GASTROINTESTINAL

CONSTIPATION

DEFINITION

Passage of unduly hard feces, usually occurs when intestinal transit time is prolonged and excessive.

Caused by lack of motility and/or moisture

SYMPTOMS

Abdominal discomfort

Loss of appetite

LAXATIVE USE

Acute constipation

Chronic constipation

Preparation for radiologic or gastrointestinal exam

Preparation for GI surgery

To avoid straining

Postoperative

CHF

DIET CORRECTION TO CONSTIPATION

Increase Fluids

Increase Fibers

Increase Exercise

CLASSIFICATION OF LAXATIVES

Hydrophillic Colloids (bulk forming)

Saline Cathartic

Surface Wetting (stool softener)

Lubricant Oils

Stimulant Cathartics

HYDROPHILLIC COLLOIDS

Indigestible fibers

Increases bulk which increases water in intestinal lumen

Leads to increased motility

Must consume with water

Onset of action: 24 to 72 hours (not for acute use)

Example: Psyllium (Metamucil®)

USE: Chronic constipation

SALINE CATHARTICS

Inorganic, poorly absorbed salts

Increases osmotic pressure which increases water in intestinal lumen

Increases bulk which increases motility

Onset: 30 minutes to 3 hours

Use: Acute constipation or prepare for exam

Side Effect: Diarrhea, habit forming

SURFACE WETTING AGENT

Reduces stool surface tension promoting water and fat mixture

Onset: 1 to 3 days

Use: Prevent constipation, prevent straining

Habit Forming

LUBRICANTS

Lubricates intestinal lumen

Onset: 6 to 8 hours

Use: acute and chronic constipation

Side Effects

Habit Forming

Decreases absorption of fats and fat soluble medications

Aspiration pneumonitis if taken at bedtime

STIMULANT CATHARTICS

Irritates intestinal mucosa and stimulates peristalsis

Onset: 2 to 8 hours

Use: Acute constipation, preparation for exam

Side effects

cramping

habit forming

DIARRHEA

Etiliology

Increase amount of osmotically active substance in GI lumen

Increased rate of intestinal secretions

Alteration of permeability of intestinal lumen

Increased rate of peristalsis

Infection

DRUG THERAPY

Narcotic Derivatives

Contraindicated in infectious diarrhea

Adsorbants

Hydrophillic Colloids

absorbs water

Restore Intestinal Flora

Electrolyte Replacement

ADSORBANTS

Absorbs toxins and bacteria causing diarrhea

Also absorbs medications and vitamins

Administer at different time

Useful to prevent infectious diarrhea especially when traveling

RESTORE INTESTINAL FLORA

Replaces natural flora bacteria in intestinal tract (lactobacillus acidophillus)

Useful following broad spectrum antibiotic therapy

Onset: 1 to 2 days

Alternatives: dairy products

ELECTROLYTE REPLACEMENT

Especially useful in children that have had diarrhea

Replaces fluid and electrolytes

EXAMPLE: Pedialyte®

ULCERS

Etiology

Stress (physiologic not psychologic)

alcoholism

idiopathic

drug induced

bacteria induced (Helicobacter pylori)

THERAPY

ANTIBIOTICS

ANTACIDS

HISTAMINE 2 ANTAGONISTS

PROTON PUMP INHIBITORS

SUCRALFATE

ANTACIDS

Neutralizes excess acid that causes ulcerations

Provides symptomatic relief

Promotes healing of ulcers

Goal: Buffer stomach pH between 4 and 5

Exceeding pH of 5 leads to rebound acidity

Administration time: 1 and 3 hours post meal

ANTACIDS

SODIUM BICARBONATE

Best neutralizing antacid, high Na content

May neutralize too well and exceed pH 5

ALUMINUM HYDROXIDE

Weak antacid, constipating

MAGNESIUM HYDROXIDE

Good antacid, may cause diarrhea

HISTAMINE 2 BLOCKERS

Blocks H-2 receptor in stomach

Blocks secretion of acid

Promotes healing of ulcers (6 to 8 weeks)

Utilized to prevent recurrence of ulcers (life long therapy)

Prevents nocturnal acid

PROTON PUMP INHIBITORS

Prevents acid secretion

Prevents gastro esophageal reflux (GERD)

Promotes healing of ulcers

Examples

Omeprazole (Prilosec®)

Lansoprazole (Prevacid®)

SUCRALFATE

Non-absorbed

Disaccharide

Acts as a barrier on the ulcer

Allows ulcer to heal by preventing acid contact

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