Lecture xx Minor Ailments of Lower GI 2024 PDF

Treatment of minor ailments – diarrhoea, constipation and haemorrhoids NFGI Ian Towle [email protected] Learning outcomes To understand the minor ailments that affect lower GI tract – diarrhoea, constipation and haemorrhoids To know the symptoms, causes and treatments OTC medicines...

Treatment of minor ailments – diarrhoea, constipation and haemorrhoids NFGI Ian Towle [email protected] Learning outcomes To understand the minor ailments that affect lower GI tract – diarrhoea, constipation and haemorrhoids To know the symptoms, causes and treatments OTC medicines that can be supplied to treat these conditions  WWHAMM summary slide Who is it for? : infants/ elderly/frail What are the symptoms? : Include danger symptoms like dehydration/consider self-reporting (need detail) How long have symptoms persisted? : acute/chronic Action already taken? : consider OTC Medication being taken? : OTC or Rx -might cause symptoms Medical problems? Learning outcomes: Part 1 Diarrhoea To understand the minor ailments that affect lower GI tract – diarrhoea To know the symptoms, causes and treatments OTC medicines that can be supplied to treat these conditions To understand the effect on electrolyte imbalance and how this is corrected by rehydration salts Diarrhoea The passing of watery stools more than three times a day Diarrhoea can either be: – acute: diarrhoea that comes on suddenly, and lasts for upto 14 days – Persistent: lasting more than 14 days – chronic: lasts for more than 4 weeks Diarrhoea mechanisms Mechanisms that can cause diarrhoea are – Increased osmotic load in the gut lumen – Increase in secretion – Inflammation of the intestinal lining – Increased intestinal motility More than one mechanism may cause diarrhoea in an affected person Symptoms of diarrhoea Watery, frequently passed stools with or without Abdominal cramps Flatulence Weakness Nausea, vomiting, fever Headache, loss of appetite Fluid loss with subsequent dehydration may lead to electrolyte loss - Na+, K+, Mg2+, Cl- Treatment of diarrhoea Diarrhoea often goes away after a few days without treatment Drink fluids to avoid dehydration – rehydration drinks Eat as soon as you can – food high in carbohydrates Consider anti-diarrhoea medicines – loperamide Painkillers – to treat fever or headache Rehydration drinks Can replace lost electrolytes but will not treat the diarrhoea Commercial products available – Dioralyte ® – Powders for reconstitution – Directions: dissolve one sachet in 200ml of fresh drinking water and drink after each loose motion – Good to get fluids and electrolytes back into system Can make ‘home-made’ preparation ‘home made’ preparation WHO recommendation Half a small spoon of salt and six level small spoons of sugar dissolved in one litre of water or Lightly salted rice water www.who.int/cholera/technical/en/ Antidiarrhoeals Slow transit time through the GI tract which increases water and electrolyte absorption Loperamide 2mg tablets - adults and children over 12 years - 2 capsules initially then one after each loose motion to max 8 in 24 hours Not a preferred treatment Medication induced diarrhoea Take a history – Newer or as required more likely Laxatives Antibiotics Metformin NSAIDs PPIs Warning symptoms - refer Blood or mucous in motions – bright red is ok in small amounts Signs of dehydration – lethargy, headache, dry mouth Long period of time - >5 days? Vomiting for more than one day High fever Recent change in bowel habit or travel abroad Learning outcomes – part 2 To understand the minor ailments that affect lower GI tract – constipation To know the symptoms, causes and treatments OTC medicines that can be supplied to treat these conditions Constipation The passage of hard stools (faeces) less frequently than the patient’s own normal pattern Inability to completely empty the bowel Symptoms of constipation Change in stool frequency Stools can become unusually hard, lumpy, large or small Stomach ache and cramps Feeling bloated, nauseous, loss of appetite Chronic problems – hemorrhoids, faecal impaction  Causes of constipation Poor