Diarrhea & ConstipationASSIGNMENT # 1

PATH-202

Submitted to: Dr. Imtiaz Ahmed Khan

Submitted by: Waqas Nawaz 11-arid-975

DVM 4th semester

CONSTIPATION

Constipation, costiveness, or irregularity is a condition of the digestive system in which a person experiences difficulty in defecation. Obstipation is used for severe constipation that prevents passage of both stools and gas.

Common among children and pregnant women; Constipation refers to infrequent or hard stools. It is the passage of dry and hard stools, usually fewer than 3x a week. People with this condition may find bowel movement painful and difficult.

1-SIGN & SYMPTOMS:

A desire to defecate

Pain and intestinal discomfort

Swelling in the abdomen, cramps and colic

In some cases up to several days without being able to defecate with grave harm and body poisoning

Constipation is one of the main causes of hemorrhoids and appendicitis, as well as acne and general intoxication of the body.

Difficulty in starting or completing a bowel movement

Infrequent and difficult passage of stool

Passing hard stool after prolonged straining in the toilet

Excessive gas & Sense of bloating

Intestinal obstruction

Vomiting

Headaches

Loss of appetite

Coated (furred) tongue

Offensive breath

Bad taste in your mouth

You are considered constipated if you have two or more of the following for at least 3 months:

Straining during a bowel movement more than 25% of the time.

Hard stools more than 25% of the time.

Incomplete evacuation more than 25% of the time.

Two or fewer bowel movements in a week

Types of stool:

Type 1: Separate hard lumps, like nuts (hard to pass)

Type 2: Sausage-shaped, but lumpy

Type 3: Like a sausage but with cracks on its surface

Type 4: Like a sausage or snake, smooth and soft

Type 5: Soft blobs with clear cut edges (passed easily)

Type 6: Fluffy pieces with ragged edges, a mushy stool

Type 7: Entirely liquid

Type 1 and 2 indicate constipation, with 3 and 4 being the "ideal stools" especially the latter, as they are the easiest to pass, and 5–7 being further tending towards diarrhea or urgency.

2-CAUSES:

Poor diet Poor bowel habits Medications Painkillers Travel Age Pregnancy Laxative abuse Irritable bowel syndrome Intestinal obstruction Inadequate fiber and fluid intake Environmental changes

1-CONSTIPATION CYCLE:

2-PATHOLOGY OF CONSTIPATION:

depression; impaired cognitive function; spinal cord compression; cerebral tumour; hypercalcaemia; hypokalaemia; hypothyroidism; Abdominal tumour (intestinal tumour, or compression from tumour external

to bowel). Painful ano-rectal conditions.

CONSTIPATION DURING PREGNANCY : Constipation is among the top three most uncomfortable complaints listed by

pregnant women.

What causes constipation during pregnancy:

In the first trimester it is caused by progesterone which slows down intestinal activity

In the later part of pregnancy the pressure of your uterus on your intestines and rectum makes your system sluggish

Iron supplement that you need for anemia has a constipating effect. Stress and tension contributes to constipation You are more susceptible to constipation if you had this problem in your

prepregnancy days You lead a sedentary lifestyle

3-PATHOPHYSIOLOGY OF CONSTIPATION:

Medications

Opioids

Calcium-channel blockers

Anticholinergic

Decreased motility Ileus Mechanical obstruction Metabolic abnormalities Spinal cord compression Dehydration Autonomic dysfunction Malignancy

4-TREATMENT & CURE:

Drink 8 to 10 glasses of water per day (drink them before meals and never during or after meals it affects digestion).

Eat one carrot a day (don’t forget to drink a lot of pure water). Exercise preferably before going to bed.

Eat high fiber diet to provide natural bulk in daily food intake and help move food to the rectum; increase quantity of fruits & vegetables

Take bulk-forming laxatives to absorb water in the intestines and acts as stools softener; this can be in the form of fiber supplements & Daily exercise

For people with severe symptoms, surgical removal of colon may be an option

DIARRHEA

Diarrhea describes bowel movements (stools) that are loose and watery. It is very common and usually not serious. Many people will have diarrhea once or twice each year. It typically lasts two to three days and can be treated with over-the-counter (OTC) medicines. Some people have diarrhea often as part of irritable bowel syndrome or other chronic diseases of the large intestine.

The World Health Organization defines diarrhea as the passing of liquid or watery stools at least 3 times in a 24-hour period. However, it is the consistency rather than the number of stools that is important. Frequent passing of formed stools is not diarrhea. Breastfed babies normally passes loose or pasty stools. The mother can tell if her baby has an abnormal stool. We call it “mother’s definition”.

TYPES OF DIARRHEA:

Acute Diarrhoea

sudden onset and lasts less than two weeks

90% are infectious in etiology

10% are caused by medications, toxin ingestions, and ischemia

Viral, Bacterial, Protozoa (90%)

Medications

Laxatives or diuretic abuse

Ingestion of environmental preformed toxin such as seafood

Ischemic Colitis

Chronic Diarrhoea

Diarrhoea which lasts for more than 4 weeks

Most of the causes are non-infectious

Irritable Bowel Syndrome

Diverticular disease

Colorectal Cancer

If stools contain blood or mucus, it is called dysentery. If diarrhea persists for 14 days or longer, it is called persistent diarrhea.

