HEPATO-BILIARY

and
PANCREATIC FUNCTION

CLINICAL INSTRUCTOR: KRISTINE MAE V. PARCON, RN

 OBJECTIVES
1. Identify the metabolic functions of the liver and the alterations that occur with
hepatic disorders.
2. Explained liver function tests and the clinical manifestations of liver dysfunction in
relation to pathophysiologic alterations of the liver.
3. Related jaundice, portal hypertension, ascites, varices, nutritional deficiencies, and
hepatic coma to pathophysiologic alterations of the liver.
4. Described the medical, surgical, and nursing management of patients with esophageal
varices.
5. Compared the various types of hepatitis and their causes, prevention, clinical
manifestations, management, prognosis, and home health care needs.
6. Used the nursing process as a framework for care of the patient with cirrhosis of the
liver.
7. Compared the nonsurgical and surgical management of patients with cancer of the liver.
8. Described the postoperative nursing care of the patient undergoing liver
transplantation.
 01
LIVER CIRRHOSIS
 DEFINITION

→Cirrhosis is a complication
of many liver disease
characterized by abnormal
structure and function of
liver.

→ Cirrhosis is extensive,
irreversible scarring of the
liver, usually casued by
chronic reaction to hepatic
inflammation and necrosis.
Causes
-Alcohol abuse
-Chronic viral infections
-Fatty liver
-Inherited Disease.
-Autoimmune hepatitis
-Block Bile Ducts
-Chronic Heart Failure
Signs and Symptoms
o Nausea
o Loss of Appetite
o Weight gain/ascites
formation
o Jaundice
o Itchy Skin
o Fatigue
o Bruising easily
o Bloating
Risk Factors

-Drinking too much alcohol.

-Being overweight.

-Having viral hepatitis.

 Complications

❑ Portal Hypertension.
This is the most common serious complication.
Portal hypertension is an increase in the
pressure in your portal vein (the large blood
vessel that carries blood from the digestive
organs to the liver).
 Diagnosis Liver Biopsy
A sample of liver tissue (biopsy) is
removed from your liver and examined
Liver Function Test under the microscope.

Liver function tests are blood

tests used to help diagnose and
monitor liver disease or damage.
The tests measure the levels of
certain enzymes and proteins in
your blood.

Imaging Test
Imaging test show the size, shape and
texture of the liver. These tests can
also determine the amount of scarring,
the amount of fat you have in your
liver and fluid in your abdomen.
Medical Management
•Alcohol-related liver disease: If you’ve developed cirrhosis
from alcohol abuse, stop drinking alcohol. If you need help,
ask your healthcare provider for recommendations for alcohol
addiction treatment programs.
•Hepatitis B or C: Several approved antiviral medications are
available to treat hepatitis types B and C.
•Inherited liver diseases: Treatment depends on the specific
inherited disease. Treatments are aimed at treating symptoms
and managing complications.
•Autoimmune hepatitis: Treatment includes medications to
suppress your immune system.
•Diseases that damage or block bile ducts in the
liver: Treatments include medications such as ursodiol
(Actigall®) or surgery to open narrowed or blocked bile ducts.
Nursing Management

• Improving nutritional status.

• Promoting rest.
• Monitoring and managing
complications.
• Reducing risk of injury. Nurses must also
assess for:
• Providing skin care. • Bleeding
• Fluid Retention
• Malnutrition
 Surgical Management

Liver Transplant/ Surgery

- A liver transplant is a procedure to replace
your liver with a healthy liver from a deceased
donor or with part of a liver from a living donor.

