Transcript Drug use in Gastrointestinal Diseases

Pornchanok Srimongkon
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/figure/
A000265.B1090/?report=objectonly
Outline
 Structure and functions of the
digestive system.
 Diseases within the oral cavity.
 Stomach and small intestine
diseases.
 Colon and rectal diseases.
Structure and functions of the digestive system.
 GI tract
 Teeth
 Tongue
 Esophagus
 Stomach
 Small
and large
intestine
 Rectum
 Anus
Mucosa, gland
 Hepatobiliary
 liver
 gall bladder
 pancreas
Structure and functions of the digestive system.
Oropharynx
 Salivary gland
 Parotid
 Submanibular gland
 Sublingual gland
A = Nasopharynx
B = Uvula
C = Hypopharynx
D = Larynx
E = Tongue
F = Oropharynx
Structure and functions of the digestive system.
Chewing or Mastigation
 Functions
 Grind food into smaller
 Lubricate
 Amylase enzyme
 The chewing 50-80
kg./molar!
Structure and functions of the digestive system.
 Peristalsis
http://www.healthcentral.com/acid-reflux/h/antacidpills-relieve-gas-in-intestines.html
http://www.ksbrhospital.com/site/SP/index.php?p=
Apthous ulcer
Angular stomatitis
Oral thursh
Dental caries, tooth decay
Gingivitis
1. Apthous ulcer
 Unknown causes
 Pain 2-3 days
 Oral Mucosa
 Autoimmune
 Related to Stress,
Constipation,
Indigestion, Menstruate,
chronic fever
 Duration up to 2 wk
http://dentyomarajconference.blogspot.com/2012/02/blog-post_13.html
1. Apthous ulcer
 Treatment
 Drug use
 Avoid eating spicy
 Pain: Paracetamol,
foods.
 Wash out mouth with
salt water.
 Fix the cause.
NSAIDs ex. Ibuprofen
 Steroid cream to reduce
the inflammation and
promote healing:
triamcinolone paste
http://www.plazathai.com/show-342547.html
http://www.thairx.com/dmdrug.asp?did=knlor
http://www.aussietip.com/forum/topics/0425795337-sms-
2. Angular stomatitis
 Cause: lack of vit B2
(riboflavin)
 Other causes: Dermatitis,
hypersaliva
 Bean, milk, meat, yolk,
liver, greens
http://dental.anamai.moph.go.th/oralhealth/PR/E-book/elderly/keld03.html
 Tx: find the cause
 Vit B2 3 times/day for 3
days
http://drcarebear.exteen.com/20110609/entry-1
3. Oral thrush
 Candida albicans
 Fungal infection
 Baby and child with
poor nutrition (lack of
immunization)
 Poor in oral hygiene
 Adults who take broad
spectrum antibiotics
or immunodeficiency
http://www.edentalhealth.com/oral-thrush/
3. Oral thrush
 Treatment:
 Clean, to brush the teeth
 Baby: entering the water after milk feeding
 Drug use:
 Gentian violet solution apply 3-4 times a day
for 5-7 days
 Clotrimazole troche
 Nystatin solution
 Ketoconazole tab
2 weeks
4. Dental caries, tooth decay
 Garbage from sugar
and carbohydrate
 Bacteria form it to acid
http://www.kroobannok.com/blog/11268
http://www.cashewthai.com/?name=knowledge&file=readknowledge&id=13
• Symptoms:
• Toothache, tooth pain
• Pulp inflammation
• Purulent
4. Dental caries, tooth decay
 Suggestions:
 Avoid eating sugary
foods or cold.
 Brush the teeth and
tongue properly.
 Use dental floss.
 Drug use:
 Paracetamol or
NSAIDs (Ibuprofen)
for pain
 Antibiotics use for
purulent
5 Gingivitis
 Poor oral hygiene
 Calcium plaque
 Bacteria release toxin
induce gingivitis, swollen
gums, bleeding without
pain
 Shorten gum, loose the
teeth, bad breath, pus
http://www.mayoclinic.com/health/medical/IM01745
5 Gingivitis
 Treatment:
 See the dentist for scrape
plaque
 Prevention:


Brush the teeth
properly.
