SPONDYLOSIS AND GASTROENTERITIES INTRODUCTION:- Spondylosis (spinal osteoarthritis) is a degenerative disorder It may affect the cervical(neck), thoracic(mid-back), lumbar(low-back) regions of the spine It may cause loss of normal spinal shape and function Commonly seen in individuals after the age of 40 years Spondylosis refers to the degenerative changes in the spine such as bone spurs and degenerating intervertebral discs Spondylosis changes in the spine are frequently referred to as osteoarthritis Degeneration of cervical intervertebral disc and the secondary degeneration of cervical intervertebral joints, leads to injury of spinal cord, nerve roots and vertebral artery, and shows corresponding signs and symptoms Lumbar spondylosis:- Lumbar spondylosis is a medical condition in which chronic pain is experienced by the patient in the lumbar region (lower back) due to compression of the intervertebral discs Age:- The discs are dehydrate, become thinner and become harder, then provide less support to the vertebrae resting on the discs Repetitive strain injury (RSI) caused to lifestyle like driving, travelling, intense work in farm, who carry loads on their head Congenital deformity:- stenosis of cervical spinal canal Genetics:- if family has history Mental health :- depression, anxiety

1. CASE PRESENTATION ON
SPONDYLOSIS AND
GASTROENTERITIES
PRESENTED BY:-
CHANDANA C
III PHARM D
06 - SSCP

2. SPONDYLOSIS
INTRODUCTION:-
• Spondylosis (spinal osteoarthritis) is a
degenerative disorder
• It may affect the cervical(neck),
thoracic(mid-back), lumbar(low-back)
regions of the spine
• It may cause loss of normal spinal shape
and function
• Commonly seen in individuals after the
age of 40 years

3. DEFINITION:-
• Spondylosis refers to the degenerative
changes in the spine such as bone spurs
and degenerating intervertebral discs
• Spondylosis changes in the spine are
frequently referred to as osteoarthritis

4. Cervical spondylosis:-
• Degeneration of cervical intervertebral
disc and the secondary degeneration of
cervical intervertebral joints, leads to
injury of spinal cord, nerve roots and
vertebral artery, and shows
corresponding signs and symptoms
Lumbar spondylosis:-
• Lumbar spondylosis is a medical condition
in which chronic pain is experienced by
the patient in the lumbar region (lower
back) due to compression of the
intervertebral discs

5. ETIOLOGY:-
• Age:- The discs are dehydrate, become
thinner and become harder, then provide
less support to the vertebrae resting on
the discs
• Repetitive strain injury (RSI) caused to
lifestyle like driving, travelling, intense
work in farm, who carry loads on their
head
• Congenital deformity:- stenosis of
cervical spinal canal
• Genetics:- if family has history
• Mental health :- depression, anxiety

6. PATHOGENESIS:-
Degeneration of intervertebral disc
Narrowing of intervertebral disc
Unstable of the spine
Hypertrophy of vertebral body, facet
joints, ligaments
Compression of spinal cord, nerve roots, vertebral artery
Bulge or
extrusion of IVD

7. CLINICAL FEATURES:-
1. CERVICAL SPONDYLOSIS:-
• Chronic neck pain may spread into the
shoulder or down the arm
• Chronic neck stiffness
• Upon compression of spinal cord or
nerve roots:- tingling, numbness,
weakness in the arms, hands
• Migraine, dizziness, or vertigo

8. RADICULOPATHY:-
i. compression of the cervical roots leads to
ischemic changes that cause sensory
dysfunction(radicular pain) or / and motor
dysfunction(weakness)
ii. Pain, weakness, numbness in the
distribution of a nerve root
MYELOPATHY:-
i. Numbness, tingling of the hands
ii. Balance and coordination difficulty
iii. Bowl/Bladder disturbance

9. 2. LUMBAR SPONDYLOSIS:-
i. Pain and morning stiffness
ii. Pain in the back, legs, thighs and buttocks
that worsens the standing and walking
iii. Muscle weakness
iv. Leg weakness and numbness

10. DIAGNOSIS:-
• X-RAY:- shows loss of disk height or bone spurs
• Magnetic resonance imaging (MRI):- This
study can create better images of soft tissues
such as muscles, discs, nerve, the spinal cord
• Computed tomography(CT) scan:- This
specialised X-ray study allows careful
evaluation of the bone and spinal canal

