimulate hepatic regeneration
in partially hepatectomized rat livers.
✓ The intraperitoneal administration of silybin has been
shown to cause a marked increase in the ribosomal protein
synthesis.

▪ Antioxidant activity:
✓ The possible antioxidant mechanisms of silymarin include:
A. prevention of free radical formation via inhibition of
reactive oxygen species (ROS)‐producing enzymes;
B. direct scavenging of free radicals actions;
C. promotion of the synthesis of protective molecules (e.g.,
heat shock proteins);
D. activation of antioxidant enzymes such as superoxide dis
mutase.

Anti-fibrotic Actions:
✓ Hepatoprotective properties of silymarin may include anti-
fibrotic activity, thereby interfering with the process that
occurs in the hepatocytes secondary to injury and
inflammation when collagen invades the normal structure
of the hepatocyte.

Question 35

mushroom poisoning and milk thistle

Answer 35

The Amanita phalloides (the so‐called death cap)
mushroom poisoning is associated with a severe morbidity
and a high mortality rate due to progressive fulminant
hepatic failure.
▪ The main toxic agents of Amanita phalloides are
amatoxins, that is, DNA‐dependent RNA polymerases II
inhibitors that dysregulate protein synthesis causing liver
necrosis .

The human lethal dose is approximately 0.1 mg/kg body
weight.
▪ There are no worldwide accepted guidelines on the
treatment of amatoxins‐induced liver failure.
▪ Several case reports describe successful treatment with an
intravenous silybin administration, even in the severely
poisoned patient..

Empiric experience suggests the administration of
milk thistle after mushroom ingestion in association with
N‐acetylcysteine and multiple‐dose activated charcoal.

Question 36

tumeric in liver diseases

Answer 36

Scientific name: Curcuma longa.
▪ Part used: rhizome.
▪ Constituents: curcuminoids, the chief of which is
curcumin.
▪ Mechanism: the protective effects of curcumin on liver
mainly attributed to its antioxidant properties.
▪ The curcumin is found to be 10 times more antioxidant
than vitamin E.
▪ Curcumin increases activity of glutathione peroxidase and
superoxide dismutase enzymes.

Curcumin has been confirmed as a “generally recognize
d as safe” compound by FDA, and it is stated not to have
any toxic effect.
▪ A healthy individual with a 70 kg body weight can
consume 4–10 g turmeric powder in accordance with
JECFA and EFSA’s suggestion that curcumin’s ADI
value should be 0–3 mg/kg.
▪ Up to 12 g/day intake of curcumin has been shown to
have no harmful effects on individuals.

Turmeric is well tolerated but the bioavailability is poor
and daily doses of at least 2g are normal.
▪ Hydroalcoholic fluid extracts or tinctures of the herb or
encapsulated powders are the formulations employed.
▪ Contraindicated in patients with gallstones or
blockage of the bile duct