See the dentist to check
up every 6 months
http://www.umm.edu/patiented/articles/gingivitis_000438.h
Dyspepsia
Peptic ulcer
Gastroesophageal reflux disease: GERD
Nausea and vomiting
1.Dyspepsia
 Symptoms:
 stomachache, abdominal discomfort
 Abdominal colic, burning stomach, bloating,
burping frequently, nausea, vomiting
 Divided into 3 groups:
1. Ulcer-like dyspepsia
 Stomachache, know the specific position
 Nocturnal pain or empty stomach
 The pain should relieves after take some food
2. Reflux-like dyspepsia
1.Dyspepsia
 Heartburn, belching
 Causes: overeating,
overweight, tightness
wearing suit
http://www.medicinenet.com/gastroesophageal_reflux_disease_gerd/article.htm
1.Dyspepsia
3. Dysmotility-like dyspepsia
 Caused by abnormal bowel movements.
 Symptoms: Bloated distension after eating.
 With air or gas in the stomach.
 Nausea Vomiting
1.Dyspepsia
 Risk factors of dyspepsia:
 Eating difficulty digested food (high-fat diet)
 Food or drinks that cause gas in the stomach. (soft
drink, nuts)
 The talk between Dining.
 การเร่งรีบเคี้ยวอาหาร ทาให้เคี้ยวไม่ละเอียด
 Gum chewing
 Sleep immediately after eating.
 Diseases: Gallstones in the gallbladder, cirrhosis
1.Dyspepsia: Alarm symptoms
 Age > 40 years
 Awakening pain
 Weight loss
(>5% within 1 mo or >10%
within 6 mo)
 History of GI bleeding
 Chronic vomiting
 Dysphagia
 Jaundice
 Anemia
 Hepatomegaly,




splenomegaly,
lymphadenopathy
Fever
Abnormal excretion
habits.
Palpation of the
abdominal mass.
Family history of GI
cancer
1.Dyspepsia
 Treatment: lifestyle modification
 Avoid: smoking, chewing gum, alcohol, tea, coffee





and soft drink consumption
Dining on time, avoid spicy and difficulty digested
food
Do not sleep immediately after dining
Chewing food thoroughly, do not talk while eating
Lose weight
Relaxing and exercise
1.Dyspepsia
 Drug use: duration 2 wk then + 4 weeks (total 6-8 wk)
 Ulcer-like dyspepsia:
 Antisecretory drugs: Cimetidine, Omeprazole
 Reflux-like dyspepsia:
 Antisecretory drugs + prokinetic drugs
(domperidone/metoclopramide) + simethicone
 Dysmotility-like dyspepsia:
 Prokinetic drugs (domperidone/metoclopramide) +
simethicone
2.Peptic ulcer
 Causes:
Damaging factors:
• Pepsin hormone
• Hydrochloric acid
• Helicobactor pyroli infection
Protecting factors:
• Sodium bicarbonate
• Mucosa
• Blood circulation
http://www.rayur.com/peptic-ulcer-definition-causes-sign-symptoms-diagnosis-and-treatment.html
2.Peptic ulcer
2.1 Gastric ulcer
2.2 Duodenal ulcer
http://www.hopkins-gi.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Cat_ID=83F0F583-EF5A-4A24-A2AF0392A3900F1D&GDL_Disease_ID=80AD1118-6659-4B04-B560-71B95E3B7FA9
2.Peptic ulcer
 Symptoms: stomachache, Middle abdominal pain,
colic distension, bloating, burning, indigestion,
nausea, vomiting
 Chronic and related to meal
 Alarm symptoms:
 Bloody stool
 Hematemesis
 severe pain > 6 hr
 Severe anemia
2.Peptic ulcer
 Risk factors: smoking, alcohol consumption,
stress, not dining on time, some medications
(aspirin, ibuprofen)
 Treatment:
 Lifestyle modification:
 Dining on time.
