1. The document discusses acute and chronic diarrhea and constipation in the field of gastroenterology.
2. It covers the epidemiology, classification, mechanisms, and causes of both infectious and non-infectious diarrhea. Common causes include bacterial toxins, medications, lactose intolerance, and irritable bowel syndrome.
3. The evaluation and management of diarrhea is outlined, including hydration, diet modification, and symptomatic treatments like loperamide. Distinguishing infectious from non-infectious diarrhea can guide appropriate treatment.
CHRONIC DYSPEPSIA
Seminar Prepared by :-
Ali Abdulazeem
Shilan Adnan Abdulrahman
Alaa Shamil
Guldan Hameed
Internal Medicine
College of Medicine - University of Kirkuk
CHRONIC DYSPEPSIA
Seminar Prepared by :-
Ali Abdulazeem
Shilan Adnan Abdulrahman
Alaa Shamil
Guldan Hameed
Internal Medicine
College of Medicine - University of Kirkuk
basics about chronic liver disease for a pediatrician. fast and easy guide to common causes of chronic liver diseases in children
Please leave a comment if you like it..
GERD is the commonest GI problem afflicting the mankind. The cause is lax LES which is just opposite to Achalasia cadia. That is why GERD is also known as Chalasia cardia.
Diarrhea is loose, watery stools. Having
diarrhea means passing loose stools three or more times a day. Acute diarrhea
is a common problem that usually lasts 1 or 2 days and goes away on its own.
Diarrhea lasting more than 2 days may be a
sign of a more serious problem. Chronic diarrhea—diarrhea that lasts at least 4
weeks—may be a symptom of a chronic disease. Chronic diarrhea symptoms may be
continual or they may come and go.
Diarrhea of any duration may cause
dehydration, which means the body lacks enough fluid and electrolytes—chemicals
in salts, including sodium, potassium, and chloride—to function properly. Loose
stools contain more fluid and electrolytes and weigh more than solid stools.
People of all ages can get diarrhea. In the
United States, adults average one bout of acute diarrhea each year, and young
children have an average of two episodes of acute diarrhea each year.
Acute infectious diarrhea
Seminar Prepared by :-
Mohammed Musa
Mohammed Saadi
Hussein Jassam
Mahmoud Ahmed
Meran Salih
Internal Medicine
College of Medicine - University of Kirkuk
Ulcerative Colitis: Case Presentation & Disease Overviewfarah al souheil
patient presenting with bloody stools and systemic signs with no previous medical complaints was diagnosed with amoebiasis on top ulcerative colitis (sigmoid-proctitis)
A seminar about DIARRHEA can be presented breifly in 10 minutes or less..
Includes classifications and some details
this would give you a general idea about diarrhea and how to approach it..
THERE ARE SOME NOTES UNDER THE SLIDES
basics about chronic liver disease for a pediatrician. fast and easy guide to common causes of chronic liver diseases in children
Please leave a comment if you like it..
GERD is the commonest GI problem afflicting the mankind. The cause is lax LES which is just opposite to Achalasia cadia. That is why GERD is also known as Chalasia cardia.
Diarrhea is loose, watery stools. Having
diarrhea means passing loose stools three or more times a day. Acute diarrhea
is a common problem that usually lasts 1 or 2 days and goes away on its own.
Diarrhea lasting more than 2 days may be a
sign of a more serious problem. Chronic diarrhea—diarrhea that lasts at least 4
weeks—may be a symptom of a chronic disease. Chronic diarrhea symptoms may be
continual or they may come and go.
Diarrhea of any duration may cause
dehydration, which means the body lacks enough fluid and electrolytes—chemicals
in salts, including sodium, potassium, and chloride—to function properly. Loose
stools contain more fluid and electrolytes and weigh more than solid stools.
People of all ages can get diarrhea. In the
United States, adults average one bout of acute diarrhea each year, and young
children have an average of two episodes of acute diarrhea each year.
Acute infectious diarrhea
Seminar Prepared by :-
Mohammed Musa
Mohammed Saadi
Hussein Jassam
Mahmoud Ahmed
Meran Salih
Internal Medicine
College of Medicine - University of Kirkuk
Ulcerative Colitis: Case Presentation & Disease Overviewfarah al souheil
patient presenting with bloody stools and systemic signs with no previous medical complaints was diagnosed with amoebiasis on top ulcerative colitis (sigmoid-proctitis)
A seminar about DIARRHEA can be presented breifly in 10 minutes or less..