Transjugular Intrahepatic Portosystemic Shunt

- The TIPS procedure is used for the treatment of
varices by upper endoscopy with banding to
relieve portal hypertension.
 Pre-Operative
Considerations
Evaluation will include the
following items:
➢ History and Physical examination,
it usually provide important
information.
➢ History of previous blood
transfusion, drug abuse, or
excessive alcohol intake.
➢ Family History of jaundice,
anemia, hereditary liver disease,
and prior adverse reactions to
anesthesia.
➢ Medical history includes the
use of analgesics and
alternative medications.
Post-Operative
Considerations
➢ Patient should be monitored for
signs of hepatic decompensation,
such as ascites, worsening
jaundice,
encephalophatyh,coagulopathy, and
renal impairment.
➢ Prothrombin time, Serum Bilirubin
level, renal function and IV fluid
infusions should be also be
monitored.
 Prognosis
Treatment leads to improvement in most
cases when the disease is disdcovered in
its earlier stages. Most patients are able
to live a normal life for many years. The
outlook is less favorable if the liver
damage is extensive or if someone with
cirrhosis does not stop drinking.People
with cirrhosis usually die of bleeding
that can’t be stopped, serious infections
of kidney failure. They often enter
irreversible coma in their last days.
 02
PANCREATITIS
 DEFINITION
→Pancreatitis is an
iflammation of the pancreas.It
happens when digestive enzyme
start digesting the pancreas
itself.Pancreatitis can be
acute or chronic. Either form
is serious and can lead to
complications.
PATHOPHYSIOLOGY
Damage to Pancreatic cells
↓
Inflammation
↓
Edema of the Pancreas and Pancreatic Duct
↓
Obstruction to Flow of Pancreatic Enzymes
↓
Activation of Pancreatic Enzymes Inside
Pancreas
(Amylase, Lipase, Trypsin)
↓
Autodigestion of the Pancreas
↓
COMPLICATION WILL OCCUR
Signs and Symptoms
• Hemorrhagic pancreatitis
• Pain produces post-hemorrhage
• Nausea and Vomiting necrosis
(bile-stain vomitus)
• Abdominal tenderness Laboratory findings that
and distention with support pancreatitis are as
fever follows:
• Anorexia and weight ❑ Elevated urine and serum
loss amylase
• Hyperglycemia ❑ Elevated serum
• Jaundice amylase,lipase
• Ecchymosis ❑ Elevated wbc, bilirubin,
• Severe dehydration serum alkaline and
• Steatorrhea phosphate
• Hypocalcemia
Risk Factors

o Excessive alcohol consumption

o Cigarette Smoking
o Obesity
o Diabetes
o Family History of Pancreatitis
 Causes
• Gallstones
• Alcoholism
• Certain medications
• High triglyceride levels in the
blood (hypertriglyceridemia)
• High calcium levels in the
blood (hypercalcemia), which
may be caused by an overactive
parathyroid gland
(hyperparathyroidism)
• Pancreatic cancer
• Abdominal surgery
• Cystic fibrosis
• Infection
• Injury to the abdomen
• Obesity
• Trauma
Complications

• Kidney Failure
• Breathing Problems
• Infection
• Pseudocyst
• Malnutrition
• Diabetes
• Pancreatic Cancer
 Diagnosis MRI
To look for abnormalities in the
Blood Test gallbladder, pancreas and ducts.

Look for elevated levels of

pancreatic enzymes(amylase,lipase, Endoscopic Ultrasound
along with white blood cells,
To look for inflammation and
kidney function and liver enzymes.
blockages in the pancreatic duct
or bile duct.
Abdominal Ultrasound
To look for gallstones and pancreas Stool Tests
inflammation.
In chronic pancreatitis to measure
CT - Scan levels of fat that could suggest
your digestive system isn’t
To look for gallstones and assess the
extent of pancreas inflammation. absorbing nutrients adequately.
Medical Management Nursing Management
• Early Eating • Avoid drinking alcohol
• Pain medications • Stop smoking
• Intravenous (IV)fluids • Choose a low-fat diet.
• Procedures to remove bile • Drink more fluids.
products
• Pancreas Procedures
• Treatment for alcohol
dependence
• Medication changes.
• Pain on management
• Enzymes to improve digestion.
 PROGNOSIS
Acute Pancreatitis
Some mild cases revolve
without treatment, but
severe, acute pancreatitis
can trigger potentially fatal
complications. The mortality
rate ranges from less than 5%
to over 30%, depending on how
severe the condition is and
if it has reached other
organs beyond the pancreas.
Chronic Pancreatitis
• Associated with significant
morbidity and reduced quality of
life, as it can be a challenging
condition to manage effectively.
• In some patients, the disease may
eventually burn out after may
years of pain. Leaving residual
exocrine insufficiencies.
• Pancreatic malignancy is a risk
in those who have had the disease
for 20 years or more; new or
evolving symptoms should
therefore undergo investigation.
 GASTROINTESTINAL,
HEPATO-BILIARY
and
PANCREATIC FUNCTION
DRUG CLASSIFICATIONS
 01
Antiemetic

