minor ailments - lower GI

Question 1

what is diarrhoea

Answer 1

the passing of watery stool more than three times a day

Question 2

what are the three types of diarrhoea

Answer 2

acute
persistent
chronic

Question 3

characteristics of acute diarrhoea

Answer 3

comes on suddenly, lasts upto 14 days

Question 4

characteristics of persistent diarrhoea

Answer 4

lasts more than 14 days

Question 5

characteristics of chronic diarrhoea

Answer 5

lasts more than 4 weeks

Question 6

what are the mechanisms that cause diarrhoea

Answer 6

• increased osmotic load in the gut lumen
• increase in secretion
• inflammation of the intestinal lining
• increased intestinal motility

Question 7

symptoms of diarrhoea

Answer 7

watery, frequently passed stools.
can have:
- abdominal cramps
- flatulence
- weakness
- nausea, vomiting, fever
- headache, loss of appetite

Question 8

what can fluid loss lead to

Answer 8

electrolyte loss

Question 9

how to treat diarrhoea

Answer 9

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

Question 10

what do dehydration drinks do

Answer 10

replace lost electrolytes but will not treat diarrhoea

Question 11

example of rehydration drink

Answer 11

dioralyte
lightly salted rice water can be used as at home recipe

Question 12

how do antidiarrhoeals work

Answer 12

they slow transit time through the GI tract which increases water and electrolyte absorption

Question 13

warning symptoms of diarrhoea (must refer)

Answer 13

• blood or mucous in motions
• signs of dehydration
• lasts a long time
• vomitting >1 day
• high fever
• change in bowel habit or travel abroad

Question 14

what is constipation

Answer 14

the passage of hard stools less frequently that the patients on normal patter

inability to completely empty the bowel

Question 15

symptoms of constipation

Answer 15

• change in stool frequency
• stools can become unusually hard/lumpy/large/small
• stomach ache & cramps
• bloated, nauseous, no appetite

Question 16

causes of constipation

Answer 16

• poor diet (lack of fibre/fluids)
• lack of mobility
• medication
• pregnancy
• medical conditions

Question 17

treatment of constipation

Answer 17

lifestyle advice
- increase in fibre, adding bulking agents
- increase fluid intake
- increase daily exercise

laxatives

Question 18

what are the three types of laxatives

Answer 18

stimulant
bulk forming
osmotic

Question 19

what do stimulant laxatives do

Answer 19

increase intestinal motility

Question 20

how long to stimulant laxatives take to work

Answer 20

8-12 hours

Question 21

side effects of stimulant laxatives

Answer 21

abdominal cramps
excessive fluid loss
electrolyte imbalance

Question 22

examples of stimulant laxatives

Answer 22

Senna, bisacodyl

Question 23

how do bulk forming laxatives work

Answer 23

they stimulate peristalsis in a similar way to dietary fibre

Question 24

how long do bulk forming laxatives take to work

Answer 24

24-36 hours

Question 25

why is it important to drink water while taking bulk-forming laxatives

Answer 25

to avoid impactioni

Question 26

side effects of bulk forming laxatives

Answer 26

flatulence and abdominal bloating

Question 27

examples of bulk forming laxatives

Answer 27

bran isphaghula husk

Question 28

how do osmotic laxatives work

Answer 28

they reduce fluid in the bowel by osmosis so must drink plenty while using

Question 29

how long do osmotic laxatives take to work

Answer 29

up to 3 days

Question 30

side effects of osmotic laxatives

Answer 30

flatulence abdominal pain colic

Question 31

examples of osmotic laxatives

Answer 31

lactulose magnesium

Question 32

warning symptoms of constipation (refer)

Answer 32

- constipation alternating with diarrhoea - blood or mucus in motions - weight loss - abuse of laxatives - vomiting - fever - angina

Question 33

what do the anal vascular cushions do

Answer 33

act to assist the anal sphincter in maintaining continence

Question 34

what are haemorrhoids

Answer 34

abnormal swelling or enlargement of the anal vascular cushions

Question 35

symptoms of haemorrhoids

Answer 35

- 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)

Question 36

causes of haemorrhoids

Answer 36

- excessive straining - increasing age - raised intra-abdominal pressure (pregnancy, chronic cough)

Question 37

how to treat haemorrhoids

Answer 37

- treat the constipation - creams, ointments and suppositories (treat symptoms not cure) - local anaesthetic, astringent & barrier cream

Question 38

warning symptoms of haemorrhoids (refer)

Answer 38

- exclude other causes of rectal bleeding eg malignancy, IBD

Question 39

how does loperamide work

Answer 39

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

Question 40

what form of laxative should you never give to those using opioids

Answer 40

bulk-forming laxatives

Question 41

why shouldn't you give bulk forming laxatives to those using opioids

Answer 41

they have very little peristalsis, can lead to complications having too much in the bowel

Question 42

which laxatives should be used during pregnancy

Answer 42

osmotic