Diarrhea & ConstipationASSIGNMENT # 1PATH-202Submitted to: Dr. Imtiaz Ahmed KhanSubmitted by: Waqas Nawaz11-arid-975DVM 4th semesterSymptoms ofconstipationHeadacheAbdominalbloatingLow backpainSense ofrectalfullnessFaculty of Pharmacy - Alexandria University(Egypt)
CONSTIPATIONConstipation, 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 andbody poisoning Constipation is one of the main causes of hemorrhoids and appendicitis, as well asacne 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 least3 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 liquidType 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 externalto bowel). Painful ano-rectal conditions.CONSTIPATION DURING PREGNANCY : Constipation is among the top three most uncomfortable complaints listed bypregnant women.
What causes constipation during pregnancy: In the first trimester it is caused by progesterone which slows downintestinal activity In the later part of pregnancy the pressure of your uterus on your intestinesand 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 yourprepregnancy 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 orafter meals it affects digestion).Eat one carrot a day (don’t forget to drink a lot of pure water). Exercise preferablybefore going to bed.Eat high fiber diet to provide natural bulk in daily food intake and help move food tothe rectum; increase quantity of fruits & vegetablesTake bulk-forming laxatives to absorb water in the intestines and acts as stoolssoftener; this can be in the form of fiber supplements & Daily exerciseFor people with severe symptoms, surgical removal of colon may be an option
DIARRHEADiarrhea 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 Diarrhoeasudden onset and lasts less than two weeks90% are infectious in etiology10% are caused by medications, toxin ingestions, and ischemiaViral, Bacterial, Protozoa (90%)MedicationsLaxatives or diuretic abuseIngestion of environmental preformed toxin such as seafoodIschemic ColitisChronic DiarrhoeaDiarrhoea which lasts for more than 4 weeksMost of the causes are non-infectiousIrritable Bowel SyndromeDiverticular diseaseColorectal CancerIf stools contain blood or mucus, it is called dysentery. If diarrhea persists for 14 days orlonger, it is called persistent diarrhea.
1-SIGN & SYMPTOMS: Abdominal bloating or cramps Thin or loose stools Watery stool Sense of urgency to have a bowel movement Nausea and vomiting In addition to the symptoms described above,the symptoms of complicated diarrhea include:1. Blood, mucus, or undigested food in the stool2. Weight loss3. Fever2-CAUSES: MALNUTRITIONo Alcoholo Caffeine in soda, tea, coffee & chocolateo Food that cause gas such as beans & appleso Nicotineo Spicy foodso Foods high in acids such as orangeo Fatty foods such as sausage & buttero Dairy products, particularly for those who are lactose intolerant BACTERIAo E.colio Salmonellao Shigellao Campylobactero Vibrioo Yersinio Clostridium difficleo S.aureuso B.cereuso C.botulinum VIRUSo Rotaviruso Adenoviruseso Caliciviruseso Astroviruseso Norwalk agents and Norwalk-like virusesCOMMON DIARRHEAS Age <2 years: Rotavirus Age 2-5 years: Cholera; E. coli;Shigellosis All ages: E.coli; Campylobacter Immunocompromized: Amebiasis;CryptosporidiumDiarrheaPersistentMultiplecauseDysenteryBacillaryAmoebicWateryCholeraE. coliRotavirus
FUNGIo Yeasto Candida PARASITEo Entameba histolyticao Giardia lambliao Cryptosporidiumo 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 ofwater Food and water contaminated directly or indirectly with feces or vomitus of infectedpersons are the principal mode of transmission. Ingestion of raw or inadequatelycooked seafood or eating shelfish from coastal and estuarine waters can causeoutbreaks of diarrhea. Person-to-person transmission occurs by hand-to-mouthtransfer of the agent from feces of an infected individual. Respiratory spread ispossible 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 anaccumulation of non‐absorbable water‐solublecompounds– non absorbed substance exert osmotic pressure– -cease with fasting, discontinue oral agentsCauses:o Purgatives like magnesium sulfate ormagnesium containing antacidso Especially associated with excessiveintake of sorbitol and mannitol.o Disaccharide intoleranceo Generalized malabsorptiono Lactose intolerance2-Malabsorption DiarrheaMechanism:– Luminal Phase (Intraluminal maldigestion)– Mucosal Phase (Mucosal loss & Mucosal disease)– Transport Phase (Fat malabsorption=Streatorrhea)Causes:o Bacterial outgrowtho Pancreatic insufficiencyo Mucosal disease (Crohn’s disease & Celiac sprue)Celiac Sprue:Gluten sensitive enteropathyReaction against gluten in dietEpidemiology: Whites (European)Normal IliumCeliac sprue
3-Secretory DiarrheaMechanism:– Active intestinal secretion of fluid and electrolytes as well as decreasedabsorption.– 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 enterotoxino Vasoactive Intestinal Peptide hormone in Verner-Morrison syndromeo Bile salts in colon following ileal resectiono Laxatives like docusate sodiumo Carcinoid tumours4-Inflammatory DiarrheaMechanism:– Damage to the intestinal mucosal cell leading to a loss of fluid and blood– Pain, fever, bleeding, inflammatory manifestationsCauses:Immunodeficiency patiento Infective conditions like Shigella dysentaryo Inflammatory conditionsUlcerative 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 neuropathyo Post vagotomyo Hyperthyroid diarrhoeao Irritable Bowel Syndrome
4-TREATMENT & CURE: Inj. Ciprofloxacin Inj. Metronidazole Inj.Ranitidine C. Bifilac T.Paracetamol Non-specific treatmento hydrationo Absorptions (Kaopectate®)o Bismutho Antiperistaltics/opiate derivativeso Fiber supplementation ORS (Oral Rehydration Solution) Antibiotics choiceo E. coliQuinoloneo ShigellaQuinolone or TMP-SMXo Vibrio choleraTetracycline or quinoloneo SalmonellaQuinolone or TMP-SMXo CampylobacterErythromycin or quinoloneo Yersiniatetracycline, TMP-SMX, or quinolone