Antidiarrheal & Laxatives in Medicine

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the bodyweight loss percentage indicative of severe dehydration?

10%

20%

15% (correct)

Which characteristic is present in moderate dehydration according to the Clinical Dehydration Scale?

Thirsty, restless or lethargic but irritable when touched (correct)

Eyes normal

Drowsy, limp, cold or sweaty ± comatose

Tears present

What does a Modified Vesikari score of 2 indicate?

Moderate dehydration score

Patients require primary care hospitalization

Maximum diarrhea episodes of 4-5 per 24-h period (correct)

No diarrhea and normal fecal output

What skin condition is associated with mild dehydration?

Pale skin color Signup and view all the answers

According to the severity of dehydration scale, what is characteristic of CNS presentation in severe dehydration?

Lethargic/comatose Signup and view all the answers

Which pathogen is NOT commonly detected in children with persistent diarrhea?

Listeria monocytogenes Signup and view all the answers

What clinical sign is most commonly used to assess the presence and severity of dehydration in children?

Loss of body weight Signup and view all the answers

Which of the following symptoms is frequently associated with persistent diarrhea?

Mucus in stools Signup and view all the answers

Which parameter was reported by the highest percentage of Clinical Practice Guidelines as indicative of dehydration?

Skin turgor Signup and view all the answers

In evaluating the need for a medical visit for children with diarrhea, which of the following is NOT a recommended indication?

Mild loss of appetite Signup and view all the answers

What is the sodium concentration range recommended for hypo-osmolar ORS formulations?

45-60 mmol/L Signup and view all the answers

Which oral rehydration solution formulation is specifically recommended for malnourished children?

ReSoMal Signup and view all the answers

What is the osmolarity of the current standard ORS as per the 2002 formulation?

245 mOsm/L Signup and view all the answers

What critical role does the sodium-glucose transporter type 1 (SGLT1) play in intestinal absorption during diarrheal diseases?

Mediates transport of glucose coupled with sodium Signup and view all the answers

Which oral rehydration solution has the highest glucose concentration according to the 2002 standard?

Current standard ORS Signup and view all the answers

In case a child fails on oral rehydration therapy, which of the following is a recommended alternative method?

Intravenous fluids Signup and view all the answers

What percentage of clinical practice guidelines (CPGs) recommend the low-osmolarity ORS formulation?

60% Signup and view all the answers

What common characteristic is associated with ORS formulations recommended for children according to CPGs?

Hypo-osmolarity Signup and view all the answers

What is the primary function of prebiotics in the intestinal system?

To enhance the number of beneficial anaerobic bacteria Signup and view all the answers

What is the recommended approach for travelers at high risk of diarrhea?

Antibiotic chemoprophylaxis for short-term use Signup and view all the answers

Which of the following symptoms is NOT used to define chronic idiopathic constipation?

Regular diarrhea without laxative use Signup and view all the answers

What is the effectiveness level of bismuth subsalicylates for preventing traveler's diarrhea?

Moderate effectiveness with no contraindications Signup and view all the answers

How prevalent is constipation globally?

14-16% Signup and view all the answers

Which of the following is a common misconception about probiotics?

They can completely prevent all gastrointestinal diseases Signup and view all the answers

Which group is more prevalent in chronic constipation cases?

Women Signup and view all the answers

Why are probiotics not recommended for the prevention of traveler's diarrhea?

They do not provide significant effectiveness Signup and view all the answers

What is the primary approval indication for Linaclotide in Spain?

Irritable bowel syndrome with constipation Signup and view all the answers

What mechanism does Lubiprostone utilize to enhance intestinal fluid secretion?

Activates CIC-2 chloride channels Signup and view all the answers

Which of the following is NOT a pharmacological effect of Lubiprostone?

Produces antidiarrheal effects Signup and view all the answers

What happens to sodium ions during the action of Lubiprostone?

Sodium ions are expelled into the intestinal lumen Signup and view all the answers

What role does water play in the mechanism of Lubiprostone?

Follows sodium to maintain isotonic equilibrium Signup and view all the answers

Which of the following statements about Lubiprostone is true?

It rebuilds the intestinal mucosal barrier function. Signup and view all the answers

What is the ultimate result of Lubiprostone's mechanism of action in treating constipation?

Easier passage of stool Signup and view all the answers

How does Lubiprostone contribute to mucosal barrier function?

By promoting tight junction protein complex restoration Signup and view all the answers

What is the recommended approach for introducing fibre-rich foods?

Introduce gradually to allow adaptation of the gastrointestinal tract Signup and view all the answers

What is the primary mechanism of action of psyllium as a bulk-forming laxative?

It forms a gel-like mass that softens stools Signup and view all the answers

Which laxative is recommended as a first choice over others for chronic constipation?

Polyethylene glycol Signup and view all the answers

What is a key characteristic of osmotic laxatives like polyethylene glycol?

They bind water and cause it to be retained in the stool Signup and view all the answers

Why is adequate water intake recommended when consuming fibre supplements?

It complements the effects of fibre supplements Signup and view all the answers

Which type of laxative is recommended as a rescue treatment option?

Stimulant laxatives Signup and view all the answers

What common effect does the gel-like mass of psyllium have on stools?

Makes them softer and easier to pass Signup and view all the answers

What is the basis for recommending methylcellulose as an alternative to psyllium?

