Bowel disorders

Question 1

0

Outline constipation as a bowel disorders

Answer 1

• A change in bowel habit that results in no stools being passed for at least three days
• Slower bowel transit allows more water to be reabsorbed from faecal matter
• Stools become hard and difficult to pass

Question 2

Outline what causes constipation

Answer 2

• Low fluid intake/ dehydration
• Lack of fibre
• Lack of exercise
• Changes in diet
• Pregnancy
• Medication

Question 3

Outline signs and symptoms of contstipation

Answer 3

• Difficulty passing stools
• Pain when passing stools
• Hard/solid stools are more hard and solid
• Bloating or abdominal discomfort

Question 4

Outline when to refer for constipation 1

Answer 4

• Children under 12
• Blood or mucus in stools
• Significant change in bowel habit
• Unexplained weight loss

Question 5

Outline when to refer for constipation 2

Answer 5

• Long duration or symptoms (more than 1 week)
• Presence of pain, bloating and nausea
• OTC medication failure
• Prescribed medication known to cause constipation

Question 6

Outline 1 type of treatment for constipation

Answer 6

Stimulant laxatives which stimulate nerve endings in the
bowel to promote the movement of the stools
- Usually effective in 8-12 hours;
- Suitable for short term use only

Question 7

Outline the recommended dose for stimulat laxatives

Answer 7

Dulcolax 5mg tablets (bisacodyl)
* ONE to TWO tablets before bedtime
Dulcolax Adult Pico Liquid (sodium picosulphate 5mg/5mL)
* ONE to TWO 5mL spoonfuls before bedtime
Senokot 7.5mg tablets (Senna fruit)
* ONE to TWO tablets before bedtime
Senokot Max strength (Senna fruit)
* ONE 15mg tablet before bedtime

Question 8

Outline concerns with stimulant laxatives

Answer 8

• Not for regular use
• Not for long term use
• Can affect bowel tone
• Often misused

Question 9

Outline a 2nd treatment for constipation

Answer 9

• Bulk forming laxatives which contain natural fibre and
  increase the mass of the stools,
  encouraging the intestine to
  move faster(HOLD WATER IN STOOLS)
• Usually effective in 24-36 hours;

Question 10

Outline the recommended dose for bulk forming laxatives

Answer 10

Fybogel Hi-fibre (ispaghula husk)
* Take one sachet in the morning and one in the evening.
* Take at least two hours before going to bed
Other bulk forming laxatives include Methylcellulose

Question 11

Outline concerns with bulk forming laxatives

Answer 11

Taste and texture are challenging
* not suitable for patients with impaction, obstruction or atonic bowel
* Not for use in patients with alternating bowel habit
* Not suitable for patients with difficulty swallowing
* Has been known to cause rashes and itching to some patients

Question 12

Outline a 3rd treatment for constipation

Answer 12

• Osmotic laxatives which increase the
  amount of water in the large
  bowel
• Increase stool volume prompting
  a bowel movement
• Usually takes 24-48 hours to
  work
• e.g. Movicol and Lactulose

Question 13

Outline the recommended dose for osmotic laxatives

Answer 13

Movicol Sachets (Macrogol 3350, Sodium chloride, Sodium bicarbonate, Potassium chloride)
* 1-3 sachets daily in divided doses
Lactulose Oral Solution (Lactulose 3.3g/5ml).
* 15-45ml either once daily or split in two divided doses

Question 14

Outline concers with osmotic laxatives

Answer 14

• Cost
• Taste
• Bulky
• Can cause diarrhoea if misused
  HOWEVER SAFE FOR PREGNANCY

Question 15

Outline a 4th treatment option for constipation

Answer 15

• Faecal Softeners act by adding water to faecal
  matter, their other mode of action appears to be reducing surface
  tension
• Glycerin appears to have some softening effect
• Oil based softeners appear to primarily have a lubricating effect
• Making them easier to pass
• E.g docusate sodium, glycerin, paraffin

Question 16

Outline the recommended dose for faecal softeners

Answer 16

Docusate Docusate sodium 100mg capsules
Take 1 capsule 3 times a day , increase to 5 times a day if necessary
* Glycerol (4g glycerol suppository)
* One to be inserted rectally as required
* Liquid Paraffin
* Two to six 5mL spoonfuls when required

Question 17

Outline concerns of faecal softeners

Answer 17

Docusate Sodium
* Takes a few days to work
* Can cause nausea, diarrhoea, cramps and rashes/itching
Glycerol
* requires rectal insertion, not popular
* Can cause cramps, irritation and wind
Liquid paraffin
* is potentially dangerous, can cause pneumonia if inhaled
* Causes vitamin deficiency with repeated use

Question 18

Outline lifestyle advice for constipation

Answer 18

• Drink plenty of fluids
• Increase dietary fibre intake
• Improve toilet routine
• Increase exercise or activity

Question 19

Outline diarrhoea as a bwoel disorder

Answer 19

• An increase in bowel movements involving loose or watery stools
• When the lining of the large intestine becomes inflamed, insufficient fluid is removed from the food in the intestine.
• Stools then become looser/liquid-like when they are excreted from
  the body
• Can lead to dehydration

