minor ailments of the lower GI tract Flashcards
What is diarrhoea?
The passing of watery stools more than three times a day
What is acute diarrhoea?
Comes on suddenly and lasts up to 14 days
What is persistent diarrhoea?
Lasting more than 14 days
what is chronic diarrhoea?
lasting more than 4 weeks
who is more susceptible to dehydration from diarrhoea?
Young children under the age of 6 and elderly people
What are mechanisms that cause diarrhoea?
- increased osmotic load in the gut lumen (eg. after heavy meal with carbs) to maintain peristalsis
- increase in secretion
-inflammation of intestinal lining
-increased intestinal mobility
What are the symptoms of diarrhoea?
- watery, frequently passed stools
- abdominal cramps
- flatulence
- weakness
- nausea, vomiting, fever
- headache, lose of appetite
What are treatments for diarrhoea?
Often goes away after a few days without treatment
- drink fluid to avoid dehydration - rehydration drinks
- eat as soon as you can - food high in carbs
- consider anti-diarrhoea medicines - loperamide
- painkillers to treat fever or headache
What medications can cause diarrhoea?
laxatives
antibiotics
metformin
NSAIDS
PPIs
What medications can cause diarrhoea?
laxatives
antibiotics
metformin
NSAIDS
PPIs
When to refer symptoms of diarrhoea?
Blood or mucous in motions
Signs of dehydration
Long period of time >5 days
vomiting for more than a day
high fever
recent change in bowel habit or travel abroad
What is constipation?
the passage of hard stools less frequently than the patients normal own pattern
what are symptoms of constipation?
- change in stool frequency
- stools can become unusually hard, lumpy or small
- stomach ache and cramps
- feeling bloated, nauseous, loss of appetite
- chronic problems - hemorrhoids, faecal impaction
causes of constipation?
Poor diet - lack of fibre
Lack of mobility
Medication (opioids, antidepressants, anti-epileptics, iron supplements)
Pregnancy
Medical conditions (eg. diabetes, parkinson’s, underactive thyroid)
What are treatments to constipation?
- lifestyle advice
-increase fibre in diet - laxatives (stimulant, bulk-forming and osmotic)
How does a stimulant laxative work, what are sides effect and examples?
increases intestinal motility
onset of 8-12 hrs (usually night time administration)
Side effects: abdominal cramps , excessive fluid loss, electrolyte imbalances
eg. senna bisacodyl
how does a bulk forming laxative work, what are side effects and examples?
Stimulates peristalsis in similar way to dietary fibre
onset action 24-36hrs
stimulates anal sphincter - can be used to get rid of haemorrhoids
Drink plenty of water to avoid impaction
Side effects: flatulency and abdominal bloating
eg. bran, ispaghula husk
how does osmotic laxitives work, what are the side effect and some examples?
Retain fluid in the bowel by osmosis so important to drink plenty
Onset action of 3 days
Side effects: flatulence, abdominal pain, colic
Examples: lactulose (good for pregnancy) magnesium salts (laxido, movicol)
what are refer symptoms of constipation?
Constipation alternating with diarrhoea
Blood or mucous in motions ( small amounts of bright red is ok)
Weight loss
Abuse of laxatives
vomiting
fever
angina
what are haemorrhoids?
the anal vascular cushion act to assist the anal sphincter in maintaining continence.
- abnormal swelling or enlargement of the anal vascular cushions
what are symptoms of haemorrhoids?
Bright red rectal bleeding on surface of stool
Pruritus (itch) due to chronic mucous discharge and irritation
Soiling due to impaired continence or mucus discharge
Large prolapsed haemorrhoids can thrombose - very painful
Causes of haemorrhoids?
- excessive straining
- increasing age
- raised intra-abdominal pressure eg. pregnancy, chronic cough
Treatment of haemorrhoids
• Treat the constipation
• Creams, ointments, suppositories ( treat symptoms but does not cure it)
• Local anaesthetic (anusol Hc), astringent (can help shrink pile) and barrier cream
what are warning symptoms of haemorrhoids?
Exclude other causes of rectal bleeding:
Malignancy
Inflammatory bowel disease
Diverticular disease
what are other anal symptoms wrongly attributed to haemorrhoids?
Anal fissure, absess, personal fistula
