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Vomiting, Diarrhea, and Constipation

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Slide 1 :

Vomiting, Diarrhea, and Constipation Chapter 83

Slide 2 :

Vomting Pathophysiology Highly coordinated activity of the GI tract, CNS, and vestibular system. Three stages: Nausea, retching, and emesis

Slide 3 :

Vomiting Clinical features: Define the vomitus: bloody, bilious, nonbilious, feculent, posttussive. Determine what symptoms accompany the vomiting: Fever, abd pain, back pain, headache

Slide 4 :

Vomiting Physical exam Assessment of hydration status Abd exam: tenderness, peritoneal signs, hernias, masses Unsuspected causes: scars on dorsum of hands (bulemia), hyperpigmentation (addison disease)

Slide 5 :

Treatment Aggressive volume repletion Treat the underlying condition: eg DKA

Slide 6 :

Vomiting Antiemetics Zofran: 5-HT3 receptor antagonist Reglan: D2 dopaminergic antagonist and weak 5-HT3 blockade Phenergan/Compazine: H1 histaminergic, M1 muscarinic and D1 dopaminergic antagonists Meclizine/Benadryl/Dramamine: H1 antagonist Scopolamine: M1 antagonist

Slide 7 :

Constipation Most common digestive complaint in the US

Slide 8 :

Constipation Pathophysiology Multifactorial Decreased fiber intake Decreased water intake Exercise Medications: CCB, Fe, narcotic analgesics, antipsychotics Medical conditions: hypothyroidism, lead poisoning, chronic neurologic disorders, hyperparathyroidism Obstruction of GI tract

Slide 9 :

Constipation Clinical features: presence of hard stools that are difficult to pass “some pt’s become bowel fixated and feel they are constipated if they do not have regular bowel movements. They are not.”

Slide 10 :

Constipation Treatment Dietary modification/exercise regimen/adequate fluid Disimpactment of fecal impaction (enemas rarely work for impactions) Surgical eval for obstruction

Slide 11 :

Constipation Medications Metamucil: fiber (increases bulk, transit time, motility) Colace: emollient (facilitates mixture of stool fat and water) Dulcolax,Senna, Ex-lax: stimulants (increases motility) Magnesium: (shortens colonic transit time) Gycerin suppository: (stimulates rectum prompting defecation( Lactulose, Golytely: (osmotically active, nonabsorbable sugars; pull h2o into the gut) Enemas: (colonic distention encourages evacuation)

Slide 12 :

Diarrhea Second most common reason for work absenteeism.

Slide 13 :

Diarrhea Pathophysiology Four basic mechanisms Increased intestinal excretion Decreased intestinal absorption Increased osmotic load Abnormal intestinal motility

Slide 14 :

Diarrhea Viral Diarrheal Diseases Rotavirus: primarily in children, watery Norwalk: school aged children and adults, n/v/d symptoms 1-2 days Enteric adenovirus Majority of all acute e

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Diarrhea. Second most common reason for work absenteeism. DiarrheaMajority of all acute episodes of more Diarrhea. Second most common reason for work absenteeism. DiarrheaMajority of all acute episodes of diarrhea. Viral diarrhea has no WBC’s. Diarrhea ... less

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