Common gastrointestinal problems -Diarrhea -Vomiting - Constipation

1. DIARRHOEA
Dr. Anupama
Marasini

2. DEFINITION
• Defined as passage of abnormally liquid or
unformed stools at an increased frequency
• Stool weight more than 200 g/ day

3. Classification
•Acute - < 2 weeks
•Persistent- 2 to 4 weeks
•Chronic- > 4 weeks

4. ETIOLOGY/CAUSES OF ACUTE
DIARRHEA
• 90 % - INFECTIOUS AGENTS
---- Faeco-Oral Transmission
Eg . Bacteria– E.coli, Salmonella
Virus – Rota, Norwalk, Adeno virus
Parasite- Giardia
• 10 % - Medications (antibiotics , Toxic ingestions

5. History and Physical Exam
Main goals
• Estimate the level of dehydration
• Identify likely causes on the basis of history
and clinical findings

6. History
• Onset, frequency, quantity, and character of diarrhea
• Associated symptoms:
– nausea, vomiting, fever, abdominal pain, tenesmus,
malaise
• Recent oral intake, antibiotic use
• H/o travel
• symptoms of dehydration

7. Physical Exam
• Vitals
• Signs of dehydration
• Abdominal exam

8. Investigations
• Stool Examination:
– Microbiologic analysis of stools
– Cultures for bacterial pathogens
– Inspection for ova & parasites

9. Treatment
• Most acute diarrhoeas – Mild & self limited
• Indications for evaluation
– Profuse diarrhoea with dehydration
– Grossly bloody stools
– Duration >48 hrs without improvement
– Severe abdominal pain in patient >50years
– Elderly
– Immunocompromised patients

10. Treatment
• Fluid & electrolyte replacement
– Oral Rehydration Solution
– I.V fluids rehydration – Normal Saline, Ringers lactate
1. Replacement of established losses
 48 hrs of mod diarrhea(6-10 stools/24hrs)  1-2 lit fluid
2.Replacement of Ongoing loss  200ml/episode
3.Replacement of normal daily requirement:  1-1.5 L

11. Treatment
Antibiotics
• Empirical therapy
– Febrile – Ciprofloxacin 500 mg twice a day for 3-5
days
– Suspected giardiasis – Metronidazole 250 mg
3times a day for 5 days

12. Chronic diarrhea
• Diarrhea lasting 4 wks
• Needs evaluation to exclude serious
underlying pathology

13. Causes of Chronic Diarrhea
• Drugs- Laxatives, Antacids,Antibiotics
• Hyperthyroidism
• Lactose Intolerance
• Irritable bowel Syndrome
• Colon Neoplasm/Cancer
• HIV

14. INVESTIGATIONS
• CBC with differential
counts
• Serum electrolytes,
• Liver function tests
• Calcium, Magnesium,
Phosphorus,
• TSH, total T4,
• HIV testing

15. Complications of Diarrhea
1. Dehydration and shock
2. Acute Renal Failure
3. Sepsis
4. Metabolic acidosis
5. Electrolyte imbalance
6. Malnutrition

16. CONSTIPATION

17. CONSTIPATION
• Infrequent passage of hard stools 2 or less
than 2 episodes per week
• Patient complain of straining, a sensation of
incomplete evacuation and abdominal
discomfort

18. Causes of constipation
• Gastrointestinal causes
1. Dietary- lack of fibre and/or fluid intake
EXCESSIVE JUNK FOODS
1. Irritable Bowel Syndrome
2. Colonic Carcinoma/ Cancer
3. Anorectal Disease - hemorrhoids

19. • Non- Gastrointestinal Causes
1. Drugs- Iron supplements, aluminium
containing antacids, Opiates
2. Neurological – Stroke, Spinal cord lesions
3. Metabolic- Diabetes, Hypothyroidism,
Pregnancy
4. Others; Depression

20. Management Of Constipation
1. Lifestyle modifications
a.Adequate fibre intake in diet- 30gm per day
Fibres helps to promote movement of materials
through the digestive system and increases the
stool bulk
Eg. Wheat flour, beans and vegetables, spinach,
fruits

21. b.Plenty of fluids intake
c.Exercise
d.Avoid stress
2. Laxatives
a. Bulk forming Laxatives : Dietary fibres (bran)
b.Osmotic Laxatives : Lactulose
c.Stool softeners : liquid paraffin

22. 3. Prokinetics
a.Metoclopramide
b.Domperidone
4.Treat the cause Eg. Drugs, Hypothyroidism

23. Complications of Constiption
1.Hemorrhoids (piles)
2.Anal Fissures
3.Urinary retention, UTI
4.Fecal Incontinence
5.Bowel perforation
6.Poor quality of life

24. VOMITING

25. VOMITING
Vomiting: Forcible voluntary or involuntary
emptying of stomach contents through the
mouth
Nausea : uneasiness of the stomach that often
comes before vomiting

26. Causes of Vomiting
1. Acute
a. Gastrointestinal
• Acute Gastroenteritis
• Hepatitis
• Appendicitis
• Intestinal Obstruction
• Cholecystitis
• Pancreatitis

27. b. Non gastrointestinal
1. Infections – UTI, meningitis
2. Diabetic Ketoacidosis
3. Drugs- Chemotherapy, Antibiotcs,Iron
4. Toxins- Bacterial toxins

28. Chronic Causes of Vomiting
1. Gastro- intestinal
• Gastro-esophageal reflux
• Gastritis
• Bowel Obstruction
• Food Allergy
• Gastric Outlet Obstruction

29. 2 Non-gastrointestinal Causes
• Raised intracranial pressure
• Uremia

30. Management/Treatment
1. Fluids Resuscitation
Oral fluids – if he/she can tolerate
Intravenous Fluids; Ringers lactate, Normal
Saline
2.Antiemetics
Ondansetron
Promethazine

31. 3.Monitor urine output and look for signs of
Dehydration
4. Treat the underlying cause
Eg. Acute gastritis, Peptic Ulcer disease- PPI
Acute appendicitis- Emergency surgery
UTI - Antibiotics

32. Complications of Vomiting
1. Dehydration and Shock
2. Electrolyte Imbalance
3. Metabolic Alkalosis
4. Acute Renal Failure
5. Failure to wt gain/ Wt loss
6. Esophagitis