Antiemetic
➢ Antiemetic drugs are
medicines that ease nausea
or vomiting.
➢ The feeling of nausea
results from complex process
in the body, and this is why
various drugs have been
designed to ease nausea in
different situations.
Mechanism of Action
➢ These medication work by
blocking chemical messenger
called neurotransmitters,
which send information about
nausea to the brain.
Blocking their signals can
keep a person from feeling
nauseous and vomiting.
Indication
➢ Nonspecific nausea & vomiting
➢ Chemotherapy-induced N & V
➢ Vertigo (e.g Meniere’s disease)
➢ Motion sickness
➢ GI disorder
➢ Postoperative N & V
 Types of Antiemetics
❑ ANTIEMETICS FOR SURGERY
❑ ANTIEMETICS FOR MOTION SICKNESS Examples:
(ANTIHISTAMINE) o Dopamine antagonist:
Examples: Metoclopramide (Reglan),
o Dimenhydrinate (Dramamine,Gravol)
o Meclizine (Dramamine Less
Droperidol (Inapsine),
Drowsy,Bonine) Domperidone
o Corticosteroids:
❑ ANTIEMETICS FOR STOMACH FLU Dexamethasone
Examoples:
o Bismuth-subsalicylate (Pepto-Bismol) ❑ ANTIEMETICS
o Glucose, Fructose, or phosphoric acis
o (Emetrol)
Examples:
o Vitamin B-6 (Pyridoxine)
❑ ANTIEMETICS FOR CHEMOTHRAPY o Metoclopramide
Example:
o Serotonin 5-HT3 receptor
antagonists: Dolasetron (Anzemet)
o Dopamine antagonist:
prochlorperazine (Compazine)
 Side Effects
o Antihistamines: sleepiness, dry mouth, and dry nasal
passages
o Bismuth-subsalicylate: blackish stool and changes in
tongue color.
o Cannabinoids: an altered sate of perception and
dizziness
o Corticosteroids: indigestion, increased appetite or
thirst and acne.
o Dopamine receptor blocker: fatigue, constipation,
ringing in the ears, dry mouth, restlessness and muscle
spasms.
o NK1 receptor blockers: dry mouth, reduced urine volume,
and heart burn
o Serotonin receptor blockers: fatigue, dry mouth and
constipation.
 Adverse Effects
o Worsening of Nausea or Vomiting
o Severe constipation
o Muscle weakness
o Convulsions
o Loss of hearing
o Rapid heartbeat
o Severe drowsiness
o Slurred speech
o Psychological symptoms, like hallucinations or
confusions.
Contraindication o Do not take these
and o
medications with alcohol
Use with caution in
Precaution children and the elderly
o Women who are pregnant or
breastfeeding should not
use these medications
o Use antidopaminergics
with caution in patients
with renal disease
o Use of chlorpromazine
with caution with hepatic
disease.
 02
Antacid
 ANTACID
➢ Antacids are group of
inorganic chemicals that
neutralize stomach acid.
➢ Antacids are available OTC
and many patients use them
to self-treat a variety of
GI symptoms.
➢ Antacids are quick-relief
methods that work by
directly counteracting the
acidity inside your stomach.
The presence of these acids
is natural in the stomach
because they work to help
digest food.
Mechanism of Action
➢ The antacids act by neutralizing
the acid in the stomach and by
inhibiting pepsin, which is
proteolytic enzyme. Each of
these cationic salts have a
characteristics pharmacological
property that determines its
clinical use.
Indication
➢ Symptomatic relief of GI hyperacidity
➢ Treatment of hyperphosphatemia,
prevention of formation of phosphate
urinary stones.
➢ Treatment of calcium deficiency,
prevention of hypocalcemia
➢ Prophylaxis of stress ulcers, relief
of constipation.
 Types of Antacid
❑ POPULAR ANTACID BRANDS INCLUDE:
❑ ANTACIDS USUALLY COME IN THE o Alka-Seltezer
FOLLOWING DRUG FORMS: o Maalox
o Mylanta
o Liquid o Rolaids
o Chewable gummy or tablet o Tums
o Tablet that you dissolve in
water to drink
 Side Effects
Side effects vary based on antacid ingredients, but can
include:
• Gas or belching
• Swelling in the feet, ankles, and hands (products
containing sodium bicarbonate, such as Alka-Seltzer)
• Constipation (products containing calcium or aluminum)
• Diarrhea (products containing magnesium)

