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DISORDER
Content
Introduction about GI disorder.
Peptic Ulcer
Constipation
Diarrhea
Introduction about GI
disorder
The gastrointestinal (GI) tract is
composed esophagus, stomach,
small intestine, large intestine,
colon, rectum, biliary tract,
gallbladder, liver, and pancreas.
Disorder related to any of this
organ are called Gastro Intestinal
Disorder.
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Peptic Ulcer
A
peptic
ulcer,
also
known
as PUD or peptic ulcer disease, is the
most common ulcer of an area of
the gastrointestinal tract that is usually
acidic and thus extremely painful. It is
defined as mucosal erosions equal to
or greater than 0.5 cm.
TYPES:
Duodenum (called duodenal ulcer)
Esophagus (called esophageal ulcer)
Stomach (called gastric ulcer)
ETIOLOGY
Common causes
Helicobacter pylori infection
Nonsteroidal anti-inflammatory drugs
Critical illness (stress-related mucosal damage)
Uncommon causes
Hypersecretion of gastric acid (e.g., ZollingerEllison syndrome)
Viral infections (e.g., cytomegalovirus)
Vascular insufficiency (crack cocaineassociated)
Radiation
Chemotherapy (e.g., hepatic artery infusions)
Rare genetic subtypes
Idiopathic
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PATHOPHYSIOLOGY
Gastric and duodenal ulcers occur
because of an imbalance between
aggressive factors (gastric acid and
Symptoms
Abdominal pain that is often epigastric and described as
burning, abdominal fullness, or cramping
A typical nocturnal pain that awakens the patient from
sleep (especially between 12 AM and 3 AM)
The severity of ulcer pain varies from patient to patient,
and may be seasonal, occurring more frequently in the
spring or fall.
Changes in the character of the pain may suggest the
presence of complications
Heartburn, belching, and bloating often accompany the
pain
Nausea, vomiting, and anorexia, are more common in
patients with gastric ulcer than with duodenal ulcer, but
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may also be signs of an ulcer-related complication
SIGNS:
Weight loss associated with nausea,
vomiting, and anorexia
Complications, including ulcer bleeding,
perforation, penetration, or obstruction
DIGNOSIS:
Laboratory tests
Gastric acid secretory studies
Fasting serum gastrin concentrations are only
recommended for patients unresponsive to therapy,
or for those in whom hypersecretory diseases are
suspected.
The hematocrit and hemoglobin are low with
bleeding, and stool hemoccult tests are positive
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Tests for Helicobacter pylori
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Cont...
Prostaglandin Analogs:
They bind to the EP3 receptor on
parietalcells and stimulate the Gi pathway,
Cont...
Antacids:
Systemic: Sodium bicarbonate.
Nonsystemic: Magnesium hydroxide,
Alluminium hydroxide gel.
Ulcer Protective: Sucralfate.
Anti H. pylori drugs : Amoxicillin,
Clarithromycin,
Metronidazole,
Tinidazole, Tetracyclin.
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Constipation
Constipation include infrequent bowel action twice a
week or less, that involves straining to pass hard
faeces & which may be accompanied by a sensation
of pain or incomplete evacuation
Functional constipation is defined as two or more of
the following complaints present for at least 12
months in the absence of laxative use:
straining at least 25% of the time;
lumpy or hard stools at least 25% of the time;
a feeling of incomplete evacuation at least 25% of
the time;
two or fewer bowel movements in a week.
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ETIOLOGY:
Extent of absorption & secretion of fluid from
GIT generally parallels transit time --- a slower
transit time will lead to formation oh hard stool
& constipation
Agents altering the intestinal motility either
directly or by acting on ANS affect the transit
time of food along the GIT
Motility is largely under cholinergic control --anticholinergics or drug with anticholinergic
side effect Motility
Constipation
Opoid cause tone of smooth muscle,
suppress forward peristalsis, rais
sphincter tone at ileocaecal valve & anal
sphincter
Constipation.
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Cont...
CLINICAL MENIFESTATION:
Signs and symptoms
Infrequent bowel movements, stools of insufficient
size, a feeling of fullness, or difficulty and pain on
passing stool.
Hard, small or dry stools, bloated stomach,
cramping abdominal pain and discomfort, straining
or grunting, sensation of blockade, fatigue, headache,
and nausea and vomiting
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DIAGNOSIS:
Laboratory tests
A series of examinations, including proctoscopy,
sigmoidoscopy, colonoscopy, or barium enema,
may be necessary to determine the presence of
colorectal pathology.
Thyroid function studies may be performed to
determine the presence of metabolic or
endocrine disorders.
With laxative abuse, fluid and electrolyte
imbalances (most commonly hypokalemia),
protein-losing
gastroenteropathy
with
hypoalbuminemia may be present.
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TREATMENT ALGORITHM
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TREATMENT:
NONPHARMACOLOGIC THERAPY
Dietary modification to increase the amount of
fiber consumed.
Include at least 10 g of crude fiber in their daily
diets
Encourage patients to exercise (achieved even by
brisk walking after dinner)
To adjust bowel habits so that a regular and
adequate time is made to respond to the urge to
defecate
To increase fluid intake
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Cont...
PHARMACOLOGICAL TREATMENT:
By using laxative or purgative.
Different types of laxative or purgative used
Laxative or Purgative
Bulk forming.
E.g.Dietary fibre
Stool softener.
E.g. DOSS
Stimulant Purgatives
Diphenyl methanes
e.g. Bisacodyl
5-HT4 agonists.
e.g. Tegasarod
Osmotic Purgative
e.g. Lactulose
Anthraquonones
Senna
Fixed oil
e.g. castor oil
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Cont...
Cont...
Cont...
Altered intestinal motility produces diarrhea by three
mechanisms:
o reduction of contact time in the small intestine
o premature emptying of the colon
o bacterial overgrowth
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DIAGNOSIS:
Laboratory tests
Stool analysis studies include examination for
microorganisms, blood, mucus, fat, osmolality, pH,
electrolyte and mineral concentration, and cultures.
Stool test kits are useful for detecting gastrointestinal
viruses, particularly rotavirus.
Occasionally, total daily stool volume is also determined.
Direct endoscopic visualization and biopsy of the colon
may be undertaken to assess for the presence of
conditions such as colitis or cancer.
Radiographic studies are helpful in neoplastic and
inflammatory conditions.
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TREATMENT:
NONPHARMACOLOGICAL :
Dietary management is a first priority in the
treatment of diarrhea
Most clinicians recommend discontinuing
consumption of solid foods and dairy
products for 24 hours
Rehydration and maintenance of water and
electrolytes are primary treatment goals until
the diarrheal episode ends
Oral or i.v infusion of WHO-ORS.
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PHARMACOLOGICAL TREATMENT:
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DRUGS
References
Joseph T Dipiro et al. Rosemary R. Berardi,
Lynda S. Welage Peptic Ulcer Disease;
Pharmacotherapy; Page : 629
Joseph T Dipiro et al; William J. Spruill;
William E. Wade l; Diarrhoea, Constipation,
and
Irritable
Bowel
Syndrome;
Pharmacotherapy; Page 677.
Roger Walker, Cate Whittlesea; S. E. Ghosh,
M. Kinnear; Peptic Ulcer Disease; Clinical
Pharmacy & Therapeutics; Page: 149
Roger Walker, Cate Whittlesea; P. Rutter;
Constipation & Diarrhoea; Clinical Pharmacy &
Therapeutics; Page: 187
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