1. Diarrhea & Constipation
ASSIGNMENT # 1
PATH-202
Submitted to: Dr. Imtiaz Ahmed Khan
Submitted by: Waqas Nawaz
11-arid-975
DVM 4th semester
Symptoms of
constipation
Headache
Abdominal
bloating
Low back
pain
Sense of
rectal
fullness
Faculty of Pharmacy - Alexandria University
(Egypt)
2. 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
3. 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
4. 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.
5. 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
6. 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.
7. 1-SIGN & SYMPTOMS:
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 stool
2. Weight loss
3. Fever
2-CAUSES:
MALNUTRITION
o Alcohol
o Caffeine in soda, tea, coffee & chocolate
o Food that cause gas such as beans & apples
o Nicotine
o Spicy foods
o Foods high in acids such as orange
o Fatty foods such as sausage & butter
o Dairy products, particularly for those who are lactose intolerant
BACTERIA
o E.coli
o Salmonella
o Shigella
o Campylobacter
o Vibrio
o Yersini
o Clostridium difficle
o S.aureus
o B.cereus
o C.botulinum
VIRUS
o Rotavirus
o Adenoviruses
o Caliciviruses
o Astroviruses
o Norwalk agents and Norwalk-like viruses
COMMON DIARRHEAS
Age <2 years: Rotavirus
Age 2-5 years: Cholera; E. coli;
Shigellosis
All ages: E.coli; Campylobacter
Immunocompromized: Amebiasis;
Cryptosporidium
Diarrhea
Persistent
Multiple
cause
Dysentery
BacillaryAmoebic
Watery
CholeraE. coliRotavirus
8. FUNGI
o Yeast
o Candida
PARASITE
o Entameba histolytica
o Giardia lamblia
o Cryptosporidium
o 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
9. 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 intolerance
o 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 outgrowth
o Pancreatic insufficiency
o Mucosal disease (Crohn’s disease & Celiac sprue)
Celiac Sprue:
Gluten sensitive enteropathy
Reaction against gluten in diet
Epidemiology: Whites (European)
Normal Ilium
Celiac sprue
11. 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
12. 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
13. 4-TREATMENT & CURE:
Inj. Ciprofloxacin
Inj. Metronidazole
Inj.Ranitidine
C. Bifilac
T.Paracetamol
Non-specific treatment
o hydration
o Absorptions (Kaopectate®)
o Bismuth
o Antiperistaltics/opiate derivatives
o 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