Includes classifications and some details
this would give you a general idea about diarrhea and how to approach it..
THERE ARE SOME NOTES UNDER THE SLIDES
Diarrhea- easy ppt for Nurses
definition of Diarrhea
types of Diarrhea
risk factors of Diarrhea
Clinical manifestations of Diarrhea
Assessment & Diagnostic tests of Diarrhea
Management of Diarrhea
Medical management
Nursing Management
Diarrhea is an increased frequency and decreased consistency of fecal discharge as compared with an individual’s normal bowel pattern.
It is often a symptom of a systemic disease.
Acute diarrhea is commonly defined as shorter than 14 days’ duration.
Persistent diarrhea as longer than 14 days’ duration.
Chronic diarrhea as longer than 30 days’ duration.
Most cases of acute diarrhea are caused by infections with viruses, bacteria, or protozoa, and are generally self-limited.
Diarrhea & Constipation by dr Mohammed Hussien.
Ass. Lecturer of Gastroenterology & Hepatology
Kafrelsheik University
Membership at American Collage of Gastroenterology (ACG)
Membership at Egyptian association for Research and training in Hepatogastroentrology
Patient safety Incident (PSI) is an unplanned or unintended event or circumstance that could have resulted or did result in harm to a patient while in the care of a health facility. In this presentation, I explored the concepts of patient safety and patient safety incidents. I also explored the concept of Reporting systems, properly now known as reporting and learning systems - because learning is paramount in the reporting system. I focused on the minimal information model, which is more routinely used compared to the intermediate and full information models.
It is unacceptable that there is still a lot of new HIV infections, particularly when there is a known high-risk exposure to the disease. It is important to know that Post-exposure prophylaxis is a medical emergency, and as part of effort to reduce the burden of HIV, post-exposure prophylaxis has been found to be effective when done appropriately. This presentation explores the concept of post-exposure prophylaxis for HIV and the latest changes in the guidelines.
“Undetectable = Untransmittable” (U=U) is a campaign that has caused a few controversies, not to mention the medicolegal implications. This campaign confirms that the sexual transmission of HIV can be stopped once the infected partner is virologically suppressed. How true is this and how relevant is it? In this presentation, I discussed the concept of U=U as one of the measures to reduce the incidence of HIV and help people live a more fulfilling life while also living with the disease.
TB remains an important disease condition globally, particularly with the high prevalence of HIV in many parts of the world. While there is interest in providing the adequate and often readily-available treatment, it might do more harm to the patient. In this presentation, I explored the concept of IRIS in the management of tuberculosis.
Experiencing any type of bleeding can be uncomfortable and frightening for patients, and it is one of the primary reasons they seek medical attention. In this case presentation, I will discuss some crucial approaches to patients who present with lower gastrointestinal bleeding, as well as some key take-home messages.
Headache is a common condition encountered by clinicians in general practice and primary care on a daily basis. Although most headaches are mild, some can be severe and debilitating. It is therefore crucial to recognize common symptoms, identify warning signs, and develop an appropriate management plan for headaches.
This is a presentation about the importance of Evidence Based Medicine and how it acts as a crucial tool in decision making to empower the quality of medical services for better patient outcomes.
It highlights the steps in EBM process, how to identify the parts of a well built clinical question, resources for literature search, critical appraisal of the evidence, and how to apply the evidence to the patient.
Infection Prevention and Control in Hospitals by Dr DeleKemi Dele-Ijagbulu
Infection prevention and control is everybody's business! It is an essential, though often under-recognised and under supported part of the infrastructure of health care. However it saves lives and prevents avoidable morbidity and mortality. This presentation highlights the importance and the practical components of infection prevention and control in the hospital setting.
This presentation on renal function touches on basic anatomy and physiology, investigations relevant to kidney function and clinical practice, and focuses on clinically important disorders - including glomerular diseases - nephrotic syndrome & Glomerulonephritides, acute kidney injury, Chronic kidney disease, HIV and CKD including HIVAN, and renal calculi
Tuberculosis is a chronic, wasting, communicable disease, which made a huge comeback with the HIV pandemic, making it an opportunistic infection, and and an AID-defining infection. This presentation explores the different types of tuberculosis in terms of their locations (pulmonary and extra-pulmonary) as well as in terms of their drug susceptibility. It also addresses the approach to the management of each one of these.
