Gastrointestinal Disorders - Emesis PDF

# Gastrointestinal Disorders ## Emesis Emesis is the involuntary, forceful expulsion of the contents of an individual's stomach through the mouth and at times through the nose. It is also known as vomiting or throwing up. In this article we will know about the causes, types, diagnosis and treatm...

# Gastrointestinal Disorders ## Emesis Emesis is the involuntary, forceful expulsion of the contents of an individual's stomach through the mouth and at times through the nose. It is also known as vomiting or throwing up. In this article we will know about the causes, types, diagnosis and treatment procedures for emesis. ### Etiology It can be caused by a number of conditions and may be present as a specific response to ailments like poisoning or gastritis or as an elevated intracranial pressure to excessive exposure to ionizing radiation. It could also occur as a sign of early pregnancy. Nausea is a symptom experienced in emesis which is actually the feeling that an individual is about to vomit or throw up. Emesis may at times lead to some complications which may be dangerous and require immediate treatments. Usually, emesis due to gastritis include the gastric secretions and they are highly acidic in nature. Emesis can occur due to the reaction of sensory nerve endings in the GI tract and the pharynx to medications/drugs. Endogenous emetic substances produced because of the radiation damage or any disease may also cause emesis. Heart and other viscera may also cause emesis. Nauseating smells, disgusting experiences etc can also cause emesis due to post operative radiation damage or vomiting (PONV) as result of the surgery and general anesthesia. Emotional stress also causes emesis. Fresh blood may sometimes be seen in a process of emesis and is known as blood vomiting. Bile can also come out in emesis which occurs in case of severe emesis where there is a duodenal contraction. ### Phases of Emesis: Emesis occurs in two phases: 1. **Retching phase of emesis:** This is the first phase of the emesis where nothing expels out but the patient may be experiencing violent hiccups. Here the abdominal muscles undergo a few rounds of coordinated contractions together with the diaphragm, and the muscles involved inspiration of the respiratory process. 2. **Expulsive phase of emesis:** This is the next phase in the act of emesis. Here in this phase there forms an intense pressure in the stomach which is brought about by enormous shifts in both the diaphragm as well as the abdomen. This may last for some time and then all of a sudden, the pressure may be released when the upper oesophageal sphincter is relaxed and thus results in the expulsion of gastric contents. ### Types of Emesis: 1. **Delayed Emesis:** This is a type of emesis which mostly occurs after 2-5 days of the administration of chemotherapy drug known as Cisplatin in about 60% of the patients undergoing the treatment. Such types of emesis are quite difficult to treat with standard antiemetic drugs and may require a combination therapy of oral dexamethasone and oral metoclopramide. 2. **Anticipatory Emesis:** Anticipatory emesis is one type of emesis that is conditioned by the severity and duration of previous reactions to chemotherapy. 3. **Cyclic Emesis:** Here there is uncontrollable vomiting and this process of emesis occurs mostly in every 2-3 months. Migraine may be the cause of such a type of emesis. 4. **Projectile Emesis:** This is one more type of emesis which actually refers to the process of throwing up of gastric contents with a great force. It throws up the contents at such a force that sometime materials also exist via the person's nose. ### Complications Associated with Emesis: 1. **Electrolyte Imbalance:** Dehydration is one of the serious complications with emesis or vomiting. Emesis may lead to depletion in the water content of the body and may also alter the electrolyte status. Emesis due to gastritis leads to direct loss of acids or protons and chloride due to emesis. Emesis can be seriously dangerous in case the gastric content enters the respiratory tract. The person may choke and may meet with a condition of an aspiration pneumonia that can be dangerous. ### Treatments for Emesis: Emesis are mostly treated with antiemetic. #### Antiemetic Drugs: This is a drug which is known to be effective against emesis and nausea. These are the medications mostly used to treat motion sickness and the side effects of medications like Chemotherapy. There are various classes of the antiemetic drugs. * **Anticholinergics:** This class of the antiemetic drug is mainly used to prevent motion sickness. Side effects such as hallucinations may occur when taken in large dose and also may lead to blurry vision, dry mouth etc and also can affect the pulse rate. Antiemetic drugs are mainly for motion sickness and also have an additional anticholinergic action. There may be side effects of this class of antiemetics like drowsiness and loss of coordination. Antiemetic drugs are mostly used as antipsychotic agents. Apart from this, they also have an anti-narcotic action. * **One more class of antiemetic drugs** which can be used in treating emesis. These are the class of antiemetics which are good for anticipatory nausea and emesis before cancer therapy. They are also used for treating vestibular disorders, one of the most effective treatments available for treating and preventing serious emesis occurring due to cancer chemotherapy. It is known that about 85%of patients achieve complete control of emesis with this drug. #### Home Remedies for Emesis: There are some effective home remedies available for emesis which is discussed below. * **System, ginger works as a natural antiemetic for preventing gines.