diet – lack of fibre and/or fluids Lack of mobility Medication – Opioid analgesics, antidepressants, anti- epileptics, iron supplements Pregnancy Medical conditions – diabetes, Parkinson’s, underactive thyroid Treatment of constipation Lifestyle advice – increase fibre in the diet, add bulking agents – increase fluid intake – increase daily exercise Laxatives – stimulant – bulk-forming – osmotic Stimulant laxatives Increase intestinal motility Onset of action 8-12 hours – usually night time administration Side effects include abdominal cramps, excessive fluid loss, electrolyte imbalance Examples include senna, bisacodyl  Bulk-forming laxatives Stimulates peristalsis in a similar way to dietary fibre Onset of action 24-36 hours Important to drink plenty of water to avoid impaction Side effects include flatulence and abdominal bloating Examples include bran, ispaghula husk Osmotic laxatives Retain fluid in the bowel by osmosis so important to drink plenty Onset of action up to 3 days Side effects include flatulence, abdominal pain, colic Examples include lactulose and magnesium salts Warning symptoms - refer Constipation alternating with diarrhoea Blood or mucous in motions – bright red is ok in small amounts Weight loss Abuse of laxatives Vomiting Fever Angina Learning outcomes- part 3 To understand the minor ailments that affect lower GI tract – haemorrhoids To know the symptoms, causes and treatments OTC medicines that can be supplied to treat these conditions Haemorrhoids (piles) The anal vascular cushions act to assist the anal sphincter in maintaining continence. Abnormal swelling or enlargement of the anal vascular cushions Prevalence: 13-36% of population - self- reporting - many anorectal symptoms are often wrongly attributed to haemorrhoids.  Symptoms of haemorroids Bright red rectal bleeding: blood is seen on the surface of the stool, not mixed in Pruritus: due to chronic mucus discharge and irritation Soiling: due to impaired continence or mucus discharge Rectal fullness or an anal lump Large prolapsed haemorrhoids can thrombose: very painful purple/blue, oedematous, tense, and tender perianal mass Causes of hemorrhoids/ risk factors Excessive straining (from chronic constipation) Increasing age Raised intra-abdominal pressure, such as: – pregnancy – chronic cough – Ascites Less common: pelvic/ abdominal masses, family history, cardiac failure, or portal hypertension Treatment of hemorrhoids Treat the constipation Creams, ointments and suppositories – these will treat the symptoms but not cure the hemorrhoids Local anaesthetic, astringent and barrier cream Short-term treatment (5-7 days) Warning symptoms - refer Exclude other causes of rectal bleeding such as: - malignancy - inflammatory bowel disease - diverticular disease. Other anorectal symptoms wrongly attributed to haemorrhoids: anal fissure, absess, perianal fistula D- Frequent and watery C- less frequent H- Abnormal swelling of passing of stool. Chronic – passing of hard, vascular cushions which acute persistent- more small bulks of can lead to thrombose – than 14 days faeces. Inability to purple and painful Symptoms- Faeces, completely empty Causes- Constipation, too nausea, abdominal pain, bowel much pressure while flatulence, what is normal, Cause- trying to defaecate. weakness antidiarrheals? Chronic cough Cause – Not enough Large meal, Lack of Symptoms- Itchiness, water? Bacteria (food fibre, NSAIDs? feeling a lump, inability poisoning)poor hygiene Symptoms- to complete a bowel Medicines. Flatulence, small movement, fever? Treatments – drinking lots hard stools, Treatments – Usually of water or rehydration abdominal pain, goes away on its own. drinks (home made is salty rectal fulness Pain killers for and sugary water. Can lead to – thrombose. Gel? Loperomide heamorroids, angina Warning – Blood mixed in (antidiarrheals) which is Treatments- Fibre feaces. something that slows and water, bulking, Cancer or heart attack transit time – not osmotic motility recommended because laxatives. Eat lighter bacteria. meals Warning symptoms – Blood Warning- blood, I (a lot and dark) more than forgot.