In the early days of the COVID pandemic, the World Tuberculosis Day was marked, with the Theme: "It is Time". It is time to take action, to ensure universal access to treatment, to stop stigma and discrimination, and to end TB.
I had the opportunity to present this topic as part of the wellness efforts for our staff members. Many of our patients live with TB, many of our staff develop TB in the process, and the COVID pandemic was already in the country, complication case identification and case management of the disease.
This presentation touches briefly on the vaginal discharges, both physiological and pathological, approach to management, and a brief touch on pelvic inflammatory disease.
Abortion remains a topical issue, globally, primary because it affects one of the fundamental rights. This presentation is not for debate, but simply highlights the South African laws and regulations as they relate to Termination of Pregnancy (TOP), and the different methods available.
This presentation focuses on the all important topic of childhood malnutrition. It addresses the different components, both acute and chronic, but focuses more on the severe acute malnutrition which is the most important killer, particularly for the under-5s.
terms like kwashiokor and marasmus are no longer in use.
This presentation focuses on the entity known as pyrexia of unknown origin / fever of unknown origin. It demonstrates both common and rare causes, and the epidemiological trend, its clinical presentation, management and prognosis.
This presentation focuses on common obstetrics emergencies. These include early pregnancy complications such as miscarriages and ectopic pregnancy. As well as abdominal pain. Other include haemorrhage, hypertensive state, and sepsis.
This presentation addresses respiratory emergencies, and the approach to their management. These include: anaphylaxis, pneumonias, flail chest, pleural effusion, pulmonary embolism,
This presentation focuses on informed decision making in clinical practice making use of evidence based practice. It addresses the use of PICO to formulate clinical question, searching the evidence/literature, critically appraising the evidence, and application of the evidence to improve the quality of clinical practice
Multiple myeloma is mostly a disease of the elderly. It is a form of haematological cancers that affects the Lymphocytes, and causes abnormal proliferation of plasma cells within the bone marrow, thus replacing the marrow, and is associated with multiple organ dysfunction.
This presentation is an introduction to the disease. It however leaves out the specific haematological treatment, because by that point, patient should have been referred to haematology.
Spinal Cord Injuries are uncommon, but they are a leading cause of high cost disability, and with ageing population, the incidence is expected to increase. This presentation looks at the many facets of spinal cord injuries.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
5. Introduction
• Diarrhoea is a variation from normal bowel movements with stools of
increased frequency and/or decreased consistency.
• Increase in frequency (> 3 loose stools/day),
• Increase in volume/size (>200 g /day) or
• loosening of bowel movements.
6. Epidemiology
• Diarrhoea is a common complaint that affects nearly all patients at
some point in their lives.
• It has a higher incidence of morbidity and mortality in patients at the
extremes of age and in immunosuppressed populations.
• It is commonly categorized as merely a bothersome symptom,
however, it can be fatal if not properly managed.
• Each year an estimated 2 billion cases of diarrheal disease and 2.5
million deaths due to diarrhoea-related illness occur worldwide
7. Classification of Diarrhoea: FREQUENCY
• FREQUENCY CLASSIFICATION
• Acute diarrhoea: up to 14 days in duration
• Persistent diarrhoea: >14 days in duration(2-4 weeks)
• Chronic diarrhoea: >30 days in duration
8. Mechanism:
Secretory
Diarrhoea
Occurs when a substance either
decreases absorption or increases
secretion of large quantities of water and
electrolytes in the gastrointestinal tract
i.e. Disordered electrolyte transportation
Leads to large stool volume (>1 L/d)
May be caused by bacterial toxins,
laxatives, or excess bile salts
9. Mechanism:
Osmotic
Diarrhoea
Occurs when a poorly absorbed
substance retains intestinal fluids and
leads to an influx of water and
electrolytes into the lumen
May be caused by lactose intolerance or
ingestion of magnesium-containing
antacids or poorly soluble
carbohydrates (lactulose); Sulphate,
Phosphate Mannitol, Sorbitol, Lactase
Deficiency, Lactulose
Unlike other mechanisms, fasting causes
diarrhoea to stop
10. Mechanism:
Exudative
Diarrhoea
Occurs when an inflammatory process in
the GI tract causes discharge of mucous,
serum proteins, and blood into the gut,
and discharged substances are excreted
in the stool
Absorption, secretory, or motility
functions are altered to accommodate
large stool volume
11. Mechanism:
Motor
Occurs when altered intestinal motility leads
to:
reduction in contact time of chyme (semifluid
combination of gastric fluids and partially
digested food) in the small intestine;
premature emptying of the colon;
and bacterial overgrowth.
