Module 7 Basic GI Flashcards
Constipation guideline
less than 3 stools per week
5 causes of constipation
low fiber diet, lack of exercise, slowed peristalsis, obstruction, or diverticulitis
firm immovable mass obstructs lower GI tract
impaction
someone with an impaction may have continuous
oozing or diarrhea around the impaction
other signs and symptoms of an impaction are…
loss of appetite, nausea, vomiting, abdominal distention, cramping and pain
Acute diarrhea usually results from
viral or bacterial infection, impaction, emotional stress, medications (such as chemo)
diarrhea is chronic when is lasts for more than
4 weeks
episodic diarrhea is
food allergy or irritant
chronic diarrhea results from
chronic GI infection, immobility, malabsorption, endocrine disorders
diarrhea that has increase in active solutes
osmotic diarrhea
osmotic diarrhea typically associated with
magnesium sulfate, epsom salt
Sodium and water rush into the colon when ingesting mag sulfate or epsom salt
osmotic diarrhea
Caused by some type of bacteria or toxin that increases the reabsorption of water in the colon
secretory diarrhea
Osmotic diarrhea common with
tube feeding
Bacterias associated with
vibrio cholerae and staph aureus
Active sites of inflammation within the bowel lumen that results in exudation of mucus, blood, and proteins
exudative diarrhea
Causes of exudative diarrhea
Crohn’s disease or ulcerative colitis
diarrhea that results from decreased absorption in the small intestine
diarrhea related to motility disturbances
causes of diarrhea related to motility disturbances
dumping syndrome after a gastrectomy and IBS
3 reasons why diarrhea is a problem
skin breakdown, fluid/electrolyte imbalance, nutrition concerns
3 groups of anti-diarrheals
absorbants, antimotility, probiotics
bismuth subsalicylate aka
Pepto-Bismol
bismuth subsalicylate is an
adsorbant
MOA for bismuth subsalicylate
Coats the wall of the GI tract and binds the causative agent for elimination
bismuth subsalicylate is a form of
aspirin
another adsorbant
activated charcoal, given in drug overdoses
loperamide aka
Imodium
diphenoxylate with atropine
Lomotil
MOA for loperamide and diphenoxylate with atropine
Slows peristalsis and has a drying effect (anticholinergic)
loperamide and diphenoxylate with atropine can be used combination with
adsorbants and opiates
adverse effects of loperamide and diphenoxylate with atropine
urinary retention, headache, dizziness, bradycardia and hypotension, dry skin, flushing
Lactobacillus organism probiotics
Bacid or Culturelle
Sacchromyces boulardii probiotic
Florastor
used specifically in treatment of c diff
Sacchromyces boulardii (Florastor)
Laxative treatment is individualized for
age, severity, and contributing factors
Treatment for constipation
Diet (increasing fiber), behavioral interventions such as walking, and then add on pharmacologic treatment for constipation
5 groups of laxatives
bulk-forming, emollient, hyperosmotic, saline, stimulant
Most misused OTC
laxatives
misuse of laxatives can lead to
dependence, inability to have a BM without the laxative
laxatives are not meant for
long term
psyllium aka
Metamucil
Bulk forming laxative
psyllium (Metamucil)
psyllium acts similar to
Acts similar to dietary fiber, absorbs water into the intestine increasing bulk, distends bowel to initiate reflex bowel activity and bowel movement
must take psyllium with a lot of water to prevent
impaction above strictures and esophageal blockage
psyllium and most all laxatives are contraindicated in patients with
fecal impaction or intestinal obstruction
two emollient laxatives
docusate sodium and mineral oil
docusate sodium aka
Colace
docusate sodium MOA
lubricates fecal material and walls, promotes fat absorption into fecal mass
docusate sodium is primarily used to prevent
opioid-induced constipation, like during post-op
docusate sodium is only given
PO
mineral oil MOA
lubricates intestines
mineral oil route
PO or PR
mineral oil is used to relieve
fecal impactions
both mineral oil and docusate sodium
prevent water from moving out of intestines
adverse effects of docusate sodium and mineral oil laxatives
skin rashes and decreased absorption of vitamins
3 hyperosmotic laxatives
glycerin, polyethylene glycol, and lactulose
MOA of glycerin, polyethylene glycol, and lactulose
Increases water content in feces, promotes distention, peristalsis, and evacuation
adverse effects of hyperosmotic laxatives
Abdominal bloating, rectal irritation, electrolyte imbalance
very mild and most common used in children experiencing constipation
glycerin
glycerin is typically given as a
suppository
lactulose is digested in the large intestine creating this hyperosmotic environment
therefore it draws water into the colon
lactulose helps to
reduce blood ammonia levels
lactulose commonly used in patients with
liver disease and hepatic encephalopathy
given before diagnostic or bowel procedures
polyethylene glycol (bowel prep/go lightly)
extremely potent and induces total cleansing of the bowel
polyethylene glycol
polyethylene glycol is reconstituted in a
water
4 saline laxatives
mag citrate, mag hydroxide, mag sulfate, and sodium salts
magnesium citrate aka
citroma
magnesium hydroxide aka
Phillips milk of magnesia
magnesium sulfate aka
epsom salts
sodium salts aka
Fleet enema
saline laxative MOA
Increase osmotic pressure and draw water into colon
Careful use of saline laxatives in patients with
renal disease because may cause magnesium toxicity
2 stimulant laxatives
bisacodyl and senna
bisacodyl aka
Ducolax
senna aka
Senokot
bisacodyl (Ducolax) route
PO or PR
senna route
PO
stimulant laxative MOA
induce intestinal peristalsis
stimulant laxative indication
constipation or whole bowel evacuation
stimulant laxative adverse effects
Nutrient malabsorption, GI irritation, electrolyte imbalance
stimulant laxatives are the most likely to cause
dependence
