Transcript 28 March 2010-Common Gastrointestinal Disorders

COMMON GASTROINTESTINAL
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 & cultures
It 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.
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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 nonabsorbable 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
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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 sphincter
Hiatal hernia
Esophageal contractions
Emptying of the stomach
Heartburn
 Regurgitation
 Nausea
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What are the complications of GERD?
 Ulcers
 Strictures
 Inflammation of the throat and larynx
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2.
Life style modifications
Drug therapy
Antacids
Anti histaminic
PPI
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Mg-Antacids
Al-Antacids
AL*Mg-Antacids
Ca carbonate-Antacids
Na bicarbonate-Antacids
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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
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"Helicobacter
pyloricus" (H. pylori).
NSAIDs
(nonsteroidal antiinflammatory
drugs).
Cigarette smoking.
Alcohol !!!
Note:Contrary to popular belief,
alcohol, coffee, colas, spicy
foods, and caffeine have no
proven role in ulcer formation.
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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).
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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).
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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.
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Acute gastritis
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Central causes (signals from the brain)
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Association with other illnesses remote from
the stomach
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Medications and medical treatments
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Mechanical obstruction of the bowel
2. Systemic causes:
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Elevated intra-cranial pressure (benign or
neoplastic)
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Inner ear disease
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Medications: (act locally on the stomach;
NSAIDs, erythromycin, or cardiac antiarrhythmics or systemically like
chemotherapeutics and opiates)
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Pregnancy
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Radiation therapy
Antiemetic agents include:
 5-HT3 antagonists:
ondansetron & others
D-2 antagonists:
domperidone &
Metoclopramide
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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 poisoning
Traveler's diarrhea
Bacterial enterocolitis
Parasites
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
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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.
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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?
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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.
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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.
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Peppermint
Bran
Sulprid
Mebeverine
Trimebutine
Thank You