Term
| What are different types of diarrhea? |
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Definition
Increased frequency and decreased consistency
- Acute - <14 days
- Persistant - >14 days
- Chronic - >30 days. Infection, in nursing homes |
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Term
| What are the 4 physiological processes of the gut? |
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Definition
- Digestion - converts nutrients to usable material
- Secretion - Fluid secreted into GI
- Motility - Secretions moved towards anus by contraction
- Absorption - products of digestion taken into the body |
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Term
| What is the etiology of diarrhea? |
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Definition
Infectious - traveler's, antibiotics
Non-infectious - Medications, lactose intolerance, fructose, artificial sweetener |
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Term
| What are the 4 changes that can cause diarrhea? |
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Definition
- Change in ion transport - Secretory. Increased secretion or decreased absorption
- Change in intestinal motility - Osmotic - poor absorption
- Increase in lumenal osmolarity - exudative - mucus and blood
- Increase in hydrostatic pressure - altered intestinal transit - premature emptying |
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Term
| What is non-pharmacologic tx for diarrhea? |
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Definition
Prevent excessive water, electrolyte, acid-base. Rehydrate and maintain w/ pedialyte.
Symptomatic relief
Diet: D/c solid and dairy |
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Term
| What are pharmacological treatments for diarrhea? |
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Definition
- Antimotility agents - opiates and derivatives. Diphenoxylate, Loperamide, Paregoric, Difenoxin
- Adsorbents - Kaolin pectin, Polycarbophil, Attapulgite
- Antisecretory agents - bismuth salicylate/pepto bismol (only for 2 days), Octreotide inhibits secretion
- Enzymes - lactase for lactose intolerance.
- Probiotics - decrease antibiotic induced diarrhea
- Antibiotics - for traveler's diarrhea. Cipro, Bactrim, Azith |
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Term
| What is the clinical presentation of constipation? |
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Definition
| Straining, lumpy/hard stools. Sensation of blockage |
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Term
| What are types of constipation? |
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Definition
- Primary constipation - idiopathic.
Normal transit - difficulty passing
Slow transit - infrequent due to slow transit
Disordered - muscle dysfunction
- Secondary constipation - Lifestyle and age. Disease, Metabolic/endocrine, neurogenic, pregnancy |
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Term
| What is non-pharmacologic tx for constipation? |
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Definition
- Increase dietary intake gradually
Maintain hydration |
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Term
| How are pharmacologic tx used for constipation? |
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Definition
Limit self tx to 7 days
Geriatrics - bulk forming laxatives are 1st line
Hospital w/o GI disease - glycerin or milk of magnesia |
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Term
| How are bulk forming agents used for constipation? |
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Definition
Adds different kinds of fiber. Attempt to be soluble to attract
water and non-fermenting. Drink water!
- Psyllium/Metamucil - natural soluble/insoluble fermentable fiber
- Methylcellulose/Citrucel - soluble fermentable fiber
- Polycarbophil/Fibercon - non-fermentable
**Increase stool mass |
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Term
| How are osmotic agents used for constipation? |
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Definition
Hyperosmotics that are poorly absorbed
- Sorbitol - increase mass by water retention
- Lactulose - lots of GI AEs
- PEG/Miralax |
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Term
| How are lubricants used for constipation? |
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Definition
Mineral oil - inhibit abs of water to increase bulk and decr transit time
**NOT recommended for routine use or for geriatrics |
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Term
| How are emollients used for constipation? |
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Definition
Allows water to interact w/ stool
Docusate/Colace |
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Term
| How do stimulant laxatives work for constipation? |
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Definition
Directly stimulate peristalsis
- Senokot/Sennosides
- Bisacodyl/Dulcolax |
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Term
| How are saline cathartics used for constipation? |
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Definition
FAST acting, poorly absorbed ions such as citrate and magnesium. Do not use routinely.
- Magnesium Citrate
- MgOH
- MgSO4 - most potent
- NaPO4/Fleet enema |
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Term
| What Tx for constipation can be used in special populations? |
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Definition
- Children - Fleet or glycerin, MgOH or senna, Docusate
- Pregnancy - Low risk are PEG, Docusate, and stimulants |
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Term
| What non-OTC therapies are there for constipation? |
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Definition
- Chronic - Lubiprostone/Amitiza
- Opioid induced - Methylnaltrexone/Relistor
- Colonoscopy - PEG, Osmoprep |
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