Adverse Effects
Adverse effects when using antacids include:
• GI: Gastric rupture, Systemic alkalosis: Headache, nausea,
irritability, weakness, tetany. Confusion.
 o People with certain medical
Contraindication conditions should talk with
their doctors before taking
and certain antacids that
Precaution contain aluminum hydroxide
and magnesium carbonate.
o People with heart failure
may have sodium
restrictions to help
decrease fluid buildup.
o People with kidney failure
may develop a buildup of
aluminum after antacids.
o People with kidney failure
also tend to have problems
with electrolyte balance.
 03

Anticoagulants

Anticoagulants
➢ Anticoagulants are medicines
that prevent the blood from
clotting as quickly or as
effectively as normal.
➢ Some people call
anticoagulants blood
thinners. However, the blood
is not actually made any
thinner – it just does not
clot so easily whilst you
take an anticoagulant.
Mechanism of Action
➢ They achieve their effects
by suppressing the synthesis
or function of various
clotting factors that are
normally present in the
blood.
Indication
➢ Atrial Fibrillation- commonly
forms an atrial appendage clot.
➢ Coronary Artery Disease.
➢ Ischemic Stroke or Heart Attack
➢ Deep vein thromboembolism, can
lead to pulmonary embolism.
➢ Post-heart valve replacement.
Types of Anticoagulants
o Vitamin K Antagonists
o Direct Oral Anticoagulants
o Low molecular weight Heparin
(LMWH)
EXAMPLES:
o Apixaban (Eliquis)
o Dabigatran (Praxada)
o Edoxaban (Savaysa)
o Enoxaparin (Lovenox)
o Heparin
o Rivaroxaban (Xarelto)
o Warfarin (Coumadin)
 Side Effects
o Passing blood in your urine.
o Passing blood when you poop or having a black poop
o Severe bruising
o Prolonged nosebleeds
o Bleeding gums
o Vomiting blood or coughing up blood
o Heavy periods in women
Adverse Effects
A patient on therapy may develop hemorrhagic complication as a
result of an existing disease predisposing to hemorrhage, such as
severe liver damage, thrombocytopenia, an endogenous coagulation
disturbance, severe hypertension, peptic ulcer or a tumor;
excessive anticoagulation due to poorly controlled treatment or
drug interaction that increase the effect of the anticoagulant.
 ❑ CONTRAINDICATIONS:
o Active Bleeding
Contraindication o Coagulopathy
and o Recent Major Surgeries
Acute intracranial hemorrhage
Precaution o
o Major Trauma

PRECAUTIONS:
o Stay safe when you are taking
medication
o Go for blood test as
instructed
o Educate about their increased
risk for bleeding
o Avoid activities that can
cause bruising or bleeding
o Take care when shaving or
tooth brushing.
 04

Hematinic Agent

Hematinic Agent
➢ Hematinic Agent is a combination
of liver, vitamins and minerals
which all support the formation
of red blood cells and the
circulatory system. This product
contains iron, liver, vitamin
B12, folic acid and vitamin C.
Mechanism of Action
➢ An agent that improve the
quality of blood by increasing
the number of erythrocytes
and/or the hemoglobin
concentration. They are used in
the treatment of anemia.
Indication
➢ Anemia
➢ Malabsorption
➢ Hemodialysis
➢ Pregnancy
➢ Premature babies
 Side Effects Additional Warning
➢ Long term intake of this amount
o Upset Stomach or throwing up of iron may cause mild stomach
o Severe du=diarrhea upset in sensitive individuals.
o Constipation Some iron supplements may cause
o Muscle Weakness gastrointestinal irritations and
o Numbness and Tingling constipation.