It serves a similar function with low evidence Signup and view all the answers

Study Notes

Introduction

University of Guadalajara School of Medicine
Focus on Antidiarrheal & Laxatives

Diarrhea

Definition:
- Acute diarrhea: Passage of numerous stools of decreased form within a 24-hour period; onset is abrupt with 3 or more loose or liquid stools, lasting 13 days or more.
- Persistent diarrhea: Diarrhea lasting between 14 and 30 days.
- Chronic diarrhea: Diarrhea lasting more than a month (>30 days).
- Infectious etiology often presents with nausea, vomiting, abdominal pain, cramps, bloating, flatulence, fever, bloody stools, tenesmus, and fecal urgency.

Epidemiology

Acute diarrhea: Leading cause of outpatient visits, hospitalizations, and lost quality of life in the USA, affecting 47.8 million annually with costs exceeding $150 million.
Acute gastroenteritis (AGE): Leading cause of child mortality and morbidity globally, particularly in low-income countries. 760,000 deaths per year in infants and children under 5 years old.
AGE: Causes approximately 240,000 emergency department visits annually, and hospitalizations in 1 in every 10-25 children.

Definition

Describes acute, persistent, and chronic diarrhea to assist in proper classification.
Provides details about associated symptoms for infectious diarrhea.

Treatment

Oral rehydration:
- Balanced electrolyte rehydration solutions are preferred over other oral rehydration options for the elderly and travelers with cholera-like diarrhea.
- Maintaining hydration through water, juices, sports drinks, soups, and crackers is helpful.
Probiotics and prebiotics:
- Probiotics and prebiotics are not recommended for general acute diarrhea except in instances of post-antibiotic associated illness.
Non-antibiotic therapies:
- Bismuth subsalicylates (BSS): Helpful for managing traveler's diarrhea in mild to moderate cases.
- Loperamide: Can be used adjunctively with antibiotics for treating diarrhea, potentially reducing its duration and improving the chance of recovery.
Antibiotic therapy:
- Empirical antimicrobial therapy is not recommended in routine cases of acute diarrhea unless the likelihood of bacterial causes is high enough to justify the potential risks of antibiotics.
- Use of antibiotics is not advised for most community-acquired cases of diarrhea, which are usually caused by viruses (norovirus, rotavirus, adenovirus).

Treatment-Prevention Counseling

Patient level counseling for prevention of acute enteric infections is not recommended in general.
Pretravel counseling regarding high-risk food and beverage avoidance to prevent traveler's diarrhea is useful.
Frequent and effective hand-washing, and use of alcohol-based hand sanitizers help prevent most forms of traveler's diarrhea but may be less helpful in cases with low-pathogen outbreaks or endemic diarrhea.
Bismuth subsalicylate may be considered for travelers, but only if no contraindications are present.
Probiotics, prebiotics or synbiotics are not recommended for preventing diarrhea.
Antibiotic chemoprophylaxis may be considered for high-risk individuals for short-term use.

Diarrhea in Children

Rotavirus: The most severe diarrheal pathogen for children.
Common pathogens in persistent diarrhea include rotavirus, norovirus, astrovirus, enteroaggregative Escherichia coli (and atypical E. coli), Giardia, and Cryptosporidium and Entamoeba histolytica.
Clinical condition and risk of severe diarrhea in children: Loss of appetite, fever, vomiting, and mucous in stools is frequent with persistent diarrhea. Fever, severe dehydration, and lethargy are common in rotavirus infection.
Indications for a medical visit.
- Age less than 2 months
- High-output diarrhea (more than 8 episodes per day)
- Severe underlying disease
- Family-reported signs of severe dehydration
- Persistent vomiting.

Assessment of Dehydration in Children

Loss of body weight and clinical signs used to assess dehydration severity.
Recommendations include assessing skin turgor, sunken eyes, general appearance, capillary refill time, and mucosal membranes.

Constipation

Definition: Characterized by infrequent, difficult bowel movements, often accompanied by excessive exertion during defecation, or a feeling of incomplete evacuation.
Chronic idiopathic constipation: Defined based on Rome III criteria.

Epidemiology of Constipation

Prevalence of chronic constipation is 14-16% globally, with a higher prevalence in women.
Prevalence increases after 60 years of age.
68% of patients have experienced constipation within 10 years of diagnosis.

Diseases Associated with Chronic Constipation

Includes digestive problems, structural and/or gastroenterological; and other systemic issues (neoplasia, neurologic, psychiatric/psychological, myopathic disorders, etc.).
Notes various specific conditions, including but not limited to, intestinal stenosis, ischaemic colitis, inflammatory bowel disease, post-surgical changes, idiopathic rectal ulcer, rectal intussusception, and pelvic floor weakness,

Treatment for Constipation

Non-pharmacological:
- High fiber intake.
- Adequate water intake.
- Regular physical exercise.

Pharmacological Measures

Bulk-forming: Psyllium or methylcellulose
Osmotic: Polyethylene glycol is generally preferred over lactulose.
Emollient/Lubricant: Includes docusate sodium, docusate calcium.
Stimulant: Bisacodyl
Secretory: Lubiprostone and linaclotide.
Prokinetic: Prucalopride.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Explore the critical aspects of antidiarrheal and laxative medications in this quiz tailored for medical students. Understand definitions, epidemiology, and the global impact of diarrhea on health. This knowledge is essential for aspiring healthcare professionals.