Lect 8 Disorders of small intestine .pdf

Disorders of the Small Intestines Diarrhea and Constipation, Malabsorption, Celiac Disease Irritable Bowel Syndrome Chapter 15 Lecture # 8 Disorders of the Small Intestines • • • • • Diarrhea Constipation Malabsorption Celiac Disease Irritable Bowel Syndrome Diarrhea • Definition – Increase in...

Disorders of the Small Intestines Diarrhea and Constipation, Malabsorption, Celiac Disease Irritable Bowel Syndrome Chapter 15 Lecture # 8 Disorders of the Small Intestines • • • • • Diarrhea Constipation Malabsorption Celiac Disease Irritable Bowel Syndrome Diarrhea • Definition – Increase in frequency of bowel movements or increase in water content of stools • Affects consistency or volume • >200 g/day adults, >20 g/kg for children • Other information – – – – A symptom Some types of bacteria like salmonella some + + Causes loss of Na and K disease like cholera Bacteria: vibrio cholera Can cause dehydration Acute, persistent, or chronic Diarrhea • Osmotic The normal range of osmolarity is 300 mOsm/ L – Increased water efflux due to an increase in osmolality Causes: – Maldigestion of nutrients, excessive sorbitol, laxatives – Resolves when patient is NPO • Secretory – – – – ‫الكائنات األولية‬ Bacterial, viruses, protozoa Disease such as Crohns, UC, Celiac Antibiotic treatments Does not resolve when patient is NPO Diarrhea • Side effect of antibiotics and other medications – Increasing GI motility – Altering the normal flora – Table 15.3 Medications that may cause diarrhea Gram positive bacteria - anaerobic Found in hospital • Clostridium difficile – C.diff Antibiotics Antibiotics Antibiotics – Result of ampicillin, amoxicillin, and clindamycin – Treatment = Vancomycin and/or metronidazole (flagyl) HANDWASHING Diarrhea • Causes • Treatment – Restore normal fluid, electrolyte, and acid-base balance – Medications • LoMotil, Immodium, Bismuth compounds, Flagyl, Lactinex – Prevention always recommended Constipation • Definition – Decrease in frequency of bowel movements – Presence of hard stools – Need to strain ‫بحاجة إلى الضغط‬ • .Causes – Slow transit time – Part of a disease process » Irritable bowel syndrome, Parkinson's, MS (Multiple sclerosis) – Impaction ‫انحشار البراز‬ – Side effect of medications Constipation • Treatment – – – – Treat underlying etiology Bowel retraining ‫إعادة تدريب األمعاء‬ ‫حقنة في الشرج‬ Enemas, cathartic, laxatives Bulking agents, stool softeners ‫تعمل على زيادة املاء لتسهيل اإلخراج‬ Laxatives Stool Softeners Osmotics Senekot Mineral Oil Lactulose Dulcolax Glycerin Sorbitol Correctol Docusate Sodium Milk of Magnesium Ex-Lax Go Lytely Constipation • Clinical manifestations – Often hard, pellet-like – Abdominal pain, bloating, gas • Medical diagnosis – Complete history & physical, CBC, TSH, serum glucose ‫ التنظير السيني املرن‬،‫تنظير القولون‬ – Colonoscopy, flexible sigmoidoscopy Malabsorption • Definition – Maldigestion of fat, carbohydrate, protein • Etiology Vili in small intestine – Decreased villous height, enzyme production, or Liver pancreas dysfunction of accessory organs due to disease – Decreased transit time – surgery ‫بسبب قطع جزء من األمعاء في عملية جراحية‬ Carbohydrate Malabsorption • Lactose malabsorption • Increased gas, abdominal cramping, diarrhea • Lactose tolerance test, lactose breath hydrogen test • Restrict milk and dairy products • Products such as lactaid can be recommended (Treatment) Protein Malabsorption • Protein-losing enteropathy • Reduced serum protein • Peripheral edema ‫االعتالل املعوي الفاقد للبروتني‬ Secondary level Theird level • Treatment – Depends on the cause Which level in loosing? Fat Malabsorption • Steatorrhea – Fat travels undigested and unabsorbed to the large intestines • Stools are frothy foul smelling and greasy in appearance • Fat soluble vitamin deficiencies • Fecal fat test or D-Xylose absorption test ‫البراز ذو رائحة كريهة ودهنية في الداخل‬ ‫مظهر‬ Celiac Disease • Definition – Damage to intestinal mucosa from gluten exposure – Genetic and autoimmune • Epidemiology ‫أكثر شيوعا مما كان يعتقد في األصل‬ • More common than originally thought • 1 in 133 People • Occurs with other immune disorders – Type 1 Diabetes, Systemic Lupus Erythematous, and Primary Biliary Cirrhosis ‫ واألولية التشمع الصفراوي‬،‫ والذئبة الحمامية الجهازية‬،‫داء السكري من النوع األول‬ • Can take an average of 11 years to diagnosis Celiac Disease • Environmental factors – Younger age for introduction to gluten – Shorter time for breast feeding – Viral infection during infancy Celiac Disease – Pathophysiology • Damage to villi; reduced height; flattened • Decreased enzyme function and surface area • Maldigestion and malabsorption Small Intestine Villi in Celiac Disease Celiac Disease –Signs/Symptoms • Diarrhea, abdominal pain, cramping, bloating, gas • Bone and joint pain • Muscle cramping, fatigue • Peripheral neuropathy, seizures • Skin rash – dermatitis herpetiformis • Mouth ulcerations • Higher risk for lymphoma and osteoporosis • Anemia Because the low Calcium Because low absorption of B complex Celiac Disease Test and Treatment • Medical Diagnosis Take a tissue from the body – Gold Standard = small bowel biopsy • Serological Testing ‫االختبارات املصلية‬ – Antibodies • Anti-tissue transglutaminase – anti-tTG • Endomysial IgA – EMA • Anti-gliadin – AGA • Treatment = DIET Irritable Bowel Syndrome (IBS) Very common for people who travel • Definition • Is a functional disorders – Abdominal pain or discomfort that occurs in association with altered bowel habits over a period of three months Diarrhea Constipation Mix = diarrhea + constipation – Three subtypes: IBS-D, IBS-C, IBS-M • Affects more women < 50 years of age Irritable Bowel Syndrome • Abnormal motility plays major role in symptoms • Abnormalities in brain-gut communication • Small intestinal bacterial overgrowth • Increased permeability of the mucosa • Life Stressors • Serotonin ‫النمو البكتيري الكثيف في‬ ‫األمعاء الدقيقة‬ ‫زيادة نفاذية الغشاء املخاطي‬ ‫ضغوط الحياة‬ (The mechanism?) Irritable Bowel Syndrome – Medical Treatment • • • • Antidiarrheal agents - LoMotil Bulking agents, laxatives – MOM Antispasmodics – Peppermint oil Agonist or antagonists for 5-HT4 (5-hydroxy troptamin) receptors When you have stomach cramps – SSRI- Selective serotonin reuptake inhibitors • Cognitive-behavioral therapies – Counseling – Relaxation techniques Summary • Diarrhea and constipation are usually signs and symptoms of much larger problems • Malabsorption can lead to nutrient deficiencies and need to be addressed • Celiac disease is not an allergy to gluten, it is an intolerance • The RD can honestly play a role on the health care team that help diagnosis celiac disease earlier