Transcript Abnormal bowel movement

Presented by:
Abdullah Al-Ruwaita
Abdullah Al-Manea
Yousif Al-Ansari
Supervised by:
Prof. Riaz Qureshi, FRCGP
Bowel
movement
Normal
Abnormal
Constipation
Diarrhea
acute
Chronic

Dif: hard, dry, lumpy stools that are difficult

Causes:
or painful to pass
- Congenital or Primary.
- Secondary which includes:
-Insufficient dietary fiber intake.
-Inadequate fluid intake.
-Decreased physical activity.
-Side effects of medications.
-Hypothyroidism.
-Obstruction by colorectal cancer.

Dif: three or more loose or watery stools per
day, without abdominal bloating, pressure, and
cramps commonly referred to as gas.
 Causes:
Infections:
- Viral
- Bacterial
- Parasites • Intestinal disorders
• Reaction to certain medications
•
 Dif:
as loose stools that last for at least four
weeks, usually means three or more loose
stools per day.
 Causes:
-
Irritable bowel syndrome
Inflammatory bowel disease
Malabsorption syndromes
Chronic infections.
Chronic
diarrhea
Irritable bowel
syndrome
Inflammatory
Bowel Disease
Celiac Disease
Ulcerative
colitis
Crohn's disease
Lactose
intolerance
 Dif:
is a gastrointestinal syndrome
characterized by chronic abdominal pain and
altered bowel habits in the absence of any
organic cause. It is the most commonly
diagnosed gastrointestinal condition.
 prevalence
of IBS in North America estimated
from population-based studies is
approximately 10 to 15 percent
 in Europe found an overall prevalence of
11.5 percent
 2:1 female:male

Chronic abdominal pain (as a crampy sensation
and abdominal pain)

Altered bowel habits (ranging from diarrhea,
constipation)
-
Diarrhea (frequent loose stools of small, fecal
incontinence and feeling of incomplete evacuation)
-
Constipation (Stools are often hard, may last from
days to months)Other gastrointestinal symptoms

Other gastrointestinal symptoms (Upper GI
symptoms)



Rome III diagnostic criteria:
Recurrent abdominal pain or discomfort.
at least 3 days per month in the last 3 months associated
with 2 or more of the following:
(1) Improvement with defecation
(2) Onset associated with a change
in frequency of stool
(3) Onset associated with a change
in form (appearance) of stool
 many
disorders present with similar
symptoms (r/o),
 Routine laboratory studies (complete blood
count, chemistries) are normal in IBS.

"Alarm" or atypical symptoms which are not
compatible with IBS include (red flags) :
•
Rectal bleeding
Nocturnal or progressive abdominal pain
Weight loss
Laboratory abnormalities such as anemia,
elevated inflammatory markers, or electrolyte
disturbances
•
•
•

Patients with one of these alarm symptoms
require further imaging studies and/or
colonoscopy









It is not clear why patients develop IBS. Sometimes it
occurs after an infection of the intestines. This is called
post-infectious IBS. There may also be other triggers;
Brain-gut signal problems (thalamic activity).
GI motor problems (unpleasant stimuli).
Hypersensitivity (stimulation of various receptors in the
gut wall).
Mental health problems (Such as anxiety, depression).
Bacterial gastroenteritis.
Small intestinal bacterial overgrowth.
Food sensitivity (food intolerance to certain foods).
Child Abuse
Crohn's disease
 Ulcerative colitis
 Diverticulosis
 Celiac Disease
 Lactose intolerance
 Colon malignancy
 Peptic ulcer disease
 Biliary liver disease
 Chronic pancreatitis
 Medications
 Lymphoma of the GI

 Patient
education:
Education of the proposed mechanisms of IBS
helps to validate the patient's illness
experience and sets the basis for therapeutic
interventions
 Dietary
-
modification: dietary history may
reveal patterns of symptoms related to
specific foods.
Lactose (similarity that may occur in symptoms of IBS and lactose
intolerance, an empiric trial of a lactose free diet should be considered )
-
-
Exclusion of gas-producing foods
Food allergies
Gluten sensitivity
Carbohydrate malabsorption
Fiber (increase in the intake of fiber is often recommended)
 Physical
activity
 Psychosocial
therapies
-
Cognitive behavior therapy
Relaxation training
-
Gut-directed Hypnotherapy
-
 MEDICATIONS:
-
Antispasmodic agents
o
o
Mebeverine
Alverine
Dicyclomine (an anticholinergic)
-
Antidepressants (TCAs, SSRIs)
o
 Mind
and body often combine to increase the
distress of IBS patients.
 Psychological
intervention worth considering.
 IBS
patients can be managed well by family
physicians.
 Don’t
forget “red flags” for referral to GI
specialist is a must !
Chronic
diarrhea
Irritable bowel
syndrome
Inflammatory
Bowel Disease
Celiac Disease
Ulcerative
colitis
Crohn's disease
Lactose
intolerance

