ny.sharepoint.com Diarrhea, Constipation presented by eee eae ad pharmaceutics, Minia University Diarrhea is an increase in the frequency of bowel movements, Ceo a eet ers ea erty * Diarrhea of the acute self-limiting type is generalh eres aaa oes aT eaice Sele mile Ras We (eg. toxigenic Escherichia coli and Sree TS Nee eee ae Ti ee RSS a SO a hypersecretion of fluid and resulting in watery diarrhed, often with little or no fever or other symptoms. cae com Coe children, also produce watery diarrhea Acute diarrhea can also have non-infective causes, such as Brora Rue me oie Mechanisms of diarrhea Secretory diarrhea : results from increased water and electrolyte Be ul a i Deed lumen, water wil nat be absorbed from the intestine Pree eee es Exudative diarrhea: occurs with inflammatory bowel diseases, or ulcerative cals, and other severe infections such as E call ather {farms of fod poisoning (outpouring af mucous + blood) Notility diarrhea: caused by the rapid movement of fod through the intestines (hypermatity). the food moves too quickly through the Bl tract, there is nat enough time for sufficient nutrients and water tobe cents CamScanner 3 is a> g.u0all+ 3 ny.sharepointcom a aT PAOD Ot 3. drug-induced ce rl) 5. Protozoal ‘Sudden onset of abnormally frequent May be don tn acute diarrhea is Self limiting with 2 days And can be treated With OTC Ped es ens ey Pao aE aay CamScanner 3 3 a> g.u0allSa NAST-1C-) 10 ee) a Toxle Pathogens secrete toxins ( enterotoxins ) which bind with Se oe Te oa PR Ly aa rd Microorganisms directly invade epithelial cells of large intestine produce a dysentery - like symptoms cy ee Kacey 4 frequent passage of small-volume stools ( bland, pus J ‘Acute diarrhea that may develop among tourists visiting foreign countries with | eS Characterized by |. nausea , vomiting ee Ca ee) Ce eC Sel-imiting and usually subsides aver 3-5 days CamScanner 3 ig 4>guaall3 ny.sharepoint.com Called food intolerance diarrhea , may be the result of y ( eggs, banana, mango, chocolate. fi 2. Excessive fats or spicy foods 3. Carbohydrates : lactose disaccharide , sucrose Lactose isnot hydralyzed ta manosacchers Due to {congenital absence of lactase enzyme 2. Decrease activity of enzyme due to inflammation. fered EE * Lactose act as osmotic diuretic producing hyperasmolarity in intestine... draws fluids into the intestinal lumen ... Diarrhea Se eee Se ad PAC ay sodium and potassium salts Re ase23 ny.sharepointcom © een Tay Seay es sy ms Be apo Deter Ce) Ce Deed ERD) Fee ATED) For (5-7days) ed | >. crue induced MEU Set eLie y + Mainly depends on Po me ia SR ete a eee mg aad 2. watery, greenish-mucaid diarrhea 1. oral vancomycin 2 oral metronidazole ( cheap, less resistant ) RRR)3 ny.sharepoint.com Aotaci containing Negnesium Pee CRS au en LC ESD PT ae RO WN cu) ee ROE ea Pu ue) TE eC Meee ele) Psychogenic:- stress ( increase parasympathetic activity ) Np aCe ere 1- Wash your hand after going to toilet or changing diapers and before eur Pa ae a aa aR aad the label). EMan e Rica un eeo ea eek TUR Peres ee onthe er ka mn RC) Cee ee Rd UR CLs SO ee aL eee Oa a aa Roh sees ae CamScanner 3 lis a> g.u0all23 ny.sharepoint.com f{} ttt + Fluid and electrolyte replacement by oral rehydration therapy CDE ee Rom Ro ua ane ny eee + Oral rehydration salts (ORS) are designed to replace water and electrolytes lost through diarrhea and vomiting, but they Pee Ree AC eS Gd They contain sodium and potassium salts to replace these essential ions, and citrate and/or bicarbonate to correct Pn Penne an Sata ee Oe ae od carrier for the transport of sodium ions and hence water Pree ae Camu CO Sen ees + Morphine and opioid drugs cause constipation by increasing the sphincter tone of ‘the small and large bowel and reducing intestinal motility. Thus, enhancing fluid and electrolyte reabsorption and decreasing the volume of intestinal contents. BC ea gee eee Re a their surfaces which are ultimately excreted in the stool. In addition, adsorbents, particularly hydrophilic organic polymers (e.g, pectin and bulk-forming agents), bind eer een cen ewe te tea Rua Ad Pees eo Ce + One point of view is to regard diarrhea as the natural PCR Mea en ee cue Mem Ot bo ere RCT MATa a PUN eee Tas om cnr an at MLA COLL Va Pee ems e Bee MT aU ea pee Peet a POC nC ume LUM LE ae CL easel ie Ma Me Pee ame Maou {heatment, serious underlying causes of diarrhea must Bereee ees Rake oe CamScanner 3 3 a>g.u0all3 ny.sharepoint.com Bice lttsg Sern eed Tee ee