12. Other
mechanisms
Diarrhoea may also be caused by increased
contact time, which leads to overgrowth of
faecal bacteria and rapid dumping of chyme
into the colon that is unable to absorb water
It may occur with bypass surgery, intestinal
resection, or administration of
metoclopramide
It is important to rule out faecal
incontinence
19. Non-infectious diarrhoea
• Diarrhoea is classified as non-infectious when symptoms worsen or become
chronic in the absence of an identifiable infectious organism – virus, bacterium,
protozoan.
• Infectious aetiologies may be ruled out with a negative stool culture and testing
for ova and parasites
• Non-infectious diarrhoea can occur
1. acutely due to medication and food intolerance or
2. chronically due to primary gastrointestinal (GI) disease, such as inflammatory
bowel disease.
20. Lactose Intolerance
• Lactose intolerance occurs when lactose is not properly absorbed,
travels to the intestine, and is used as an energy source for bacteria
residing in the intestinal tract.
• Undigested lactose creates an osmotic pull in the GI tract that leads to
water retention in the bowel and subsequent diarrhea.
• As with all food intolerances, avoidance of the causative food products
is highly recommended
21.
22. Irritable bowel syndrome (IBS)
• It is a relapsing and remitting disorder of the bowel associated with
abnormal defecation and abdominal discomfort/pain
• To diagnose IBS, patients must be symptomatic for at least six months
23. Non-infectious diarrhoea: Approach to
Management
• Hydration and diet management:
• The main component of treatment for acute non-infectious diarrhoea
is hydration therapy to maintain water and electrolyte balances
despite the loss of important salts in the stool.
24. Non-
infectious
diarrhoea:
Approach
to
Managem
ent cont.
Symptomatic treatment:
Loperamide (Imodium) is an OTC antidiarrheal
that can be used for symptom management in
adult patients with acute non-infectious
diarrhoea in the absence of bloody stools or
fever.
Loperamide is administered as a 4-mg dose,
followed by 2 mg after each unformed stool,
with a maximum total dose of 16 mg/d.
25. Infectious diarrhoea
• Infectious diarrhoea is defined as diarrhoea due to infectious
aetiology, which is commonly associated with symptoms of nausea,
abdominal cramps, and vomiting.
• Causative agents for this infection include viral, bacterial, and
protozoal sources, which may be passed through contaminated food
and drinks or by fecal-oral contamination via sexual intercourse,
community pools, poor water sanitation, gardening, and other
sources.
26. Infectious diarrhoea cont.
• Those at risk for infectious diarrhoea include
• immunocompromised patients,
• extremes of age,
• travellers,
• patients in chronic care facilities,
• those with altered GI physiology (including patients taking proton
pump inhibitors and antibiotics)
27. Infectious diarrhoea cont.
• Infectious diarrhoea can be subclassified as either watery or bloody
diarrhoea (dysentery)
• Watery diarrhoea tends to be less severe than bloody diarrhoea,
• Norovirus, Enterotoxigenic E coli (ETEC) and Vibrio cholera are leading
causes of watery diarrhoea.
• Dysentery is associated with more severe complications and is commonly
caused by Shigella species and Salmonella bacteria.
• Some species such as Escherichia coli may cause either watery or bloody
presentations
28. Infectious diarrhoea: Viral diarrhoea
• Viral sources are the leading cause of diarrhoea worldwide.
• Viral gastroenteritis affects the stomach and small intestine and
commonly presents with diarrhoea and nausea.
• It is commonly associated with fever, nausea, vomiting, watery
diarrhoea, and abdominal pain
30. Initial Evaluation: History, cont.
• Relationship to meals, specific foods, fasting, & stress
• Medical, surgical, travel, water exposure history
• Recent hospitalizations, antibiotics
• History of radiation
• Current/recent medications
• Diet (including excessive fructose, sugar alcohols, caffeine)
• Sexual orientation
• Possibility of laxative abuse
31. Initial Evaluation: Physical Examination
• Most useful in determining severity of diarrhea
• Orthostatic changes
• Fever
• Bowel sounds (or lack thereof)
• Abdominal distention, tenderness, masses, evidence of prior surgeries
• DRE
• Skin, joints, thyroid, peripheral neuropathy, murmur, edema
32. Initial Evaluation: Physical Examination
Vital signs
Orthostatic signs (feeling
lightheaded or dizzy after
standing up, blurry vision,
weakness, fainting (syncope),
confusion, nausea)
hyperventilation, fever
Volume status
Skin tenting, dry mucous
surphases, tachycardia,
hypotension, mental status
Abdominal and
rectal exam.