Inflammatory bowel disease (IBD) is comprised of
two major disorders:
1.Ulcerative colitis (UC).
2.Crohn's disease (CD).
•IBD can present at any age:
–The peak :15 - 30 years.
– A second peak 50
•Etiology is unknown but there are 3 main factors
contributing to it : Genetic factors,
environmental factors, diet.
 Ulcerative
colitis is characterized by
recurring episodes of inflammation limited to
the mucosal layer of the colon.
•major symptoms of UC are:
-Diarrhea
-rectal bleeding
( usually fresh blood )
-Tenesmus
-passage of mucus
-crampy abdominal pain

No single modality is enough for Diagnosis .

Combination of clinical picture,
laboratory, Endoscopy, pathology.
Colonscopy findings:
–The vascular markings are lost, petechiae, exudates,
touch friability, and frank hemorrhage may be
present.

–In Pathology, biopsy shows :
–Crypt abscesses.
–chronic changes including branching of crypts, atrophy
of glands, and loss of mucin in goblet cells


–Rule out infection
–5 ASA (5-amino salicylic acids)- therapy:
•Rectal ( if the UC extend less than 20 cm )
•Oral ( if the UC extend more than 20 cm +) in combination with
rectal

–Corticosteroids:
•Systemic: Prednisolone
•Local acting: enema.

–Immunomodulators :
•Azithyoprine
•Methotrexate


–Anti TNF therapy
 Is
a disorder of uncertain etiology that is
characterized by transmural inflammation of
the gastrointestinal tract.
 SYMPTOMS:
–Fatigue.
–Diarrhea.
–Abdominal pain.
–Weight loss.
–Fever.
–Bleeding is very rare.
Colonoscopy:
• Endoscopic features include focal ulcerations adjacent to
areas of normal appearing mucosa along
with polypoid mucosal changes that give a cobblestone


Wireless capsule endoscopy
Serologic markers
•Inflamatory marker : ESR, CRP
•Antibody tests :
•Antineutrophil cytoplasmic antibodies (pANCA) > with UC
•Anti-Saccharomyces cerevisiae antibodies (ASCA) > with CD


Stool markers — fecal calprotectin.
The intestinal complications of Crohn's disease include
the following:
-Intestinal obstruction
-Fistulas
-Abscess
-Hemorrhage (bleeding) - Unusual in Crohn's
disease
-Malabsorption
-Carcinoma, Colonic disease increases risk of
colon cancer
The longer you have Crohn's disease, the more likely
you are to develop complications that can be fatal.


The goals of treatment of Crohn's disease are to 
reduce the underlying inflammation, which then
relieves symptoms, prevents complications, and
maintains good nutrition.
Aspirin-like anti-inflammatory drugs 
(mesalamine) reduce the inflammation.
Corticosteroids reduce inflammation and 
suppress the immune system.
Antibiotics reduce inflammation indirectly by 
reducing infection.
Immunosuppressants suppress the immune 
system.
Surgery. (alternative). 

Celiac disease is a medical condition in which the
absorptive surface of the small intestine is damaged
by a substance called gluten. This results in an
inability of the body to absorb nutrients: protein, fat,
carbohydrates, vitamins and minerals, which are
necessary for good health.
SYMPTOMS:
–anemia.
–chronic diarrhea.
–weight loss.
–Fatigue.
–cramps and bloating.
–irritability.

 Screening
 Biopsy:
A definitive diagnosis can only be
made by a small bowel biopsy.
 Celiac
disease as yet has no known cure, but
can usually be effectively treated and
controlled. The treatment of celiac disease is
strict adherence to a GLUTEN FREE DIET FOR
LIFE.
 Lactose
intolerance means the body cannot
easily digest lactose, a type of natural sugar
found in milk and dairy products. Lactose
intolerance occurs when the small intestine
does not make enough of an enzyme called
lactase.
 Lactose
intolerance most commonly runs in
families, and symptoms usually develop
during the teen or adult years.
 It
could be temporary

Symptoms of lactose intolerance can be mild to
severe, depending on how much lactase the body
makes. Symptoms usually begin 30 minutes to 2
hours after eating or drinking milk products.
symptoms may include:
•Bloating.
•Pain or cramps.
•Gurgling or rumbling sounds in your belly.
•Gas.
•Loose stools or diarrhea.
•Throwing up.
 medical
 To
history.
confirm a diagnosis:
-Hydrogen breath test
-Lactose tolerance test
 Fortunately,
lactose intolerance is
relatively easy to treat. No known way
exists to increase the amount of lactase
enzyme the body can make, but
symptoms can be controlled through diet.
Who is ready ?
Questions ?