Gastrointestinal Problems 2
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- Created by: amazingemilyjones
- Created on: 08-04-19 22:51
Gastrointestinal Problems 2
Gastrointestinal Problems 2
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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
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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
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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
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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
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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
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Diarrhoea: Treatment
- Oral rehydration therapy - electrolytes
- Loperamide - over 12 years
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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
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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)
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IBS: Treatment Options
- Antispasmodics - mebeverine, hyoscine butlylbromide, peppermint oil
- If constipation is predominant - bulk forming/stimulant laxative
- If diarrhoea is predominant - loperamide
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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)
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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
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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
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