Question 20

Outline what causes diarrhoea

Answer 20

• Bacterial or viral infections (gastroenteritis)
• Dietary changes
• Food allergies and food poisoning
• Alcohol in excess
• Poor hand hygiene (faecal-oral route)
• IBS

Question 21

Outline signs and symptoms of diarrhoea

Answer 21

• Increased frequency of stools
• Loose or liquid-like stools
• Abdominal cramps
• Bloating
• Nausea and vomiting
• Increased urgency to pass stools
• Flatulence

Question 22

Outline when to refer for diarrhoea

Answer 22

• Children under 12
• 1 day duration in under 1s
• 2 days duration in under 3s and elderly
• Symptoms persisting for 3 days or more in others or recurrent
• If patient shows signs of dehydration
• Diarrhoea accompanied by fever or severe nausea and vomiting
• Anyone returning from holiday abroad
• Blood in stools

Question 23

Outline 1 treatment option for diarrhoea

Answer 23

Rehydration Salts
* Replaces lost fluids and
electrolytes (salts)
* Reduces risk of severe
dehydration
* Dehydration is a significant risk
in babies and children
* E.g dioralyte

Question 24

Outline the recommended dose for dioralyte

Answer 24

Dioralyte sachets
* One to be taken immediately in approximately 200mL of water and drink
immediately
* To be taken after every loose motion (Poo!)

Dioralyte Relief sachets (Pre-Cooked Rice Powder 6G, Sodium Citrate 580Mg, Sodium Chloride
350Mg And Potassium Chloride 300Mg.)
* One sachet after each loose motion (watery stool) up to a maximum of 5
sachets per day for 3-4 days.

Question 25

Outline concerns with rehydration salts

Answer 25

* Managing patient expectations * Taste * Requirement to reconstitute as instructed * Young children still need to see a doctor

Question 26

Outline a 2nd treatment option for diarrohea

Answer 26

- Antidiarrhoeals or Antimotility Agents which stop stools from being passed by slowing bowel movement and allowing fluids to be reabsorbed - Very effective treatment but not without risk * E.g. loperamide, kaolin and morphine

Question 27

Outline the recommended dose for antidiarrhoeals

Answer 27

Imodium (Loperamide 2mg capsule) * Take 2 capsules to start treatment. Take 1 capsule after each loose bowel movement, up to a maximum of 6 capsules per day. Imodium Plus * Take TWO caplets immediately. Then take one caplet after each loose bowel movement. Kaolin and Morphine * Shake the bottle, Mix 2 teaspoons (10ml) of the medicine in water and consume. Repeat this dose up to 3 times a day if required.

Question 28

Outline concerns of antidiarrhoeals

Answer 28

* May simply delay seeking medical advice * may hide symptoms of infection * Not suitable for children under 12 * Kaolin and morphine has a potential for abuse

Question 29

Outline lifestyle advice for diarrhoea

Answer 29

* Stay at home and get plenty of rest * Stay off school/work until you have not had diarrhoea for at least 2 days to reduce spread of bacterial infection * Small frequent sips of fluids (water/squash) * Eat when you are able to * Effective handwashing would have the most significant impact

Question 30

Outline Irritable bowel syndrom as a bowel disorder

Answer 30

- Common long term bowel condition that affects bowel function with associated symptoms and pain which is intermittent. - It affects up to 20% of the population. - Common in women but cause unknown

Question 31

Outline what causes IBS

Answer 31

MaAIN SYMPTOMS * Abdominal pain * Abdominal distension * Disturbed bowel habit OTHER SYMPTOMPS * Nausea * Lethargy * Urinary symptoms

Question 32

Outline when to refer for IBS

Answer 32

* Children * Older people with recent onset * Pregnancy * Blood in stools * Unexplained weight loss * Unresponsive to treatment * Not previously diagnosed

Question 33

Outline a treatment option for IBS

Answer 33

- Antispasmodics which work on smooth muscle within the gastrointestinal tract to relax muscle and reduce pain from spasm - side effects are relatively rare * E.g. peppermint oil, mebeverine * hyoscine

Question 34

Outline the recommended dose for Antispasmodics

Answer 34

Colpermin (peppermint oil 0.2% capsules) * One capsule three times a day. This dosage may be increased to two capsules three times a day if discomfort is severe. Buscopan (hyoscine 10mg tablets) * The recommended starting dose is 1 tablet three times daily; this can be increased up to 2 tablets four times daily if necessary. Colofac IBS (mebeverine 135mg tablets) * One tablet three times a day, preferably 20 minutes before meals.

Question 35

Outline safety concerns of antispasmodics

Answer 35

* Only work for spasm symptoms no direct effect on bowel movement symptoms * Require diagnosis first so some patients may be disappointed * Colpermin not suitable for nut allergy suffers * Can cause skin reactions and swelling * Hyoscine can also cause dry mouth and allergic response * No children

Question 36

Outline lifestyle advice for IBS

Answer 36

* Relaxation techniques might be beneficial * Some alternative therapies might also be of benefit. * Following a low fat, low sugar, high fibre diet * Adding bran to the diet * Avoid certain sweeteners * Identifying aggravating factors * Some patients benefit from a reduction in caffeine intake