Adverse Effects
o Allergic reactions signs; rash, hives,
itching, red swollen, blistered, or
peeling, skin with or without fever,
wheezing, tightness in the chest or
throat, trouble breathing, swallowing
or talking, unusual hoarseness; or
swelling of the mouth, face, lips,
tongue.
 ❑ CONTRAINDICATIONS:
Contraindication o Some research suggests that taking
so much hematinic agent daily
and might increase the risk of heart
Precaution attack in people who have heart
problems and also increase the
risk of cancer such as lung or
prostate cancer.

PRECAUTIONS:
o Before taking this drug
medication, tell your doctor or
pharmacists if you are allergic to
it; or if you have any other
allergies. This product contains
inactive ingredients, which can
cause allergic reactions or other
problems.
Examples:
• Vitamin B12

• Iron

• Folic Acid

• Vitamin D
 05

Antipruritic
 Antipruritic
➢ This medication mis used to
Indication
treat variety of skin ➢ Antipruritic, also known as
conditions (e.g., eczema, anti-itch drug , are medication
dermatitis, allergies, that inhibit the itching often
rash). associated with sunburns,
allergic reactions, eczema,
Mechanism of Action psoriasis, chickenpox, fungal
infections, insect bites and
stings like mosquitoes, fleas,
➢ Antipruritic drug acts
and mites and contact dermatitis
centrally by a property to
and urticaria caused by plants
sedation.
such as poison ivy.
➢ H1 Receptor antagonists have
a peripheral antipruritic
action only when itch is due
to histamine release, as in
wealing disorders.
Contraindication ❑ CONTRAINDICATIONS:
o Because of its anticholinergic
and effect, topical use is
Precaution contraindicated in urinary retention
or narrow angle glaucoma.

❑ PRECAUTIONS:
o Clean and dry hands before using
o Clean and dry the affected area
o Apply small amount of medication to
the affected area and gently rub in
o Do not bandage, cover, or wrap the
area unless directed to do so by
your doctor.
 Side Effects
Adverse Effects Examples
o Calamine Lotion
o Stinging, burning, irritation, o Hydrocortisone Antipruritic
dryness, or redness at the time Topical
of application site may occur.
o Acne, excessive hair growth.
“hair bumps” (folliculitis), skin
thinning/discoloration, or
stretch mark may also occur. If
any of these effects persist or
worsen, notify your doctor or
pharmacist promptly.
 06

ANTIHYPERLIPIDEMICS
 Antihyperlipidemics Indication
➢ Bile Acid Sequestrants are used as
➢ Use to lower lipid (fats) in the treatment for primary
hypercholesterolemia (high
the blood, particularly low
cholesterol and high LDL) as an
density lipid (LDL) adjunct to diet and exercise.

➢ Cholestyramine is also used to treat

Mechanism of Action pruritus associated with partial
biliary obstruction.
➢ These drugs lower VDLs and
plasma triglycerides by
stimulating lipoprotein lipase.
They also lower cholesterol by
inhibiting its synthesis and
enhancing excretion in the bile.
Contraindication ❑ CONTRAINDICATIONS:
o Allergy to HMG-Coa reductase
and inhibitors.
Precaution o
o
Active liver disease.
Pregnancy
o Impaired endocrine function
o Renal Impairment

❑ PRECAUTIONS:
o These drugs are used cautiously in
patients with a history of
alcoholism, non-alcohol-related
liver disease, acute infection,
hypotension, trauma, endocrine
disorders, visual disturbances and
myopathy.
 Side Effects Adverse Effects
o Cough o CNS: headache, anxiety,
o Diarrhea fatigue, drowsiness
o Indigestion o GI: GI upset, constipation,
o Itching fecal impaction, nausea,
o Nausea aggravated hemorrhoids
o Temporary redness of the face and o Hema: Increased bleeding
neck time, decreased production of
o Vomiting clotting factors.
o Musculoskeletal: muscle
aches. Muscle pains
o Other: rash, fat-soluble,
vitamin deficiencies.
 07