 Avoid Caffeine, alcohol, smoking, spicy food, some
medication
 Enough rest, reduce stress
 Drug use: antacid, antisecretory drug
2.Peptic ulcer
 Antacid:
 Neutralization HCl acid in the stomach
 Aluminium, Magnesium, Calcium carbonate and
Sodium bicarbonate
 1-2 tablespoon 3 times after meals and bedtime
2.Peptic ulcer
 Antisecretory drugs: cimetidine, ranitidine,
omeprazole
 Anti-gastric acid secretion
 The stomach is healed
3. Gastroesophageal reflux disease (GERD)
 Causes: A condition in which the stomach contents
(food or liquid) leak backwards from the stomach
into the esophagus
 This action can irritate the esophagus, causing
heartburn and other symptoms.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/figure/A000265.B19609/?report=objectonly
3. Gastroesophageal reflux disease (GERD)
 Risk factors:
 Alcohol (possibly), coffee, mint
 Hiatal hernia
 Obesity
 Pregnancy
 Smoking
 Sleep immediately after eating
 Tightness wearing
(in the middle of the body)
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/
3. Gastroesophageal reflux disease (GERD)
 Call for any of the following symptoms:
 Bleeding
 Weight loss
 Hoarseness
 Loss of appetite
 Frequent vomiting
 Feeling filled up quickly when eating
 Choking (coughing, shortness of breath)
 Trouble swallowing (dysphagia) pain with
swallowing (odynophagia)
3. Gastroesophageal reflux disease (GERD)
 More common symptoms:
 Feeling that food is stuck
behind the breastbone
 Heartburn or a burning
pain in the chest (under
the breastbone)
 Increased by bending,
stooping, lying down, or
eating
 More likely or worse at
night
 Relieved by antacids
 Less common symptoms:
 Bringing food back up





(regurgitation)
Cough or wheezing
Difficulty swallowing
Hiccups
Hoarseness or change in
voice
Sore throat
 Nausea after eating
http://www.i-am-pregnant.com/encyclopedia/Pregnancy/Heartburn
3. Gastroesophageal reflux disease (GERD)
 Change your eating habits.
 Eat several small meals instead of two or three large
meals.
 After you eat, wait 2 to 3 hours before you lie down.
Late-night snacks aren't a good idea.
 Chocolate, mint, and alcohol can make GERD worse.
 Spicy foods, foods that have a lot of acid (like
tomatoes and oranges), and coffee can make GERD
symptoms worse in some people.
3. Gastroesophageal reflux disease (GERD)
 Do not smoke or chew tobacco.
 If you have GERD symptoms at night, raise the
head of your bed 6 in. (15 cm) to 8 in. (20 cm)
 Do not wear tight clothing around your middle.
 Lose weight if you need to. Losing just 5 to 10
pounds can help.
http://www.teluguone.com/vanitha/content/good-food-to-avoid-heart-burn-74-2416.html
3. Gastroesophageal reflux disease (GERD)
 Drug use:
 Antacid: every hour or as
needed
 Antisecretory drugs: 4
wks
 Histamine receptor
antagonist: cimetidine,
ranitidine
 Proton pump
inhibitors: omeprazole
4. Nausea and Vomiting
 Nausea is an unpleasant, queasy feeling in the
throat or stomach that may result in vomiting.
 Vomiting is emptying the stomach as a result of
strong gagging and retching that leads to throwing
up.
 Vomiting can come in waves as the
natural movement (peristalses)
is reversed, and involuntary contractions
in the walls of the stomach and
esophagus force the stomach contents
out.
4. Nausea and Vomiting
4. Nausea and Vomiting
 Nausea and vomiting are not diseases, but they are
symptoms of many conditions such as:
 Motion sickness or seasickness
 Early stages of pregnancy
 Medication-induced vomiting
 Intense pain
 Emotional stress (such as fear)
 CNS causes: Bulimia or other psychological illnesses
 Ingestion of toxins or excessive amounts of alcohol
4. Nausea and Vomiting
 Ulcers (acute gastritis)
 Gallbladder disease
 Food poisoning
 Overeating
 Heart attack
 Infections (such as the "stomach flu")
 A reaction to certain smells or odors
 Concussion or brain injury, Brain tumor
 Some forms of cancer
4. Nausea and Vomiting
 The nausea makes it difficult to drink fluid,
making the dehydration worse, which then
increases the nausea.
 Intravenous fluids may be provided to correct this
issue and break the cycle
http://drugline.org/ail/pathography/1655/
Dehydration: increased thirst and
dry lips or mouth
http://www.full-timer.com/recognizing-and-treating-dehydration/
http://survivalscoop.blogspot.com/2010/08/signs-of-dehydration-why-you-need-water.html
4. Nausea and Vomiting
 Management:
 Liquid diet: Small amounts but often.
 ORS (Oral Rehydrate Salt)
 Relaxing
 Pregnancy: morning sickness
 Drink soda, ginger soup with
cracker in the morning
 Sit for 10-15 minutes before
getting out of bed.
