Diarrhea & Constipation ASSIGNMENT # 1 PATH-202Submitted to: Dr. Imtiaz Ahmed KhanSubmitted by: Waqas Nawaz 11-arid-975 DVM 4th semester Headache Sense of rectal Symptoms of Abdominal bloating fullness constipation Low back pain Faculty of Pharmacy - Alexandria University (Egypt)
CONSTIPATION Constipation, costiveness, or irregularity is a condition of the digestive system inwhich a person experiences difficulty in defecation. Obstipation is used for severeconstipation that prevents passage of both stools and gas. Common among children and pregnant women; Constipation refers to infrequent or hardstools. It is the passage of dry and hard stools, usually fewer than 3x a week. People withthis condition may find bowel movement painful and difficult.1-SIGN & SYMPTOMS: A desire to defecate Pain and intestinal discomfort Swelling in the abdomen, cramps and colic In some cases up to several days without being able to defecate with grave harm and body poisoning Constipation is one of the main causes of hemorrhoids and appendicitis, as well as acne and general intoxication of the body. Difficulty in starting or completing a bowel movement Infrequent and difficult passage of stool Passing hard stool after prolonged straining in the toilet Excessive gas & Sense of bloating Intestinal obstruction Vomiting Headaches Loss of appetite Coated (furred) tongue Offensive breath Bad taste in your mouth
You are considered constipated if you have two or more of the following for at least 3 months: Straining during a bowel movement more than 25% of the time. Hard stools more than 25% of the time. Incomplete evacuation more than 25% of the time. Two or fewer bowel movements in a weekTypes of stool: Type 1: Separate hard lumps, like nuts (hard to pass) Type 2: Sausage-shaped, but lumpy Type 3: Like a sausage but with cracks on its surface Type 4: Like a sausage or snake, smooth and soft Type 5: Soft blobs with clear cut edges (passed easily) Type 6: Fluffy pieces with ragged edges, a mushy stool Type 7: Entirely liquid Type 1 and 2 indicate constipation, with 3 and 4 being the "ideal stools" especially thelatter, as they are the easiest to pass, and 5–7 being further tending towards diarrhea orurgency.2-CAUSES: Poor diet Poor bowel habits Medications Painkillers Travel Age Pregnancy Laxative abuse Irritable bowel syndrome Intestinal obstruction Inadequate fiber and fluid intake Environmental changes
1-CONSTIPATION CYCLE: 2-PATHOLOGY OF CONSTIPATION: depression; impaired cognitive function; spinal cord compression; cerebral tumour; hypercalcaemia; hypokalaemia; hypothyroidism; Abdominal tumour (intestinal tumour, or compression from tumour external to bowel). Painful ano-rectal conditions. CONSTIPATION DURING PREGNANCY : Constipation is among the top three most uncomfortable complaints listed by pregnant women.
What causes constipation during pregnancy: In the first trimester it is caused by progesterone which slows down intestinal activity In the later part of pregnancy the pressure of your uterus on your intestines and rectum makes your system sluggish Iron supplement that you need for anemia has a constipating effect. Stress and tension contributes to constipation You are more susceptible to constipation if you had this problem in your prepregnancy days You lead a sedentary lifestyle3-PATHOPHYSIOLOGY OF CONSTIPATION: Medications Opioids Calcium-channel blockers Anticholinergic Decreased motility Ileus Mechanical obstruction Metabolic abnormalities Spinal cord compression Dehydration Autonomic dysfunction Malignancy4-TREATMENT & CURE: Drink 8 to 10 glasses of water per day (drink them before meals and never during or after meals it affects digestion). Eat one carrot a day (don’t forget to drink a lot of pure water). Exercise preferably before going to bed. Eat high fiber diet to provide natural bulk in daily food intake and help move food to the rectum; increase quantity of fruits & vegetables Take bulk-forming laxatives to absorb water in the intestines and acts as stools softener; this can be in the form of fiber supplements & Daily exercise For people with severe symptoms, surgical removal of colon may be an option
DIARRHEA Diarrhea describes bowel movements (stools) that are loose and watery. Itis very common and usually not serious. Many people will have diarrhea once or twice eachyear. It typically lasts two to three days and can be treated with over-the-counter (OTC)medicines. Some people have diarrhea often as part of irritable bowel syndrome or otherchronic diseases of the large intestine.The World Health Organization defines diarrhea as the passing of liquid or watery stools atleast 3 times in a 24-hour period. However, it is the consistency rather than the number ofstools that is important. Frequent passing of formed stools is not diarrhea.Breastfed babies normally passes loose or pasty stools. The mother can tell if her baby hasan abnormal stool. We call it “mother’s definition”.TYPES OF DIARRHEA:Acute Diarrhoea sudden onset and lasts less than two weeks 90% are infectious in etiology 10% are caused by medications, toxin ingestions, and ischemia Viral, Bacterial, Protozoa (90%) Medications Laxatives or diuretic abuse Ingestion of environmental preformed toxin such as seafood Ischemic ColitisChronic Diarrhoea Diarrhoea which lasts for more than 4 weeks Most of the causes are non-infectious Irritable Bowel Syndrome Diverticular disease Colorectal CancerIf stools contain blood or mucus, it is called dysentery. If diarrhea persists for 14 days orlonger, it is called persistent diarrhea.