ANTISPASMODICS
 Antispasmodics
➢ A medication that relieves,
prevents, or lowers the
incidence of muscle spasms,
especially those of smooth
Indication
muscle such as in the bowel ➢ Overactive bladder
wall. ➢ Movement problems in Parkinson’s

Mechanism of Action ➢
Disease
Diarrhea
➢ Motion sickness
➢ Anticholinergics are a broad group of ➢ Nausea & Vomiting
medicines that act on the ➢ Muscle spasms
neurotransmitter, acetylcholine. They ➢ COPD
are also called antispasmodics. By ➢ Asthma
blocking the action of acetylcholine,
anticholinergics prevents impulse
from the PNS from reaching smooth
muscle and causing contractions,
cramps or spasms.
Contraindication ❑
o
CONTRAINDICATIONS:
Overactive thyroid gland
and o Myasthenia gravis.
Precaution o
o
Skeletal muscle disorder
Closed angle glaucoma
o High blood pressure
o Coronary Artery Disease
o Chronic Heart Failure
o Chronic Lung Disease

❑ PRECAUTIONS:
o Do not use during pregnancy and
breastfeeding
o Hormonal birth control products
may not be effective if taken
with medication.
 Side Effects Adverse Effects
o Dizziness o Decreased sweating,
o Drowsiness o Dry/hot/flushed skin,
o Weakness o Fast/irregular heartbeat
o Blurred Vision o Loss of coordination
o Dry Eyes o Fainting
o Nausea o Trouble speaking
o Constipation o Mental, mood changes
o Abdominal Bloating o Difficulty in urination
o Decreased Sexual Ability
o Signs of infections
o Easy bruising/bleeding
Examples
o Atropine

o Belladonna

o Dicyclomine (Bentyl)

o Loperamide (Imodium)

o Promethazine (Phenergan)
 08

VITAMIN SUPPLEMENT
 VITAMIN SUPPLEMENT
➢ Vitamin and minerals are considered essential nutrients-
because acting in concert, they perform hundreds of roles
in the body. They help shore up bones, heal wounds and
booster your immune system. They also convert food into
energy, and repair cellular damage.
FAT-SOLUBLE VITAMINS
▪ A,D,E, and K, are stored in
the body for long periods of
time and generally pose a
greater risk for toxicity than
water-soluble vitamins when
consumed in excess. Eating a
normal, well-balanced diet
will not lead to toxicity in
otherwise healthy individual.
FAT-SOLUBLE VITAMINS
▪ Meaning they dissolve in
water. In contrast, the fat-
soluble vitamins are similar
to oil and do not dissolve in
water. Fat-soluble vitamin are
most abundant in high-fat
foods and are much better
absorbed into your blood
stream when you eat them with
fat.
BENEFITS:
❑ Vitamin A – helps form and maintain healthy teeth, bones, soft
tissues, mucous membranes, and skin.

❑ Vitamin B6 – is also called pyridoxine. Vitamin B6 helps form red blood cells and
maintain brain functions.

❑ Vitamin B12 – like other the other B vitamins, is important for metabolism. It
also helps from red blood cells and maintain the CNS.

❑ Vitamin C – also called ascorbic acid, is an antioxidant that promotes healthy

teeth and gums.

❑ Vitamin D - is also known as the “sunshine vitamin” since it is made by the body
after being in the sun. Ten to 15 minutes sunshine 3 times a week is enough to
produce the body’s requirement.
BENEFITS:
❑ Vitamin E– is an antioxidant also known as tocopherol. It helps the body form
red blood cells.

❑ Vitamin K– is needed because without it, blood would not stick together
(coagulate). Some studies suggest that it is important for bone health.

❑ Biotin– is essential fir the metabolism of proteins and carbohydrates, and in the
production of hormones and cholesterol.

❑ Niacin– is a B vitamin that helps maintain healthy skin and nerves. It also has
cholesterol-lowering effects at higher doses.

❑ Folate – works with vitamin B12 to help form red blood cells.
BENEFITS:
❑ Panthothenic – is essential for metabolism of food. It also plays a role in the
production of hormones and cholesterol

❑ Riboflavin (Vitamin B12)– works with the other B vitamins. It is important for
body growth and the production of red blood cells.