** You can try ginger tea with a little honey or even eat fresh slices of ginger for the effective results, reducing the act of emesis, especially those which are caused due to gastritis. Just boil one cup of rice in one and half cup of water and strain the solution for drinking the rice water. In treating emesis. You can prepare mint tea and take for the best benefits. Add mint leaves in one and half cup of boiling water and allow it to steep and strain the water. Then drink the mint tea for the best benefits, known to be helpful in calming the stomach and also treat nausea and emesis. You can add one and half teaspoon of cinnamon powder in boiling water and allow it to steep for few minutes and then strain the water before drinking it. However, this home remedy may not be suitable for the pregnant women before upsetting stomach etc. is vinegar. It calms the stomach and helps detoxification. You can simply mix one tablespoon of apple cider vinegar and one tablespoon of honey in a glass of water and drink it. You can repeat it as many time required. Fennel seeds are effective in digestion and ease nausea. Because of the antimicrobial properties, fennel can be used in treating emesis. Simply chewing fennel seeds would help. Tea made of few cloves can be effective in treating emesis or vomiting. For treating emesis is cumin. It is mostly effective when emesis or nausea is caused due to digestive problems. You can mix one and half tablespoon of cumin seeds in warm water and drink it for the essential results. ### Conclusion: So, above we talked about the act of emesis, its types, causes, complications along with the treatments and home remedies. In case of any emergency due to emesis or nausea kindly talk to a medical professional and take the effective treatments. # Constipation ## Overview: Constipation is defined medically as a condition when an individual passes stool fewer than three times per week and severe constipation as less than one stool per week. It is considered as a symptom of various illness rather than a disease itself. ## Etiology: There are many causes of constipation. These include: * Medications such as narcotics. antidepressants and iron pills, * Poor bowel habits: * Low fiber diets: * Abuse of laxatives: * Hormonal disorders, * Stress, * Colon cancer, * Eating disorders, * Eating a lot of dairy products, * Irritable bowel syndrome. * Neurological conditions such as Parkinson's disease or multiple sclerosis, * Inactivity, * Hypothyroidism and high levels of estrogen and progesterone during pregnancy. Constipation is usually caused by the slow movement of material through the colon. The two disorders limited to the colon that cause constipation are colonic inertia and pelvic floor dysfunction. ## Clinical Manifestation: Some of the symptoms include: * Lower abdominal discomfort, * A sense of incomplete evacuation after a bowel movement, * Straining to have a bowel movement, * Hard or small stools, * Rectal bleeding and/or anal fissures caused by hard stools. * Physiological distress and/or obsession with having bowel movements. Constipation can also alternate with diarrhea. This pattern commonly occurs as part of the irritable bowel syndrome (IBS). At the end of the spectrum there is fecal impaction, which is when the stool hardens in the rectum and prevents passage (although occasionally diarrhea may occur even with obstruction due to colonic fluid leaking around the impacted stool). The number of bowel movements generally decreases with age. Most adults have what is considered normal, between three and 21 times per week. The most common pattern is one bowel movement a day, but this pattern is rarely seen in individuals. Moreover most are irregular, and don’t have bowel movements every day or the same number every day. It is important to distinguish acute (recent onset) constipation from chronic (long duration) constipation. Acute constipation requires urgent assessment because a serious medical illness may be the underlying cause (for example, tumors of the colon). It also requires an immediate assessment if it is accompanied by symptoms such as rectal bleeding, abdominal pain and cramps, nausea and vomiting, and involuntary loss of weight. The evaluation of chronic constipation may not be urgent, particularly if simple measures are taken to relieve It. Individuals should seek medical care if constipation is of sudden onset, severe, worsening, associated with other worrisome symptoms such as loss of weight, or is not responding to simple, safe and effective treatments. Tests to diagnose the cause of constipation may include a medical history, physical examination, blood tests, abdominal X-rays, barium enema, colonic transit studies, defecography, anorectal motility studies, and colonic