Gastrointestinal Problems 2 0.0 / 5 ? PharmacyPH1122UniversityAll boards Created by: amazingemilyjonesCreated on: 08-04-19 22:51 Gastrointestinal Problems 2 Gastrointestinal Problems 2 1 of 13 Constipation Normal range of bowel movement is from 3 x daily to 3 x weekly Consider what's normal for the patient Main symptoms Hard stools which are difficult to pass Less frequent than usual Associated symptoms Abdominal discomfort Bloating Nausea Other potential causes Induced by medication Misuse of laxatives Behavioural, e.g. holding it in, especially in children 2 of 13 When to Refer Pain on defecation Blood in stools - tarry stools (GI bleeding), fresh blood (lower in GI tract) >40 years of age with sudden change, no obvious cause Lasts longer than two weeks Associated tiredness (prolonged), anaemia, thyroid dysfunction 3 of 13 Constipation: Advice and Treatment Increase dietary fibre - fruit and vegetables, wholegrain, wholewheat, wholemeal, seeds and oats Ensure adequate fluid intake Avoid sedentary lifestyle Reduce caffeine intake - leads to dehydration Bulk laxatives - ispaghula, methylcellulose, sterculia Osmotic laxatives - lactulose, macrogol Stimulant laxatives - sennosides and bisacodyl Consider time, e.g. Glycerin suppositories work within an hour, Fybogel sachets work in several days 4 of 13 Diarrhoea Normally acute and self-limiting - lasts a few days Rapid onset, watery stools passed more frequently, more than 3 times daily Associated symptoms Abdominal cramps Flatulence Weakness and malaise Triggers Recent trip abroad - tropical or subtropical region Local minor outbreaks of gastroenteritis 5 of 13 Diarrhoea: Red Flags and When to Refer Red flags Blood/mucus in stools Previous recent history Prolonged change in bowel habit Infants Certain medications Severe vomiting Pregnancy Refer: diarrhoea of greater than 1 day in children under 1 year 2 days in children under 3 years 3 days in children over 3 and adults 6 of 13 Diarrhoea: Treatment Oral rehydration therapy - electrolytes Loperamide - over 12 years 7 of 13 Irritable Bowel Syndrome One of the most common gastrointestinal conditions Chronic, relapsing and often lifelong Adult prevalence 10-20% - twice as common in women Most commonly affects 20-30 year olds Associated symptoms Abdominal pain and discomfort Pain relieved by defecation/passing of wind Altered defecation, change in stool form/frequency Associated bloating Stress can be a factor 8 of 13 IBS: Red Flags and When to Refer Red flags Blood in stools Fever Prolonged change in bowel habit Infants Severe abdominal pain Refer Children under 16 Patients over 45 with recent bowel habit Steatorrhoea (fat in faeces) 9 of 13 IBS: Treatment Options Antispasmodics - mebeverine, hyoscine butlylbromide, peppermint oil If constipation is predominant - bulk forming/stimulant laxative If diarrhoea is predominant - loperamide 10 of 13 Haemorrhoids (Piles) Abnormally swollen vascular cushion that are present in the anal canal Estimated that one in two people will experience at least one episode at some point during their lives Occur at any age - rare in anyone under 20 Affects both sexes equally More common in patients between 45-65 High incidence in pregnancy Constipation is a contributory factor Symptoms often intermittent (last few days to a few weeks) Bleeding, perianal itching, mucous discharge, pain Any blood associated is bright red (spotting around the toilet, streaking on toilet paper or visible on surface of stools) 11 of 13 Haemorrhoids: When to Refer Persistent change in bowel habit in patients over 40 years Unexplained rectal bleeding Severe pain when defecating Blood mixed in with the stool Fever 12 of 13 Haemorrhoids: Management Lifestyle advice advise on importance of correct anal hygiene keep the region clean and dry to aid healing and reduce irritation and itching use of baby wipes to cleanse, using patting not a rubbing motion Treatment Anaesthetics, e.g. lidocaine, benzocaine, cinchocaine Astringents, e.g. bismuth, zinc Anti-inflammatory drugs, e.g. hydrocortisone 13 of 13
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