Diarrhea
Constipation
Parasite
Hemorrhoids
Diarrhea
 Diarrhea describes bowel movements (stools) that
are loose and watery.
 Caused by
 Increased secretion of fluid into the intestine
 Reduced absorption of fluid from the intestine
 Rapid passage of stool through the intestine.
 Very common and
usually not serious.
http://www.charlestongi.com/charleston_gi_conditions.php?id=7
Diarrhea
 Definition:
 Stool > 3 times /day
 Watery stool > 1
time/day
 Bloody or mucous >
1 time/day
http://www.webmd.com/digestive-disorders/understanding-diarrhea-basics
Diarrhea
 Symptoms of uncomplicated diarrhea include:
 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:
 Blood, mucus, or undigested food in the stool
 Weight loss
 Fever
Diarrhea
 Acute diarrhea
 <14 days
 Main causes: infections
 Chronic diarrhea
 >4 weeks
 Causes: stress, cancer, abnormal absorption,
lactase enzyme deficiency, chronic diseases
(diabetes or hyperthyroidism)
http://amy-amirah.blogspot.com/2010/12/kitchen-and-health.html
Diarrhea
 Watery diarrhea
 Causes: enterotoxin from Vibrio cholera,
enterotoxigenic E.coli
 Food poisoning: Staphylococcus aureus, Bacillus
cereus




Heat durable
6-24 hr after eating
Nausea stomachache with no fever
Symptoms will go away by themselves within 24 hours.
 Mucous bloody or invasive diarrhea
 Causes: Shigella, Salmonella
 Stomachache, fever, N/V
Diarrhea
 Treatment:
 Prevent dehydration and electrolyte replacement
(Oral rehydration solution: ORS)
 Sugar 2 tablespoons + salt ½ teaspoon + water 750 ml
 Soft drink 375 ml + salt ½ teaspoon
 Maintain and fix the cause of the diarrhea
 Antidiarrheals drugs
 Others:
 Select low fat foods eg. Lean meat, white rice, bread
 Drink plenty of liquids
Diarrhea
 Drug use in Diarrhea:
1. Antiperistalsis: loperamide (Imodium®)
 Reduce the amount of stool.
 Avoid using in elderly and child
 Don’t use in bloody mucous stools, fever
 Over using: Distension, bloating, abdominal
cramps, pain
http://china.mims.com/resources/portal/common/document/mi
ms/mimsau.htm
http://leominnick.typepad.com/blog/2012/07/imodium-thailand.htm
Diarrhea
Drug use in Diarrhea:
2. Anticholinergics: hyoscine, dicyclomine
• Reduce abdominal pain
•
Not reduce the amount of stool.
•
Side effects (with high dose): Palpitations, dry mouth,
dry throat
http://www.drugexp.com/buscopan-sugarcoated-tablets-10mg-p516.html
http://www.mims.com/resources/portal/common/document/mims/mimsau.htm
Diarrhea
 Drug use in Diarrhea:
3. Adsorbents: activated charcoal, kaolin, pectin





Absorb toxins from the bowel
Use within 24-48 hours
Mass stools
Safe
Black stools
http://www.desiccantpacks.net/activated-carbon/
http://www.efirstaid.com.sg/product_info.php?products_id=194
Diarrhea
 Drug use in Diarrhea:
4. Colonic microflora: probiotics eg. Lactobacillus
acidophilus





Adjust to acidic pH in the gut
Inhibit bacterial growth
Prevent germ adhesion and poliferation
Improve the immunization
But delay effect
http://www.visualphotos.com/image/1x3745780/lactobacillus_acidophilus_lactobacillus
Diarrhea
 Prevention:
1. Cooked food should be clean.
2. Wash your hands before eating and defecation.
3. Defecate into a toilet
Constipation
 Constipation is defined medically as fewer than
three stools per week and severe constipation as
less than one stool per week.
 Caused by the slow movement of stool through the
colon.
 medications, poor bowel habits, low fiber diets,
abuse of laxatives, hormonal disorders, and diseases
primarily of other parts of the body that also affect
the colon.
Lifestyle
modification
Constipation
 Treatment: Find the cause and fix it.
