minor ailments - lower GI Flashcards
what is diarrhoea
the passing of watery stool more than three times a day
what are the three types of diarrhoea
acute
persistent
chronic
characteristics of acute diarrhoea
comes on suddenly, lasts upto 14 days
characteristics of persistent diarrhoea
lasts more than 14 days
characteristics of chronic diarrhoea
lasts more than 4 weeks
what are the mechanisms that cause diarrhoea
- increased osmotic load in the gut lumen
- increase in secretion
- inflammation of the intestinal lining
- increased intestinal motility
symptoms of diarrhoea
watery, frequently passed stools.
can have:
- abdominal cramps
- flatulence
- weakness
- nausea, vomiting, fever
- headache, loss of appetite
what can fluid loss lead to
electrolyte loss
how to treat diarrhoea
usually goes away on own
- can drink fluids to avoid dehydration
- eat as soon as possible (high carbs)
- consider anti-diarrhoea medication (loperamide)
- use painkillers to treat fever or headache
what do dehydration drinks do
replace lost electrolytes but will not treat diarrhoea
example of rehydration drink
dioralyte
lightly salted rice water can be used as at home recipe
how do antidiarrhoeals work
they slow transit time through the GI tract which increases water and electrolyte absorption
warning symptoms of diarrhoea (must refer)
- blood or mucous in motions
- signs of dehydration
- lasts a long time
- vomitting >1 day
- high fever
- change in bowel habit or travel abroad
what is constipation
the passage of hard stools less frequently that the patients on normal patter
inability to completely empty the bowel
symptoms of constipation
- change in stool frequency
- stools can become unusually hard/lumpy/large/small
- stomach ache & cramps
- bloated, nauseous, no appetite
causes of constipation
- poor diet (lack of fibre/fluids)
- lack of mobility
- medication
- pregnancy
- medical conditions
treatment of constipation
lifestyle advice
- increase in fibre, adding bulking agents
- increase fluid intake
- increase daily exercise
laxatives
what are the three types of laxatives
stimulant
bulk forming
osmotic
what do stimulant laxatives do
increase intestinal motility
how long to stimulant laxatives take to work
8-12 hours
side effects of stimulant laxatives
abdominal cramps
excessive fluid loss
electrolyte imbalance
examples of stimulant laxatives
Senna, bisacodyl
how do bulk forming laxatives work
they stimulate peristalsis in a similar way to dietary fibre
how long do bulk forming laxatives take to work
24-36 hours
why is it important to drink water while taking bulk-forming laxatives
to avoid impactioni
side effects of bulk forming laxatives
flatulence and abdominal bloating
examples of bulk forming laxatives
bran
isphaghula husk
how do osmotic laxatives work
they reduce fluid in the bowel by osmosis so must drink plenty while using
how long do osmotic laxatives take to work
up to 3 days
side effects of osmotic laxatives
flatulence
abdominal pain
colic
examples of osmotic laxatives
lactulose
magnesium
warning symptoms of constipation (refer)
- constipation alternating with diarrhoea
- blood or mucus in motions
- weight loss
- abuse of laxatives
- vomiting
- fever
- angina
what do the anal vascular cushions do
act to assist the anal sphincter in maintaining continence
what are haemorrhoids
abnormal swelling or enlargement of the anal vascular cushions
symptoms of haemorrhoids
- bright red rectal bleeding (blood often found on surface of stool, not mixed in)
- itching due to chronic mucus discharge and irritation
- rectal fullness or anal lump
- large prolapsed haemorrhoids can thrombose (very painful, tender mass)
causes of haemorrhoids
- excessive straining
- increasing age
- raised intra-abdominal pressure (pregnancy, chronic cough)
how to treat haemorrhoids
- treat the constipation
- creams, ointments and suppositories (treat symptoms not cure)
- local anaesthetic, astringent & barrier cream
warning symptoms of haemorrhoids (refer)
- exclude other causes of rectal bleeding eg malignancy, IBD
how does loperamide work
it stimulates MU receptors in the GI tract which slows down peristalsis and reduces transit time
allows more fluids to be reabsorbed into GI tract
what form of laxative should you never give to those using opioids
bulk-forming laxatives
why shouldn’t you give bulk forming laxatives to those using opioids
they have very little peristalsis, can lead to complications having too much in the bowel
which laxatives should be used during pregnancy
osmotic