❑ Thaiamine – helps the body cells change carbohydrates into energy.

❑ Choline– helps in normal functioning of the brain and nervous system. Lack of
choline can cause swelling of liver.

❑ Carnitine– helps the body to change fatty acids into energy.

 08
LAXATIVE & STOOL
SOFTENER
 Laxatives
TYPES:
➢ Laxative are drugs that change o BULK-FORMING
fecal consistency, speed the o OSMOTIC
passage of feces through the o LUBRICANT AND FECAL SOFTENERS
colon and aid in the o STIMULANT (CATHARTHICS)
elimination of stool from the
rectum. They are used mainly
to treat constipation and to
prepare the bowel before the
surgery or investigative
procedure. They may also used
in bowel training for patients
who have lost neurogenic
control of the bowel.
Mechanism of Action Indication
1.Bulk Forming Laxative
• Indigestible food bi-products 1. Bulk Forming Laxative
that absorb water. ➢ Constipation
• Form a bulky substance that
distends the intestine and 2. Osmotic Laxative
stimulates peristaltic movement. ➢ Acute Constipation
2. Osmotic Laxative ➢ Prevention of chronic constipation
• High doses of osmotic ally
active agents produce a rapid 3.Lubricant and Fecal Softeners
movement of water into the ➢ To minimize straining
distal small bowel and colon
• The high volume of liquid stool 4. Stimulant Laxative
produces results in bowel ➢ Constipation
evacuation.
3. Lubricant and Fecal Softeners
• Softens and lubricate the stool
4. Stimulant Laxative
• Stimulate colonic activity
 ❑ CONTRAINDICATIONS:
➢ Patients with chronic renal
Contraindication insufficiency should avoid osmotic
and laxatives containing magnesium or
potassium.
Precaution ➢ Laxative containing sodium are
contraindicated in pregnancy and in
patients with cardiac condition.
➢ Bulk forming laxatives with high
sugar content are contraindicated in
patients with diabetes.

❑ PRECAUTIONS:
o Laxatives should be seen as a short-
term solution to constipation. They
are available OTC and subject to
overuse, which can disrupt the
body’s natural emptying rhythm.
Abuse may lead to hypokalemia and
atonic non-function colon
 Stool Softeners
➢ It lowers the surface tension
at the oil-water interface of
the feces, allowing water and
lipids to penetrate the stool.
This helps to hydrate and
soften the fecal material,
facilitating natural
defecation.
Indication
➢ Stool softeners are used on a short-
term basis to relieve constipation by
people who should avoid straining
during bowel movements because of
heart conditions, hemorrhoids, and
other problems. They work by
softening stools to make them easier
to pass.
 Side Effects
o Stomach pain
o Diarrhea Or cramping may occur
o Irritated throat (with liquid or
syrup forms) may also occur
Adverse Effects
Examples
❑ Oral magnesium hydroxide (Phillips’
Milk of Magnesia)
❑ Magnesium Citrate, Lacitol
(Pizensy)
❑ Lactulose (Kristalose)
❑ Polythylene glycol (Miralax)

o Rectal Bleeding
o Rash
o Itching/swelling (especially of
the face/tongue/throat)
o Severe dizziness
o Trouble breathing
 Contraindication
and
Precaution
❑ CONTRAINDICATIONS:
➢ Hypersensitivity
➢ Intestinal obstruction, symptoms
of appendicitis or acute
abdominal pain, fecal impaction.
➢ Concomitant use of mineral oil
➢ Nausea or vomiting
➢ Use for longer than 7 days when
self medicating
❑ PRECAUTIONS:
➢ Do not take stool softeners for
more than 1 week unless your
doctor directs you to.
➢ Tell your doctor or pharmacist if
you are allergic to it or if you
have any other allergies.
➢ If you have health problems:
abdominal pain, nausea, vomiting,
sudden change in bowel habits
over the previous 2 weeks.
➢ This medication should be used
only when clearly needed during
pregnancy.
➢ It is not known if this drug
passes into breast milk. Consult
your doctor before breast-feeding