Hepatomegaly, Distension,
Bowel sounds, Tenderness,
Masses, evidence of prior
surgeries
33. Investigations
• FBC with differential
• Serum electrolytes,
• Liver function tests,
• Calcium, Magnesium, Phosphorus,
• TSH, total T4,
• INR/Prothrombin time.
• HIV
• Nutritional Studies: Iron, Serum
Folate Vitamin B12,
• Vitamin D
• ESR, CRP,
• Others Amoeba Ab, anti-
transglutaminase IgA Ab, anti-
endomyseal IgA Ab,
34. Investigations
• Anaemia - in malabsorption syndrome. (vitamin B12, folate, iron) and
inflammatory conditions.
• Hypoalbuminemia - in malabsorption, protein-losing enteropathies, and
inflammatory diseases.
• Hyponatremia and metabolic acidosis – profound secretory diarrhoea.
• Malabsorption of fat-soluble vitamins may result in an abnormal prothrombin
time, low serum calcium, or abnormal serum alkaline phosphatase.
• Hormone levels - gastrin, VIP, somatostatin, cortisol, neurokinins, calcitonin
35. Investigations: Stool studies
• Culture (more useful only for acute),
• Ova &Parasite
• Giardia Antigen,
• Clostridium difficile
• Coccidia,
• Microsporidia,
• Cryptosporidiosis
• Fecal occult blood
36. Investigations: Stool studies, cont.
• Faecal leukocytes (or marker for neutrophils: lactoferrin or calprotectin)
• Stool electrolytes for osmolar gap = 290 – 2[Na + K]
• Stool pH (<6 suggests CHO malabsorption due to colonic bacterial
fermentation to CO2, H2, and short chain FA)
• Fat content (48h or 72h quantitative or Sudan stain)
• Laxative screen (if positive, repeat before approaching
37. Imaging
• Imaging
• Abdominal X-ray series
• Abdominal CT/MRI or CT/MR enterography
• Upper gastrointestinal lseries
• Endoscopy vs Push Enteroscopy with small bowel biopsy and aspirate
for quantitative culture
• Colonoscopy vs Flexible Sigmoidoscopy, including random biopsies
38. Treatment Considerations
• Correct dehydration and electrolyte deficits
• Oral rehydration therapy (cereal-based best)
• Sports drinks + crackers/pretzels
• Metronidazole is used for the management of a number of parasitic and
anaerobic conditions.
• Metronidazole is associated with GI side effects such as nausea, diarrhoea,
metallic taste, and abdominal discomfort.
• Generally, empiric course of antibiotics is not useful for chronic diarrhea
42. Introduction, cont.
• Patients definition & concept about constipation can be different
• Patients definition:
• Straining 52%,
• hard stools 44%,
• Infrequent stool 32%
• Misconception:
• 62% believe that daily defecation is necessary to good digestive health
43. Definition
• Any of two of following symptoms for at least 3 month (not necessarily
consecutive) in a year
• Straining
• Hard or lumpy stool
• Use of digital rectal manoeuvres
• Sensation of anorectal blockage
• Sensation of incomplete evacuation
• Fewer than 3 defecation per week
44. Causes of
constipation
↓ fiber diet: most common
↓ liquid intake: 8 glasses/d is needed
↓ Exercise: bedridden, coma
Ignoring urge to defecate
Systemic: Hypothyroidism, DM, Uremia,
pregnancy, hypercalcemia, Hypokalemia
Neurological: Stroke, Parkinsonism, Multiple
sclerosis, Senility
47. Diagnosis
Good history
is enough for
most cases
Duration Frequency Consistency
blood in the
stool
weight loss
Diet Exercise Toilet habits
Laxative use
(what)
other drugs
49. PREVENTION
• High fibre diet - beans, whole grains, cereals, fresh fruits (contain the
natural laxative sorbitol), vegetables
• Limit foods with no fibre (cheese, meat, sweets, processed foods)
• Minimum fluid consumption of 1500mL daily
• Regular, private toilet routine
• Use of a laxative if using constipating medication or in presence of
diseases associated with constipation
52. Non-drug Approach
• Initial treatment: Lifestyle modification