COMMON DIARRHEAS1-SIGN & SYMPTOMS: Age <2 years: Rotavirus Abdominal bloating or cramps Age 2-5 years: Cholera; E. coli; Thin or loose stools Shigellosis Watery stool Sense of urgency to have a bowel movement All ages: E.coli; Campylobacter Nausea and vomiting In addition to the symptoms described above, Immunocompromized: Amebiasis; the symptoms of complicated diarrhea include: Cryptosporidium 1. Blood, mucus, or undigested food in the stool 2. Weight loss 3. Fever2-CAUSES: MALNUTRITION o Alcohol o Caffeine in soda, tea, coffee & chocolate o Food that cause gas such as beans & apples o Nicotine o Spicy foods o Foods high in acids such as orange o Fatty foods such as sausage & butter o Dairy products, particularly for those who are lactose intolerant BACTERIA o E.coli o Salmonella o Shigella o Campylobacter o Vibrio Diarrhea o Yersini o Clostridium difficle Watery Persistent o S.aureus Dysentery o B.cereus o C.botulinum Rotavirus E. coli Cholera Amoebic Bacillary Multiple cause VIRUS o Rotavirus o Adenoviruses o Caliciviruses o Astroviruses o Norwalk agents and Norwalk-like viruses
FUNGI o Yeast o Candida PARASITE o Entameba histolytica o Giardia lamblia o Cryptosporidium o IsosporaDIARRHEA DUE TO MICROBES:Transmission: Most of the diarrheal agents are transmitted by the fecal-oral route Cholera: water-borne disease; transmitted through water contaminated with feces Some viruses (such as rotavirus) can be transmitted through air Nosocommial transmission is possible Shigellosis (blood dysentery) is mainly transmitted person-to-person Shigellosis is a water-washed disease; transmitted more when there is scarcity of water Food and water contaminated directly or indirectly with feces or vomitus of infected persons are the principal mode of transmission. Ingestion of raw or inadequately cooked seafood or eating shelfish from coastal and estuarine waters can cause outbreaks of diarrhea. Person-to-person transmission occurs by hand-to-mouth transfer of the agent from feces of an infected individual. Respiratory spread is possible for rotavirus. 3-PATHOPHYSIOLOGY OF DIARRHEA: Osmotic Diarrhea Malabsorption/Maldigestion/Fatty Secretory Diarrhea Inflammatory Diarrhea Abnormal Motility Diarrhea
1-Osmotic Diarrhea:Mechanism: – retention of water in the bowel as a result of an accumulation of non‐absorbable water‐soluble compounds – non absorbed substance exert osmotic pressure – -cease with fasting, discontinue oral agentsCauses: o Purgatives like magnesium sulfate or magnesium containing antacids o Especially associated with excessive intake of sorbitol and mannitol. o Disaccharide intolerance o Generalized malabsorption o Lactose intolerance 2-Malabsorption DiarrheaMechanism: – Luminal Phase (Intraluminal maldigestion) Normal Ilium – Mucosal Phase (Mucosal loss & Mucosal disease) – Transport Phase (Fat malabsorption=Streatorrhea)Causes: o Bacterial outgrowth o Pancreatic insufficiency o Mucosal disease (Crohn’s disease & Celiac sprue)Celiac Sprue: Celiac sprueGluten sensitive enteropathyReaction against gluten in dietEpidemiology: Whites (European)
3-Secretory DiarrheaMechanism: – Active intestinal secretion of fluid and electrolytes as well as decreased absorption. – Large volume, painless, persist with fasting – Abnormal ION transport in intenstinal epithelial cells – Abnormal mediators – Diffuse mucosal diseaseCauses: o Cholera enterotoxin, heat labile E.coli enterotoxin o Vasoactive Intestinal Peptide hormone in Verner-Morrison syndrome o Bile salts in colon following ileal resection o Laxatives like docusate sodium o Carcinoid tumours 4-Inflammatory DiarrheaMechanism: – Damage to the intestinal mucosal cell leading to a loss of fluid and blood – Pain, fever, bleeding, inflammatory manifestationsCauses:Immunodeficiency patient o Infective conditions like Shigella dysentary o Inflammatory conditions Ulcerative colitis and Crohn’s disease
5-Abnormal Motility DiarrheaMechanism: – Increased frequency of defecation due to underlying diseases – -large volume, signs of malabsorption (steatorrhoea) – Diabetic diarrhea – Hyperthyroidism – Bloating & gasCauses: o Diabetes mellitus- autonomic neuropathy o Post vagotomy o Hyperthyroid diarrhoea o Irritable Bowel Syndrome
4-TREATMENT & CURE: Inj. Ciprofloxacin Inj. Metronidazole Inj.Ranitidine C. Bifilac T.Paracetamol Non-specific treatment o hydration o Absorptions (Kaopectate®) o Bismuth o Antiperistaltics/opiate derivatives o Fiber supplementation ORS (Oral Rehydration Solution) Antibiotics choiceo E. coli Quinoloneo Shigella Quinolone or TMP-SMXo Vibrio cholera Tetracycline or quinoloneo Salmonella Quinolone or TMP-SMXo Campylobacter Erythromycin or quinoloneo Yersinia tetracycline, TMP-SMX, or quinolone