GIT 3

Zienab Halem
Faculty of pharmacy SCU
 8 – IBS
irritable bowel syndrome

 Functional ( not structure ) GI disorder .

 Common , long term condition affects large intestine ( colon ) .
 More common in women and patients younger than 50 years .
 IBS causes cramping , abdominal pain , bloating , gas , diarrhea and
/ or constipation .
 IBS dosen’t cause changes in bowel tissue or increase risk of
colorectal cancer .
 Inflammatorybowel disease ( IBD )
And inflammatory bowel syndrome (
IBS )
 IBS divided into :

 Diarrhea predominant ( IBS – D )

 Constipation predominant ( IBS – C )
 Mixed IBS ( IBS – M ) or alternating IBS ( IBS – A )
 Screening for celiac disease in patients with IBS-D
and IBS-M .

 Guidelines recommended :
If other GI diseases are excluded and no alarm
symptoms ( e.g weight loss , bleeding and anemia )
are present , diagnosis of IBS can be made with
confidence .
 Treatment :

A – Dietary modifications :
- Avoid foods that trigger symptoms .
- Fibers supplementation : may improve symptoms of
constipation & diarrhea .
 B – pharmacological therapy .

 Antispasmodics :
 Dicyclomine ( Spasmorest )
 Clidinium ( librax ) anxiolytics
 Hyoscine N-butylbromide ( buscopan )
 Peppermint oil ( not for GERD )

 All used for IBS-D and NOT for IBS-C

 Mebeverine
Without anticholinergic side effect ( relieves painful
muscle spasms of the gut , without affecting its
normal motility ) can be used in IBS-C
1 tab / 3 times daily 20 min. before meals
 Pinaverium
1 tab / 3 times daily with food
 9 – gall stones ( cholelithiasis )
 Are stones formed within the gall bladder , about 80 % of patients
are asymptomatic .
 Gall bladder stores and concentrates bile and cholesterol is soluble
in bile .
 Function :
 1- bile acids help for digestion & absorption of fats and fat-soluble
vitamin in the small intestine .
 2- many waste products including bilirubin are eliminated from the
body by secretion into bile & elimination in feces .
 Common symptoms :
Biliary colic ( crampy pain “right upper abdominal pain ,
usually after heavy meals and lasts 1 – 4 hrs “ )
More than 5 hrs : complication .

Complications signs : Biliary colic more than 5 hrs ,

fever , persistent tachycardia , hypotension , jaundice .
 Medication :

Ursodeoxycholic acid
Reduces cholestasis , prevents formation and promotes
dissolution of cholesterol – containing gallstones .

Pregnancy : category B
Maintenance dose : 250 mg for 6 months
 Rowachol
Contains essential oils that may help to dissolve or
break up cholesterol – based gallstones .
 10 – hemorrhoids ( piles )

 Swollen blood vessels in the lower rectum .

 Pregnancy is associated with an increased risk for
hemorrhoids and there is a slightly increased prevalence
in women compared with men .
 Chronic constipation has been linked to hemorrhoids .
 Types “
 Internal hemorrhoids : located inside the rectum .
 External hemorrhoids : develop under the skin around the anus

Signs and symptoms :

External : very painful , resolves in 2 – 3 days …. Swelling may take a few
weeks to disappear …. Irritation around the anus .
Internal :bleeding during bowel movement , painful , irritation and fecal
incontinence
 Factors increased pressure ::

- Straining during bowel movements .

- Chronic diarrhea or constipation .
- Sitting for long periods on the toilet .
- Obesity , pregnancy
- Low fiber intake .
 Management :
 Life style :

1 – topical treatment .
2 – sitz bath ( soaking anal area in plain warm water 10 – 15 min 2 – 3
times daily with potassium permanganate
3 – keep the anal area clean ( avoid soap , avoid alcohol based wipes )
4 – don’t use dry toilet paper
5 – apply cold
6 – take oral pain relieves .
 Medications :

 1 – topical or suppository corticosteroids : relieve inflammation

and itching not more than 2 weeks .
 2 – topical zinc oxide , petroleum jelly , cocoa butter , hard fat
, mineral oil or shark liver oil : reduce itching .
 3 – topical local anesthetic : for who have painful external
hemorrhoids .
 4 – oral venoactive drug : daflon .
 5 – oral NSAIDs : not more than 1 week .
 Daflon
500 mg ( 1 tab ) / 4 hours for first 4 days
500 mg / 6 hours for 3 days
500 mg / twice for 3 months