minor ailments of the lower GI tract

Question 1

What is diarrhoea?

Answer 1

The passing of watery stools more than three times a day

Question 2

What is acute diarrhoea?

Answer 2

Comes on suddenly and lasts up to 14 days

Question 3

What is persistent diarrhoea?

Answer 3

Lasting more than 14 days

Question 4

what is chronic diarrhoea?

Answer 4

lasting more than 4 weeks

Question 5

who is more susceptible to dehydration from diarrhoea?

Answer 5

Young children under the age of 6 and elderly people

Question 6

What are mechanisms that cause diarrhoea?

Answer 6

• 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

Question 7

What are the symptoms of diarrhoea?

Answer 7

• watery, frequently passed stools
• abdominal cramps
• flatulence
• weakness
• nausea, vomiting, fever
• headache, lose of appetite

Question 8

What are treatments for diarrhoea?

Answer 8

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

Question 9

What medications can cause diarrhoea?

Answer 9

laxatives
antibiotics
metformin
NSAIDS
PPIs

Question 10

What medications can cause diarrhoea?

Answer 10

laxatives
antibiotics
metformin
NSAIDS
PPIs

Question 11

When to refer symptoms of diarrhoea?

Answer 11

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

Question 12

What is constipation?

Answer 12

the passage of hard stools less frequently than the patients normal own pattern

Question 13

what are symptoms of constipation?

Answer 13

• 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

Question 14

causes of constipation?

Answer 14

Poor diet - lack of fibre
Lack of mobility
Medication (opioids, antidepressants, anti-epileptics, iron supplements)
Pregnancy
Medical conditions (eg. diabetes, parkinson’s, underactive thyroid)

Question 15

What are treatments to constipation?

Answer 15

• lifestyle advice
  -increase fibre in diet
• laxatives (stimulant, bulk-forming and osmotic)

Question 16

How does a stimulant laxative work, what are sides effect and examples?

Answer 16

increases intestinal motility
onset of 8-12 hrs (usually night time administration)
Side effects: abdominal cramps , excessive fluid loss, electrolyte imbalances

eg. senna bisacodyl

Question 17

how does a bulk forming laxative work, what are side effects and examples?

Answer 17

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

Question 18

how does osmotic laxitives work, what are the side effect and some examples?

Answer 18

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)

Question 19

what are refer symptoms of constipation?

Answer 19

Constipation alternating with diarrhoea
Blood or mucous in motions ( small amounts of bright red is ok)
Weight loss
Abuse of laxatives
vomiting
fever
angina

Question 20

what are haemorrhoids?

Answer 20

the anal vascular cushion act to assist the anal sphincter in maintaining continence.
- abnormal swelling or enlargement of the anal vascular cushions

Question 21

what are symptoms of haemorrhoids?

Answer 21

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

Question 22

Causes of haemorrhoids?

Answer 22

• excessive straining
• increasing age
• raised intra-abdominal pressure eg. pregnancy, chronic cough

Question 23

Treatment of haemorrhoids

Answer 23

• 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

Question 24

what are warning symptoms of haemorrhoids?

Answer 24

Exclude other causes of rectal bleeding:
Malignancy
Inflammatory bowel disease
Diverticular disease

Question 25

what are other anal symptoms wrongly attributed to haemorrhoids?

Answer 25

Anal fissure, absess, personal fistula