11. GASTROENTERITIS
DEFINITION:-
• Gastroenteritis is a medical condition
characterized by inflammation of the
gastrointestinal tract and small intestine
resulting in some combination of diarrhoea ,
vomiting , and abdominal pain
• Transmission may occur due to consumption
of contaminated food and water or via contact
with infected individuals

12. ETIOLOGY:-
• Ingestion of contaminated food or water
• Non-infectious causes like food allergies,
drug side effects
• Infections caused by virus (adenovirus,
rota virus); Bacterial (Salmonella,
Shigella, E.coli); Parasitic (Entameoba
hystolitica, Giardia lamblia)

13. ETIOLOGY:-
This may be due to:-
• Decreased electrolyte and water
absorption
• Increased secretion by intestinal mucosa
• Increased luminal osmotic load
• Inflammation of mucosa and exudation
into lumen

14. RISK FACTORS:-
• Age - mainly in infants and geriatrics
• contact with an infected persons
• Ingesting contaminated food or water
• People with weak immune system

15. SYMPTOMS:-
• Nausea and vomiting
• Diarrhoea
• loss of appetite
• Fever
• Headache
• Abdominal pain
• Bloody stools
• Dehydration
• Lethargic

16. DIAGNOSIS:-
 It is typically diagnosed clinically , based on persons
signs and symptoms like :
• dehydration - include excessive thirst , dry mouth,
severe weakness , dizziness
• Vomiting for more than 2 days
 Other Diagnostic methods include :
• Medical history
• Endoscopy
• USG
• Physical examination
• Blood tests
• Stool tests

17. DEMOGRAPHIC DETAILS:-
• NAME:- Ann….
• AGE:- 50 years
• GENDER:- FEMALE
• IP No:- 19120047
• WARD :- GNW
• DOA:- 4/12/19
• DOD:- 5/12/19

18. SUBJECTIVE EVIDENCE:-
C/O
• Vomiting since 1 week (3-4 episodes /day)
• Loose stools since 1 week (4-5 episodes /day)
• Fever since 5 days
• Headache , backache , left side neck pain, left
side shoulder pain since 10years.

19. HISTORY:-
• Past medical history:- k/c/o type II DM since
10 years, typhoid 15 days back
• Past medication history:- glycomet GP1 (1/2 -0-
1/2)
• Social history:- NS
• Family history:- NS
• Allergies :- NKA
• Diet :- vegetarian

20. GENRAL PHYSICAL EXAMINATION:-
• BP:- 130/80 mmHg
• HR:- 74 bpm
• TEMP:- febrile
• RR:-20bpm
• SPO2:-99% on RA
• CVS:-S1S2 positive
• CNS:- Conscious and oriented
• RS:- B/L NVBS
• PA:- soft , distention

21. PROVISIONAL DIAGNOSIS:-
• Acute gastroenteritis
• Cervical spondylosis

22. OBJECTIVE EVIDENCE:-
PARAMETERS OBSERVED VALUE
Haemoglobin 11.1g/dl
RBC 3.87 milli/cumm
Neutrophils 76.9%
lymphocytes 13.1%

23. OBJECTIVE EVIDENCE CONTINUED…..
 MRI of left shoulder:-
• Supraspinatus tendon shows diffuse
thickening and increased signal s/o
moderately severe.
• Minimal glinohmeral joint infusion
• Degenrative changes in acromioclavicular joint
with capsular thickening and hypertrophy.

24.  MRI of cervical spine:-
• C4-C5 disc shows dessication, mild disc bulge
causing compression of anterior thecal sac
• C5-C6 and C6-C7 discs shows dessication , disc
bulge causing compression of anterior thecal sac
and indenting on anterior cord surface
 MRI of lumbar spine:-
• L3-L4 disc shows mild dessication
• L4-L5 disc shows dessication ,asymmetrical disc
bulge causing compression of anterior thecal sac
• L5-S1 disc shows dessication, mild disc bulge
causing compression of anterior thecal sac

25. FINAL DIAGNOSIS:-
• Acute Gastroenteritis with dehydration
• Cervical and Lumbar spondylosis with
radiculopathy
K/C/O
• Type-2 Diabetes mellitus

26. ASSESSMENT:-
• The patient is having :-
• Acute gastroenteritis with dehydration
• Cervical and lumbar spondylosis with
radiculopathy
• Type -2 diabetes mellitus
• Typhoid fever, 15 days back
• Eye problem (cataract)

27. PHARMACEUTICAL CARE PLAN:-

28. GOALS OF THERAPY:-
• To reduce the signs and symptoms of
patients
• To maintain normal blood sugar level
• To control further complication
• To maintain laboratory parameters
• To reduce the risk of morbidity and
mortality
• To improve the quality of life