• ↑fluid intake
• >25 g of fibre/day
• Fiber-bulk/distension-stool propulsion/ Effect may take weeks/ Adverse
effects: bloating, flatulence
• Exercise
• Regular bowel regimen pattern
53. Therapeutic options: Drug Measures
• Bulk-forming Agents
• Emollients/Stool Softeners: Provide moisture to stool
• Osmotics: Draw water into colon
• Hyper-osmotics
• Stimulants: Cause muscle contractions in intestines
54. Drug classes
• Those causing water evacuation in 1-6 hr
• Caster oil, Saline cathartics, PEG lavage solutions
• Those causing soft or semi fluid stool in 6-8 hr
• C-lax, Bisacodyl
• Those causing softening of stool in 1-3 days
• Psyllium, Lactulose, Mineral oil, Decussate
55. Bulk-Forming Agents
• the safest agents
• suitable for long-term use
• administered with a full glass of water or juice
• Do not use if patient is dehydrated or fluid restricted
• drug of choice for prevention; not for immediate relief
• Increase volume of stool
• Stimulate natural intestine peristalsis
• Lasts 12-24 h (even 3 days)
• Examples Psyllium, Methylcellulose, Dextran
56. Emollients/Stool Softeners
• Used for prevention not for immediate relief
• Anionic surfactants
• Decrease stool surface tension,
• Increase fluid secretion into intestine
• Lasts 1-3 days
• Example: Docusate
• SE: GI cramp
57. Lubricants
• Liquid Paraffin
• Inhibition of fluid reabsorption from colon
• Stimulation of peristaltic activity
• Softening of stool
• lasts 6-8 h
• 15-45 ml PO, or rectal
• SE: Aspiration (neonate, Geriatrics, before sleep), malabsorbtion (lipid soluble
Vit.), Anal pruritis, staining
58. Stimulant laxatives
• Bisacodyl (Dulcolax)
• Stimulates myenteric mucosal nerve plexus of the colon – rhythmic muscle
contractions
• Intermittent use - if osmotic laxatives fail or are not tolerated.
• usually given at bedtime (Oral: 6-8hr, Supp: 15-60min) – provide overnight relief
• Interactions: Milk, Antacids (EC)
• SE: Cramp, fluid and electrolyte imbalance
• Contraindication: pregnancy, lactation
59. Osmotics
• Milk of Magnesia (MOM), Mgso4 (Mg: Osmotic, Release cholecystokin)
• Indications: Antacid (5-15 ml PRN), inLaxatives (30-60 ml)
• Onset: 3-6 hr
• Administer with sufficient water to prevent dehydration.
• Limitations: frequent diarrheal, electrolyte abnormalities.
• Interactions: Quinolones, Tetracycline, Fe, EC drugs (bisacodyl, sulfasalazine)
• Breast-feeding: can be used
60. Hyperosmotics
• Glycerin, Lactulose, mannitol, Sorbitol
• Lactulose:
• Very safe to use long term;
• Takes 1-2 days to work.
• SE – bloating, flatulence, abdominal cramp, diarrhea, electrolyte
imbalance
61. Hyperosmotics cont.
• Glycerine
• Is very safe and acceptable for intermittent basis particularly in infants
• Quick onset of action (30-60 minutes).
• Less effective if the stool is dry and hard.
• Suppository: 1g, 3g
62. Tap-water enema
• 200 ml results in a bowel movement within 0.5hr
• Soapsuds are no longer recommended (proctitis, colitis)
63. Acute constipation
Glycerin suppository Sorbitol powder
Bisacodyl
(Dulcolax)
Anthraquinones ( C-
lax)
Saline laxative
(MOM)
Tap-water enema
If laxative treatment
is required for > 1
week, refer to a
physician
66. Constipation
in infants &
children
If constipation is a
persistent problem:
Consider neurological,
metabolic or
anatomical
abnormalities
If No:
Approach as adults
68. Summary
• Underlying causes of constipation should be considered
• Foundation of treatment is diet and psyllium
• Acute constipation may be treated with tap-water enema or glycerin
suppository, if needed, oral sorbitol, low dose bisacodyl or C-Lax
• Approach for chronic constipation is use of psyllium and if needed,
intermittent low-doses of other drugs