Tr eee Sue) ee eee Patty ka effect (harmless darkening of stool, tongue ) 4, Not given to cu Cts ered ( severe encephalopathy + hepatotoxicity and brain damage) + It is the decreased frequency of fecal elimination (defecation) with the eee earn ear SR eee an ae Be cote eee eee eae Je constipation has various causes but may be the result of SU ORT eR nC | Cee ee Ce ae anes Correcting, such dietary deficiencies often resolves, the. problem. although Patients do not always appreciate that time is needed for such changes to take Ce CR a MR Rr LC a ed unsuccessful: laxatives may be a useful short-term measure in these cases lack of exercise (sedentary lifestyle) Drug-induced constipation: sedative-hypnotics Ca or Al-containing antacids, tricyclic antidepressants, Opioids and ca-channel blockers, mineral Supplements cer ree) Organic, cause: hypothyroidism, tumors, painful anal lesions (hemorrhoids, fissures), Pregnancy induced ea eo 2- Increase fluid consumption. Rec Ul mee een aCe Ce Ceo Rete atte Ca eer Nee PAV erne tue ia ue nea as Saray earl} ay CamScanner 3 ls a> g.u0all23 ny.sharepoint.com ene er aed em RUC Res i) H Cec eur} Oe Std Deer Bee) Seer eg ey ttt 1- Bulk-forming laxatives: ispaghula husk, sterculia, ue pee RR OS LEC CU ere Neco oe Pao ea ee et ea os oie ad They increase fecal volume through three mechanisms, the relative contribution of each depending on the composition and properties of the substance. Rieder sic Ca Second action is like Espashula husk and sterculia contain muclloid constituents Sam Te ee | Me neem nar pag et Leese ona ee ae ape synthetic hydrophilic colloid with a similar action ania arenes Oars 1- Polysaccharide derivatives: Agar , bran , alginate, MC, CMC Na salts 2- Ca polycarbophyill: drug of choice in irritable bowel syndrome. Pesala tin eeu d ee eee ee Oe eo at ee eee eee eee + Bisacodyl is the drug of choice in constipation with ‘Tt acts mainly via ST aU ae ee ee Da oe oe OR RU OR ee Roe eee ee an eae Bisacodyl causes gastric irritation; there are therefore no oral liquid RE eau areal See eee yee eked carr it, therefore, has a relatively slow onset of action, usually acting within 10-14 oe eos Cunt Rel as CamScanner 3 33 a> g.u0all3 ny.sharepoint.com are naturally occurring glycosides, used in the form of standardized plant extracts. They are hydrolyzed by colonic bacteria to release derivatives rs be PRON RCT MRC URCUCR sc eR Me at Gee CPM ha NS acum are eae ed act through a combination of direct stimulation of the Oe aU eA CR A Mea oe De ee Le Cee Cla eh RCA aA eel eo A ST Pies eal Me rao a ha ee Cee uh Ra Ne RRC ecard avarice yes ue me ee ag Cea eae Re ea ee Pre M a e es oe See tate UC Oe CMa La OL Pee Lr RN A ie ieee eg eo ca intestine. Their presence in the intestine creates a INTs RAM Ng eR Ce er PCN MU AO SL PTE MALONE are aoc one ci Ra a Le Ld and promoting evacuation. The effects of the inorganic Pee ae Ceca ae om Mera ag watery evacuation within 3 hours and smaller doses act Coes MCLE © Docusate sodium is an that acts by lowering the surface tension of the intestinal contents. This allows fluid and fat to penetrate, Ce eae haa eee Pee ae een ue ee Indications: Dee ee eR one ek surgery, Perianal disease, Myocardial infarction*, and abdominal hernia. © Precautions: Pee ceca eee RC ee ese Pant) eC ee et PD eenrtsi0 CamScanner 3 33 a> g.uaall3 ny.sharepoint.com + Liquid paraffin is indigestible and absorbed to only a small extent. It penetrates and softens the feces and Co A eM RAR Mn eC MELACC Le trele(F One Re Re Ou Liquid paraffin is considered to have limited eS TCO OAT ne eel MR LL CST cme a CRN the absorption of fat-soluble vitamins and cause absorption toxicity if used with emollient Seance eee CU ee en CC) ene nau a re GC en ae Sarr Cee ee eu RuC eRe ea esau aa Irae) @Adverse effects: ‘About 20% of Mg is absorbed; If renal function is impaired it gives toxic Mg Coe oe cue) ites ra Dotter en CS aC Rec ma Sere A ee ese ec eo Seria eee ce Rs Byte om rece Seiarlcat 1-Diarrhea and vomiting which lead to electrolyte loss (hypocalcemia, hypokalemia) 2-Loss of muscle tone. Ere aU ew Cee ao eeu Reo EOS in Mee Tet ae a Re OC scr feat eRe cau racy CamScanner 3 ls a> g.u0allLaxative in pregnancy Mineral oil is contraindicated because of possible toxicity. Stimulant laxative is contraindicated as It may lead to premature Flee Osmotic or saline laxative may lead to electrolyte imbalance. Laxatives of choice: Bulk forming, emollient. CamScanner 3 ls a> g.u0all