29. TREATMENT OPTION:-
• Antidiarrheal:- Metronidazole, Tinidazole
• Antiemetic:- Ondansetron
• Topical NSAIDs:- Diclofenac 1% gel, Ibuprofen
10% gel
• Analgesic and antipyretic:- Paracetamol,
Ibuprofen, Diclofenac
• Antineuropathic drugs:- Pregabalin,
Gabapentin, Amitriptyline
• Proton pump inhibitor:- Pntoprazole

30. TREATMENT CHART:-
BRANDNAME GENERIC NAME DOSE FREQUENCY ROA DA
Y-1
DA
Y-2
Inj.Microtaz Piperacillin+Tazobactum 4.5g 1-1-1 IV  .  .
Inj.Metrogyl Metronidazole 400mg 1-1-1 IV  .  .
Inj.Pan Pantoprazole 40mg 1-0-1 IV  .  .
Inj.Emeset Ondansetron 4mg 1-1-1 IV  .  .
Inj.PCT Paracetamol 1g 1-1-1-1 IV  .  .
Inj.Nervigen Pregabalin+nortriptyline+
methylcobalamine
In
100mlNS
1-0-0 IV  .  .
Tab.Sporolac Lactic acid bacilli - 1-1-1 PO  .  .
Inj.Pregabalin Pregabalin 75mg 0-0-1 IV  .  .
IVF NS Normal saline 100ml/hr - IV  .  .
Inj.H.Actrapid Soluble insulin - - SC  .  .
Cap.Redotil Racecadotril 100mg 1-1-1 PO  .  .
Inj.Tramadol Tramadol 50mg 1-0-1 IV  .  .
Fentanyl patch Fentanyl 25mcg Once in 72hrs  .  .

31. PROGRESS REPORT:-
DAY-1:-
H/o vomiting (3-4 episodes),
loose stools (4-5 episodes) since 1week;
Headache,neckpain,shoulder pain, with
difficulty in breathing
• HR:-72bpm
• BP:-130/80mmHg
• SPO2:-99%
• RR:-20bpm
• GRBS:-252mg/Dl
• CVS:-conscious and oriented
• PA:-soft distension(+), tenderness(+)

32. DAY-2:-
C/o vomiting (2 episodes from morning)
loose stools (3 episodes from morning)
headache, neck pain, shoulder pain
No fresh complaints
HR:-83bpm
BP:-140/80mmHg
RR:-20bpm
GRBS:- 202mg/dL
RS:-B/L NVBS (+)
CVS:-S1S2 (+)
CNS:- Conscious and oriented
PA:- soft and tenderness (+)
Patient attenders are not willing for admission, they want to
go against medical advice and discharged

33. MONITORING PARAMETERS:-
• Glucose test
• Electrolytes
• MRI scan
• Hematology
• Eye test
• widal test

34. PROBLEMS IDENTIFIED:-
• Patient is having cataract, it is not
diagnosed
• Patient is having typhoid fever, 15 days
back but there is no diagnosing test
conducted
• Fentanyl and tramadol may result in
increased risk of respiratory and CNS
depression

35. PHARMACIST INTERVENTION:-
• Advice to diagnose about cataract
• Advice to diagnose about typhoid
fever

36. PATIENT COUNSELLING:-
 ABOUT DISEASE:-
• Explain the nature of condition
• Explain the role of relevant risk factors
such as obesity ,heredity and trauma
• The patient should be informed that
established structural changes are
permanent and that, although cure is not
possible at present, pain and function
can often be improved

37.  ABOUT MEDICATION:-
• Fentanyl patch may cause abuse or opioid
addiction
• If hypersensitivity reactions occurs by any
medicines immediately informed to health
care professionals
• If any ADR occurs by any medicines
informed to health care professionals
• Never take in greater amounts or more
often than prescribed

38.  LIFESTYLE ADVICE:-
• Strengthening exercises to improve
muscle strength and aerobic fitness
training
• Advice to loss weight
• Decrease stress level
• Use soft collars (neck immobilization)
• Avoid prolonged sitting or standing
• Cervical mechanical traction
• Heat and cold therapy

39.  DIET:-
• Avoid white potato and coffee as it
increase acid load in the body
• Use garlic, turmeric and ginger in food, it
shows anti-inflammatory
• Avoid spicy, hot, salty oily foods
• Replace rice with wheat
• Add more bitter vegetables like bitter
guard and drum stick in the routine food

40. THANK YOU