Week 6 - Gas, Anorectal, Pinworms Flashcards
Chronic symptoms of gas may be commonly caused by…?
- IBS
- Celiac Disease (gluten intolerance)
- Pancreatic insufficiency
- Diabetic gastroparesis
- Small bowel bacterial growth
- Lactase deficiency
- Indigestible oligosaccharides
Medications that can cause gas
- Metformin
- Alpha-glucosidase inhibitors (acarbose and miglitol)
- Psyllium fiber
- Effervescent solutions (alka-seltzer)
- Calcium carbonate (Tums, Rolaids)
Exclusions to self-treating gas
- Symptoms persist more than several days in a row
- Symptoms that occur > 3 times per month for several months AND are associated with
diarrhea or constipation - Gas is severe/debilitating
- Sudden increase in pain severity/location
- Persistent diarrhea, constipation, GI bleeding or unintentional weight loss
- Persistent even after OTC treatment
Non-pharmacological therapies to reduce/relieve gas
- Identify and avoid problematic foods/portion control
- Example: fatty foods can delay stomach emptying and cause bloating
- Eat slowly
- Don’t smoke
- Don’t chew gum
How does Simethicone work?
Prevents formation of mucus-surrounded gas pockets in the GI tract and can absorb and disperse gas within the bowel lumen
When should you take Simethicone?
Take after symptoms occur
Adult dosing of simethicone
40mg to 125mg PO QID PRN
Child dosing of simethicone
2-12 years old: 40mg to 50mg PO QID PRN
Infant dosing of simethicone
Under 2 years old: 20mg PO QID PRN
How does activated charcoal work?
It absorbs drugs and chemicals and can decrease foul odors
What is something to be aware of when taking activated charcoal?
The tablets can stain the inside of mouth and clothing
When should activated charcoal be taken?
After symptoms occur
OTC medications to treat gas symptoms
Simethicone and activated charcoal
OTC medications to prevent gas
Beano, Lactase supplements, probiotics
How does Beano (alpha-galactosidase) work?
Reduces the amount of gas that beans and vegetables produce by metabolizing indigestible oligosaccharides to glucose, galactose and fructose. Caution in diabetics
When and how should Beano be taken?
Take to prevent flatulence and take with first bite of food
How do Lactase supplements work?
Aids in digesting lactose into absorbable sugars; metabolizes lactose to glucose and galactose
When and how should lactase be taken?
Take to prevent flatulence and take with first bite of food
Common causes of hemorrhoids
- Increased pressure on veins (straining, constipation, constipation-causing medications)
- Lifting heavy objects
- Pregnancy
- Chronic diarrhea or constipation
- Laxatives (e.g. milk of magnesia, Miralax), senna
- Opioids
- Anal intercourse
- Obesity
- Low-fiber diet
FDA approved indications that can be self-treated for hemorrhoids
- Itching
- Discomfort
- Irritation
- Burning
- Soreness
- Inflammation
- Pain
- Dry anal tissue
- Swelling in perianal area
Non-pharmacological therapies for hemorrhoids
- No straining! < 10 minutes sit time
- Avoid alcohol and perfumed wipes
- Avoid dry toilet paper
- Apply cold to relieve swelling
- Diet
- Avoid caffeine, citrus, spicy foods
- Soak regularly in warm water/sitz bath (10-15 minutes 2-3 times daily)
How long can OTC medications for treating hemorrhoids be used for before seeing a doctor?
1 week
Common OTC medications for hemorrhoids
Local anesthetics, vasoconstrictors, protectants, corticosteroids, astringents, combination products
Local anesthetics (use and avoidance)
Only for topical/external use for itching, irritation, burning, discomfort, pain. Avoid in open sores. Not indicated for relief of bleeding, seepage, prolapse, or thrombosis