 Stage 1:
 Toilet training habits
 Exercise
 High fiber diet
 Drink 7-8 glasses of water/day
 Stage 2: laxatives
 Bulk-forming laxatives
 Stimulant laxatives
 Osmotic/saline laxatives
 Stool softener/surfactant laxatives
 Stage 3: surgery
Constipation
Onset: 2-3 days
 Laxatives: 1. bulk-forming (1st line)
 eg. Prune, basil seeds
 Increase water, osmotic pressure and stool in the
intestine.
 Safe and low side effect
 Side effect: Distension,
flatulence.
 Do not use: Gastrointestinal
obstruction.
Constipation
Onset: 6-8 hours
 Laxatives: 2. stimulant laxative
 eg. senna, bisacodyl
 Increase water and electrolyte onto large intestine.
osmotic pressure and stool in the intestine.
 Stimulate myenteric plexus  movement
 Addict, bowel movement dysfuction
Constipation
 Laxatives: 3. Osmotic/saline laxatives
 Lactulose, glycerin suppository (onset 30 mins), Milk
of Magnesia (MOM)
 Safe for use in baby
 Avoid MOM in kidney disease
http://drugline.org/drug/medicament/10777
Constipation
 Laxatives: Stool softener/surfactant laxatives
 anionic surfactant: Reduces surface tension in fecal,
then water leak into the stool to make it soft.
 Docusate , mineral oil
 Slow onset (24-72 hr)
Constipation
 Prevention:
 Do not suppressed your stool
 Exercise regularly to stimulate bowel movement
 7-8 glasses of water/ day
 Vegetables, fruits
Parasite: Ascaris
http://www.siamhealth.net/public_html/Disease/infectious/parasite/ascaris.htm
Parasite:Pin worm, Enterobius vermicularis, enterobiasis
http://board.postjung.com/500440.html
 Enterobiasis
Parasite: Hookworm
http://www.siamhealth.net/public_html/Disease/infectious/parasite/HOOKWORM.htm
Parasite: Hookworm
http://www.med.cmu.ac.th/dept/parasite/public/Hookworm.htm
Parasite
Gnathostoma spinigerum
http://www.bangkokhealth.com/index.php/health/health-general/food-nutrition/584%E0%B8%9E%E0%B8%A2%E0%B8%B2%E0%B8%98%E0%B8%B4%E0%B8%95%E0%B8%B1%E0%B8%A7%E0%B8%88%E0%B8
%B5%E0%B9%8A%E0%B8%94.html
Parasite: tape worm
Parasite: tape worm
Parasite
 Treatment:
 Albendazole : Zentel®
 Mebendazole : Fugacar®, Benda ®
 Niclosamide : Yomesan®
Parasite infection
 Prevention:
 Short fingernails
 Wash your hands
 Clean the toilet frequently
 Defecate in the toilet
 Eat clean food
 Wash fresh fruits and vegetables
thoroughly before eating.
 Wear the shoes
 Washing clothes thoroughly
Hemorrhoid
 Hemorrhoids are enlarged veins located in the
lower part of the rectum and the anus.
 They become swollen because of increased
pressure within them, usually due to straining at
stools and during pregnancy because of the
pressure of the enlarged uterus.
 Divided into 2 groups:
 External hemorrhoid
 Internal hemorrhoid
http://diseasespictures.com/hemorrhoids/
Hemorrhoid
http://www.pain-relief-treatments.com/hemorrhoid-pain-relief.html
Hemorrhoid
 Causes: increased pressure
 Hemorrhoids are associated
with constipation and
straining at bowel movements.
 Pregnancy is also associated
with hemorrhoids.
 Other conditions,
 for example chronic liver
disease, may also cause
increased venous pressure and
may be associated with
hemorrhoid formation.
symptoms
 The most common symptom and sign is painless
bleeding.
 There may be bright red blood on the outside of
the stools, on the toilet paper, or dripping into the
toilet. The bleeding usually is self-limiting.
 There may be other reasons to have bleeding
including inflammatory bowel disease, infection,
and tumors
Hemorrhoid
Treatment: Self-Care at Home
 Warm Sitz Baths
 Sitting in a few inches of warm water three times a day for 1520 minutes may decrease the inflammation.
Dry the anus.
Dietary Changes
 Increased fluid intake and dietary fiber
 decrease the potential for constipation
 lessen the pressure on the rectum and
Activity Suggestions
 Should not sit for long periods of time and may benefit from
sitting on an air or rubber donut.
 Exercise is helpful in relieving constipation and in decreasing
pressure on the hemorrhoidal veins
Hemorrhoid treatment: