Management of Diarrhoea and Constipation Flashcards

1
Q

Diarrhoeas

A

Acute < 14 days
Persistent > 14 days
Chronic > 30 days

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2
Q

Inflammatory diarrhoea

A

Viral, bacterial, parasitic infection
Radiation injury
IBD

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3
Q

Inflammatory diarrhoea symptoms

A

Mucoid and bloody stool
Tenesmus (urge to empty bowels when they are empty)
Fever
Crampy abdominal pain

Histology of GI tract = abnormal

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4
Q

Non-inflammatory diarrhoea

A

Osmotic
Secretory

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5
Q

Non-inflammatory diarrhoea symptoms

A

Watery
Frequent stool > 10-20 times a day
High volume depletion

Histology of GI tract = preserved

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6
Q

Osmotic diarrhoea

A

Presence of unabsorbed solute
Small stool volume
Stops/improves with diet
Maldigestion

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7
Q

Secretory diarrhoea

A

Altered transport of ions across mucosa
Increased secretion; decreased absorption
Not affected by diet

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8
Q

Infectious bacterial diarrhoea causes

A

E.coli
Campylobacter
Salmonella
C.Diff
Listeria
Vibrio cholerae

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9
Q

Infectious viral diarrhoea causes

A

Rotavirus
Norovirus
Adenovirus
Astrovirus

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10
Q

Infectious protozoal diarrhoea causes

A

Entamoeba histoltica
Giardia lamblia
Cryptosporidium

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11
Q

Non-infectious CV drugs causing diarrhoea

A

Digoxin
Quinidine
Propranolol
ACE inhibitors

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12
Q

Non-infectious GI drugs causing diarrhoea

A

Antacids (Mg salts)
Laxarives
H2 antagonists

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13
Q

Non-infectious endocrine drugs causing diarrhoea

A

Oral hypoglycaemic agents
Thyroxine

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14
Q

Non-infectious antibiotics causing diarrhoea

A

Amoxicillin
Cephalosporins
Erythromycin

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15
Q

Absorption

A

Water follows movement of electrolytes and glucose

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16
Q

Cl- transport in intestine

A

Na+/K+/2Cl- cotransporter
Actively driven by low intracellular Na+
Na+ and water enter lumen by paracellular transport

17
Q

Vibrio cholerae

A

Cholera toxins enter cells
Activates G protein > activates adenyl cyclase
Increases cellular cAMP > activation of PKA
Phosphorylation of Cl- channel
Increased efflux of Cl- and water
Diarrhoea

18
Q

Increased motility

A

Reduction in intestinal transit time = inadequate absorption

Cholinergic drugs - Pilocarpine

Anticholinesterase activity drugs - Donepezil

19
Q

Anti-motility drugs

A

Diphenoxylate + atropine
Codeine phosphate
Racecadotril

20
Q

Diphenoxylate MOA

A

μ opioid receptor on neuronal varicosities
Activation decreases ACh release
Peristalsis decrease
Segmental contraction increase

21
Q

Racecadotril MOA

A

δ opioid receptor decreases cellular cAMP levels
Decreased Cl- and water
Enkephalins are endogenous activators
Prodrug - metabolised to thiorphan
Thiorphan is enkephalinase inhibitor

22
Q

Opiates side effects

A

Rebound constipation
CNS affects
opioid dependance

23
Q

Constipation

A

Heterogeneous disorder

Primary
Secondary

24
Q

Constipation symptoms

A

< 3 bowel movements per week
Straining
Lumpy/hard stool
Sensation of anorectal obstruction
Manoeuvring required to defaecate

25
Primary constipation
Normal transit Slow transit (colonic inertia) Pelvic floor dysfunction IBS
26
Secondary constipation
Medications Metabolic disorders Endocrine disorders Psychiatric (anxiety, depression)
27
Drug induced constipation
Anticholingeric activity -Antidepressants -Antihistamines -Antimuscarinics -Antipsychotics -Antiparkinsonian agents Opioids Laxative misuse
28
Constipation treatment
Laxatives -Osmotic -Stimulant -Bulk-forming -Faecal softeners
29
Linaclotide
14 amino acid synthetic Activates Guanylate Cyclase C GC-C Increases cellular cGMP and activation of PKG Phosphorylation of Cl- channel Increased efflux of Cl- and water
30
Lubiprostone
Prostones Derived from functional natural fatty acids Activates Cl- channel (CIC-2) Increased efflux of Cl- and water May restore mucosal barrier function
31
Linaclotide & Lubiprostone side effects
Diarrhoea Nausea Vomiting Abdominal pain