1-SIGN & SYMPTOMS:

COMMON DIARRHEAS

Age <2 years: Rotavirus

Age 2-5 years: Cholera; E. coli; Shigellosis

All ages: E.coli; Campylobacter

Immunocompromized: Amebiasis;

Abdominal bloating or cramps Thin or loose stools Watery stool Sense of urgency to have a bowel movement Nausea and vomiting

In addition to the symptoms described above, the symptoms of complicated diarrhea include:

1. Blood, mucus, or undigested food in the stool2. Weight loss3. Fever

2-CAUSES:

MALNUTRITIONo Alcoholo Caffeine in soda, tea, coffee & chocolateo Food that cause gas such as beans & appleso Nicotineo Spicy foodso Foods high in acids such as orangeo Fatty foods such as sausage & buttero Dairy products, particularly for those who are lactose intolerant

BACTERIAo E.colio Salmonellao Shigellao Campylobactero Vibrioo Yersini o Clostridium difficleo S.aureuso B.cereuso C.botulinum

VIRUSo Rotaviruso Adenoviruseso Caliciviruses o Astroviruses o Norwalk agents and Norwalk-like viruses

FUNGI

COMMON DIARRHEAS

Age <2 years: Rotavirus

Age 2-5 years: Cholera; E. coli; Shigellosis

All ages: E.coli; Campylobacter

Immunocompromized: Amebiasis;

Diarrhea

Persistent

Multiple cause

Dysentery

BacillaryAmoebic

Watery

CholeraE. coliRotavirus

o Yeasto Candida

PARASITEo Entameba histolytica o Giardia lamblia o Cryptosporidiumo Isospora

DIARRHEA DUE TO MICROBES:

Transmission:

Most of the diarrheal agents are transmitted by the fecal-oral route

Cholera: water-borne disease; transmitted through water contaminated with feces

Some viruses (such as rotavirus) can be transmitted through air

Nosocommial transmission is possible

Shigellosis (blood dysentery) is mainly transmitted person-to-person

Shigellosis is a water-washed disease; transmitted more when there is scarcity of water

Food and water contaminated directly or indirectly with feces or vomitus of infected persons are the principal mode of transmission. Ingestion of raw or inadequately cooked seafood or eating shelfish from coastal and estuarine waters can cause outbreaks of diarrhea. Person-to-person transmission occurs by hand-to-mouth transfer of the agent from feces of an infected individual. Respiratory spread is possible for rotavirus.

3-PATHOPHYSIOLOGY OF DIARRHEA:

Osmotic Diarrhea

Malabsorption/Maldigestion/Fatty

Secretory Diarrhea

Inflammatory Diarrhea

Abnormal Motility Diarrhea

1-Osmotic Diarrhea:

Mechanism:

– retention of water in the bowel as a result of an accumulation of non absorbable water soluble ‐ ‐compounds

– non absorbed substance exert osmotic pressure– -cease with fasting, discontinue oral agents

Causes:

o Purgatives like magnesium sulfate or magnesium containing antacids

o Especially associated with excessive intake of sorbitol and mannitol.

o Disaccharide intoleranceo Generalized malabsorption o Lactose intolerance

2-Malabsorption Diarrhea

Mechanism:

– Luminal Phase (Intraluminal maldigestion)– Mucosal Phase (Mucosal loss & Mucosal disease)– Transport Phase (Fat malabsorption=Streatorrhea)

Causes:

o Bacterial outgrowtho Pancreatic insufficiencyo Mucosal disease (Crohn’s disease & Celiac sprue)

Celiac Sprue:

Gluten sensitive enteropathy

Reaction against gluten in diet

Epidemiology: Whites (European)

Normal Ilium

Celiac sprue

Diarrhea & malabsorption

3-Secretory Diarrhea

Mechanism:

– Active intestinal secretion of fluid and electrolytes as well as decreased absorption.

– Large volume, painless, persist with fasting– Abnormal ION transport in intenstinal epithelial cells– Abnormal mediators– Diffuse mucosal disease

Causes:

o Cholera enterotoxin, heat labile E.coli enterotoxin

o Vasoactive Intestinal Peptide hormone in Verner-Morrison syndrome

o Bile salts in colon following ileal resection

o Laxatives like docusate sodium

o Carcinoid tumours

4-Inflammatory Diarrhea

Mechanism: – Damage to the intestinal mucosal cell leading to a loss of fluid and blood– Pain, fever, bleeding, inflammatory manifestations

Causes:

Immunodeficiency patient

o Infective conditions like Shigella dysentary

o Inflammatory conditions

Ulcerative colitis and Crohn’s disease

5-Abnormal Motility Diarrhea

Mechanism:

– Increased frequency of defecation due to underlying diseases – -large volume, signs of malabsorption (steatorrhoea)– Diabetic diarrhea– Hyperthyroidism– Bloating & gas

Causes:

o Diabetes mellitus- autonomic neuropathy

o Post vagotomy

o Hyperthyroid diarrhoea

o Irritable Bowel Syndrome

4-TREATMENT & CURE:

Inj. Ciprofloxacin

Inj. Metronidazole

Inj.Ranitidine

C. Bifilac

T.Paracetamol

Non-specific treatment

o hydrationo Absorptions (Kaopectate®)o Bismuth o Antiperistaltics/opiate derivativeso Fiber supplementation

ORS (Oral Rehydration Solution)

Antibiotics choice

o E. coli

Quinolone

o Shigella

Quinolone or TMP-SMX

o Vibrio cholera

Tetracycline or quinolone

o Salmonella

Quinolone or TMP-SMX

o Campylobacter

Erythromycin or quinolone

o Yersinia

tetracycline, TMP-SMX, or quinolone