motility studies. The goal of therapy for constipation is one bowel movement every two to three days without straining. ## Risk factors include: * Sex: females are at higher risk than males * Age: individuals 65 years and older * Low income * Pregnancy women and women who just gave birth ## Treatment: Treatment may include foods high in fiber, non-stimulant laxatives, stimulant laxatives, enemas, suppositories, biofeedback training, prescription medications, and surgery. Patient should be encouraged to drink two to four glasses of water daily. Try warm liquids, especially in the morning. Include fruits and vegetables to diet. Eat prunes and bran cereal. Exercise most days of the week should be encouraged to increase GIT motility. Laxatives can also be used. Stimulant laxatives, including herbal products, should be used as a last resort because they might damage the colon and worsen constipation. ## Prevention: * Eat a well-balanced diet with plenty of fibers, fruits, vegetables, legumes, and whole-*grain bread and cereal (especially bran). * Drink 1 1/2 to 2 quarts of water and other fluids a day (unless your doctor has you on a fluid-restricted diet). Fiber and water work together to keep you regular. * Avoid caffeine. It can be dehydrating. * Cut back on milk. Dairy products can constipate some people. * Exercise regularly for at least 30 minutes a day, most days of the week. # Diarrhea ## Overview: This is a GIT (Gastro Intestinal Tract) disorder characterised by frequent loose and watery stools. It may also occur as a symptom of a health issue, such as a virus. Usually, diarrhea goes away on its own after a few days. However, if diarrhea lasts for a few weeks or you have persistent diarrhea occurring more than 10 to 12 times in a day, it’s considered severe and requires medical attention. ## Etiology: There are a number of causes of diarrhea. These include: * Food poisoning. * Stomach flu, * Lactose intolerance, * Irritable Bowel Syndrome (IBS). * Inflammatory Bowel Disease (IBD). * Contaminated food or water. * Digestive disorders, such as Crohn’s disease or ulcerative colitis, * Colorectal cancer. * Diarrhea may be caused by microbes such as Bacteria, viruses, parasitic organisms. * Irritable Bowel Syndrome (IBS) is the major cause of functional diarrhea * Reactions to medication such as laxatives, * Endocrine disorders such as Addison disease. * Carcinoid tumors can also cause diarrhea. ## Symptoms: In addition to frequent loose, watery stools, other symptoms for diarrhea include: Stomach pain, Cramps. Bloating, Thirst, Weight loss, fever, Blood in the stool ## Testing and diagnosis of diarrhea: To diagnose, we begin by collecting a thorough history and conducting a comprehensive physical exam. We’ll also talk about any medications you are currently taking. Some medication do have the potential to cause diarrhea. A blood test and stool test may be necessary to determine the cause of the diarrhea. ## Treatment: If your diarrhea does not resolve on its own within a few days, your doctor may recommend any of the following: * Over-the-counter antidiarrheal medicine, such as Loperamide and bismuth subsalicylate such as Pepto-Bismol are effective in reducing diarrhea stool output in adults and children. * Antibiotics, If it’s been determined that your diarrhea is due to a bacterial infection. Such as metronidazole, Amoxicillin, Dialoxanide etc. * Probiotics are effective in antibiotic-associated diarrhea. * Medication adjustment, if one of your current medications is causing, the diarrhea. * Oral Rehydration Salt (ORS) which comprises salt and glucose in water is effective in non-severe diarrhea cases. * Replacing fluids, by drinking more or receiving them intravenously if your dehydration is severe or you are unable to hold them down). Children and elderly people especially are at risk for dehydration. * Treating other underlying conditions, such as Inflammatory Bowel Disease or Irritable Bowel Syndrome, with the help of our multidisciplinary team to create a complete treatment plan. - **O.R.S (Oral rehydration)** to correct the electrolyte imbalance caused by loss of fluids and electrolytes through vomit and stools. - **Metoclopramide hydrochloride (10mg)** (one tablet twice daily) an anti-emetics against the vomiting. Performs its function by constricting the vessels of the intestine. - I learnt that people taking NSAIDs (non-steroidal anti-inflammatory drugs) are not only to take food with the drugs but rather to be eating regularly while taking the drug because some of the drugs reach peak serum level at a time that the food ingested simultaneously with the drug would have digested. Also, ulcer and asthma patients should avoid these drugs as it could aggravate these conditions. For patients with not so severe, Arthrotec® containing diclofenac and misoprostol could be used but with extreme caution. Misoprostol is a prostaglandin analog that will help in protection of gastrointestinal tract. - I learnt basic pharmaceutical calculations. A prescription was brought. - Ocefixing 12hrly for 5days - The standard volume of ocefix suspension is 100mg/5ml - If every 5ml contains 100mg - Then how many ml will be contained in 65mg - Xml=5=3.25ml - Hence, child will be given 3.25ml 12hrly for 5days.