CONSTIPATION

Introduction
Constipation is the term used to
describe an abnormal frequency or
irregularity of defecation, abnormal
hardening of stool that makes their
passage difficult and sometimes painful,
a decrease in stool volume or retention
of stool in rectum for prolonged period.
Also can be defined as stool frequency
less than 3 bowel movement per week.
 General Actions
Stimulation of inhibitory recto-anal
reflex
Relaxation of internal spintcher
Relaxation of external spintcher
Increased intra abdominal pressure

Note: Interference with any of these

processes can lead to constipation.
 Causes
Exact cause of constipation is still idiopathic
Decrease in intake of fiber products
Decrease in absorption of food particles
Decrease in gastric motility
Structural malformation
Obstructed defecation
Effects of some drugs
Neurologic problem
Endocrine disorder
 Clinical Features
Abdominal pain and distension
Presence of Borboygmus
Decrease appetite
Headache , Indigestion
Straining at stool
Sensation of incomplete voiding
Elimination of small volume hard
stool
 Diagnosis
History Taking
Physical Examination
Blood Test: CBC, Biochemistry,
calcium level, TFT
Structural test including flexible
sigmoidoscopy and colonoscopy
Ano-rectal manometry
 Management
Increase dietary intake
Increase in fluid intake
Treatment of underlying disease
Provide privacy for defecation
Provide adequate time for defecation
Make a daily routine for defecation
Use of laxatives: Lactulose, senna
compounds, Milk of magnesia
Gerontological consideartion
Milk of Magnesia shouls not be the
choice for older adult as it causes
CNS depression and Electrolyte
imbalances
DIARRHOEA
 Introduction
Diarrhea is increased frequency of
bowel movement (more than 3 times
per day), Increased amount of stool
(more than 200 gm per day) and
altered consistency (i.e. looseness) of
stool.
It is usually associated with urgency,
perianal discomfort, incontinence or
combination of these factors.
 Types of Diarrhea
Acute diarrhea
Chronic diarrhea
 Causes
Acute diarrhea:
Food poisoning
Gastroenteritis
Anxiety or emotional stress
Over consumption of Alcohol
Medications particularly antibiotics
Infectious agent: Virus, Bacteria,
Protozoa
 Chronic diarrhea:
Celiac disease
Chronic constipation
Hormone disorder
Cancer
Inflammatory bowel disease
Irritable Bowel Syndrome
Lactose intolerance
Certain drugs
 Clinical Features
Common symptoms includes:
Abdominal pain and cramps
Urgency to go to toilet
Nausea, Vomiting
Severe symptoms includes:
Blood in feces
Pus in feces
 Painful passage of feces
Prolonged vomiting, Inability to
increase fluid intake
Reduce or absent urination
Fever, dehydration
 Diagnosis
History taking
Physical Examination
Blood test
Urine test
Stool R/E
Endoscopy or barium enema
 Complications
Cardiac Dysrrhythmias
Dehydration
Hypovolemic shock
 Management
Rehydration
Provide plenty of fluids to prevent
dehydration
Oral rehydration therapy to replace
fluid and electrolyte
IV fluids in severe cases
 Nutrition
Treatment of underlying disease
Provide nutrition through well
balanced diet. Low fiber diet
Maintenance of personal hygiene
Ensure that the food has been
cooked well
 Medications
Anti-diarrheal medications if caused
by infection
Other medications includes anti-
mobility agent. Eg: Loperamide
INDIGESTION
 Introduction
Also known as dyspepsia
It is due to lining of digestive system
being overly sensitive to acid
Often described as the feeling of
fulness, bloating, burping and
Heartburn
 Causes
Digestive tract disorder. Eg: GERD
Irregularities in pancreas or bile duct
Stomach ulcer, Haitus hernia, Functional
dyspepsia
Artery Blockage, Diabetes Mellitus,
Hypertension
Certain drugs. Eg: NSAIDs
Psychological factors including stress
and depression
 Clinical Features
The Hallmark features are:
Persistent pain
Discomfort in mid to upper abdomen

Other symptoms and signs includes:

Bloating, Bleaching and Burping
Heartburn and Nausea
Feeling of uneasiness in the chest
 Diagnosis
History Taking
Physical Examination
Blood Test
Endoscopy
 Complications
Barretts esophagus
Perforation of stomach
 Management
Antacids
Proton Pump Inhibitor
H2-receptor antagonist
Motility stimulants
In presence of h-pylori infection:
Triple Therapy, Quadriple Therapy
 Preventions
Avoid gas producing foods
Do not lie immediately after eating
Elevation of head during sleeping
Have small frequent feeding with plenty of
fluid
Avoid smoking and alcohol
Have regular exercise
Avoid emotional and physical stress
Avoid medication that irritate gastric lining
References