COMMON GASTRO-INTESTINAL DISORDERS

How to care your self ?

28 March 2010-Common Gastrointestinal Disorders-Mahmoud El Ghazali

Across most of Europe & North America, primary care is a specific specialty that exists within a range of healthcare systems & culturesIt is at the forefront of care of most patients

Gastrointestinal disease In developed countries gastrointestinal problems are a common reason for attendance at the primary care clinic as well as the outpatient clinic of the hospital.

In developing countries, poor hygiene and malnutrition allow the spread of infective organisms.

The clinician's main role here is to treat infections promptly and to help with prevention by encouraging improved sanitation and education.

Diseases of the gastrointestinal tract & liver together account for about 10% of the total burden of illness, 20 million office visits, and nearly 10 million hospital admissions annually in Egypt

The cost of gastrointestinal diseases depends on their prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

The major function of the gastrointestinal tract is to absorb water & nutrients.

Food moves physically from mouth to colon where non-absorbable wastes are stored for periodic elimination

The diagnosis of gastrointestinal diseases derives predominantly from the patient’s history and, to lesser extent, from the physician’s examination

Gastroesophageal Reflux Disease(GERD, Acid Reflux, Heartburn)

Peptic & duodenal ulcer Nausea & vomiting Diarrhea Constipation Irritable bowel syndrome

GERD is one of the most prevalent diseases in the western world .

Recurrent heartburn (which is the hallmark of GERD) enables a diagnosis of GERD to be made by history alone

Gastroesophageal reflux disease, commonly referred to as GERD or acid reflux, is a condition in which the liquid content of the stomach regurgitates (backs up or refluxes) into the esophagus.

What causes GERD?Lower esophageal sphincterHiatal herniaEsophageal contractionsEmptying of the stomach

Heartburn Regurgitation Nausea

What are the complications of GERD? Ulcers Strictures Inflammation of the throat and larynx

1. Life style modifications2. Drug therapy

Antacids

Anti histaminic

PPI

Mg-Antacids Al-Antacids AL*Mg-Antacids Ca carbonate-Antacids Na bicarbonate-Antacids

Ranitidine & famotidine

Omeprazole,lansoprazole & pantoprazole

What is a peptic ulcer?A peptic ulcer is a hole in the gut lining of the stomach, duodenum, or esophagus. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum, a duodenal ulcer

"Helicobacter pyloricus" (H. pylori).

NSAIDs (nonsteroidal anti-inflammatory drugs).

Cigarette smoking. Alcohol !!!

Note:-Contrary to popular belief,

alcohol, coffee, colas, spicy foods, and caffeine have no proven role in ulcer formation.

What are symptoms of an ulcer?

Upper abdominal burning or hunger pain one to three hours after meals and in the middle of the night.

Complications include ulcer bleeding, ulcer perforation, and gastric obstruction.

Patients with ulcer bleeding may report black tarry stools (melena), weakness, a sense of passing out upon standing (orthostatic syncope), and vomiting blood (hematemesis).

Antacids neutralize existing acid in the stomach.

Histamine antagonists (H2 blockers) are drugs designed to block the action of histamine on gastric cells.

Proton-pump inhibitors such as omeprazole (Omez).

Nausea and vomiting are symptoms of an underlying disease and not a specific illness.

Nausea is the sensation that the stomach wants to empty itself.

vomiting (emesis) or throwing up, is the act of forcible emptying of the stomach.

Acute gastritis

Central causes (signals from the brain)

Association with other illnesses remote from the stomach

Medications and medical treatments

Mechanical obstruction of the bowel

2. Systemic causes: Elevated intra-cranial pressure (benign or

neoplastic) Inner ear disease Medications: (act locally on the stomach;

NSAIDs, erythromycin, or cardiac anti-arrhythmics or systemically like chemotherapeutics and opiates)

Pregnancy Radiation therapy

Antiemetic agents include: 5-HT3 antagonists:

ondansetron & others

D-2 antagonists: domperidone &

Metoclopramide

H-1 antagonists: diphenhydramine & meclizine

What is diarrhea?Diarrhea is an increase in the frequency of bowel movements or a decrease in the form of stool (greater looseness of stool).

What are common causes of acute diarrhea?

The most common cause of acute diarrhea is infection--viral, bacterial, and parasitic.

Bacteria also can cause acute food poisoning.

A third important cause of acute diarrhea is starting a new medication.

Viral gastroenteritis Food poisoningTraveler's diarrhea Bacterial enterocolitisParasites Drugs

What are the complications of diarrhea?Dehydration Adult children Hypotension with syncope (fainting upon standing due to a reduced volume of blood.Thirst , dry mouth and irritation of the anus .

When should the doctor be called for diarrhea?

High fever Moderate or severe abdominal pain or

tenderness Bloody diarrhea Prolonged vomiting that prevents intake of

fluids orally Acute diarrhea in pregnant women Diarrhea that occurs during or immediately

after completing a course of antibiotics

C. difficile

Oral rehydration solutions (ORS) are liquids that contain a carbohydrate (glucose or rice syrup) and electrolyte (sodium, potassium, chloride, and citrate or bicarbonate).

Absorbents. (attapulgite – polycarbophil)

Anti-motility medications. Antibiotics. Antiprotozoal.

Constipation means hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement.

What causes constipation?Medications (Narcotic pain medications) (Antidepressants such as amitriptyline) (Anticonvulsants such as phenytoin) (Calcium channel blocking) Habit- Diet-Laxatives-Hormonal disorders-Central nervous system diseases.

What treatments are available for constipation?

Dietary fiber (bulk-forming laxatives) Lubricant laxatives Emollient laxatives (stool softeners) Saline laxatives Stimulant laxatives Enemas Most herbal laxatives contain stimulant-type

laxatives and should be used, if at all, as a last resort.

IBS is a functional disease, that is, a disease in which the intestine (bowel) functions abnormally.

Theories of the cause of IBS include abnormal input from intestinal sensory nerves and abnormal stimulation of the intestines by the motor nerves.

What causes IBS?As described previously, IBS is believed to be due to the abnormal function (dysfunction) of the muscles of the organs of the gastrointestinal tract or the nerves controlling the organs.

The symptoms of slowed transportation are nausea, vomiting, abdominal bloating (the sensation of abdominal fullness), and abdominal distention (enlargement).

The symptom of rapid transportation usually is diarrhea.

Peppermint Bran Sulprid Mebeverine Trimebutine

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