COMMON GASTRO-INTESTINAL DISORDERS How to care your self ?

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• COMMON GASTRO-INTESTINAL DISORDERSHow to care
  your self ?

28 March 2010-Common Gastrointestinal
Disorders-Mahmoud El Ghazali
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Primary care..WHO??

• Across most of Europe North America, primary
  care is a specific specialty that exists within a
  range of healthcare systems cultures
• It is at the forefront of care of most patients

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Primary care..WHO??

• Gastrointestinal disease In developed countries
  gastrointestinal problems are a common reason for
  attendance at the primary care clinic as well as
  the outpatient clinic of the hospital.

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• In developing countries, poor hygiene and
  malnutrition allow the spread of infective
  organisms.
• The clinician's main role here is to treat
  infections promptly and to help with prevention
  by encouraging improved sanitation and education.

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• Diseases of the gastrointestinal tract liver
  together account for about 10 of the total
  burden of illness, 20 million office visits, and
  nearly 10 million hospital admissions annually in
  Egypt

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• The cost of gastrointestinal diseases depends on
  their prevalence, direct costs (fees, hospital
  charges, pharmaceutical costs), and indirect
  costs (time loss from work)

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From here we start the GIT
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Anatomic considerations
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GI overview

• The major function of the gastrointestinal tract
  is to absorb water nutrients.
• Food moves physically from mouth to colon where
  non-absorbable wastes are stored for periodic
  elimination

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Clinical approach

• The diagnosis of gastrointestinal diseases
  derives predominantly from the patients history
  and, to lesser extent, from the physicians
  examination

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Here we will talk about-

• Gastroesophageal Reflux Disease(GERD, Acid
  Reflux, Heartburn)
• Peptic duodenal ulcer
• Nausea vomiting
• Diarrhea
• Constipation
• Irritable bowel syndrome

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Gastro-esophageal reflux disease

• GERD is one of the most prevalent diseases in the
  western world .
• Recurrent heartburn (which is the hallmark of
  GERD) enables a diagnosis of GERD to be made by
  history alone

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Gastro-esophageal reflux disease

• Gastroesophageal reflux disease, commonly
  referred to as GERD or acid reflux, is a
  condition in which the liquid content of the
  stomach regurgitates (backs up or refluxes) into
  the esophagus.

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Gastro-esophageal reflux disease

• What causes GERD?
• Lower esophageal sphincter
• Hiatal hernia
• Esophageal contractions
• Emptying of the stomach

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What are the symptoms of uncomplicated GERD?

• Heartburn
• Regurgitation
• Nausea
• What are the complications of GERD?
• Ulcers
• Strictures
• Inflammation of the throat and larynx

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Gastro-esophageal reflux disease

1. Life style modifications
2. Drug therapy

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Antacids Anti histaminic PPI
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Antacids

• Mg-Antacids
• Al-Antacids
• ALMg-Antacids
• Ca carbonate-Antacids
• Na bicarbonate-Antacids

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Antihistaminic PPI

• Ranitidine famotidine
• Omeprazole,lansoprazole pantoprazole

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Peptic ulcer disease

• What is a peptic ulcer?
• A peptic ulcer is a hole in the gut lining of the
  stomach, duodenum, or esophagus. A peptic ulcer
  of the stomach is called a gastric ulcer of the
  duodenum, a duodenal ulcer

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What are the causes of peptic ulcers?

• "Helicobacter pyloricus" (H. pylori).
• NSAIDs (nonsteroidal anti-inflammatory drugs).
• Cigarette smoking.
• Alcohol !!!

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• Note-
• Contrary to popular belief, alcohol, coffee,
  colas, spicy foods, and caffeine have no proven
  role in ulcer formation.
• What are symptoms of an ulcer?
• Upper abdominal burning or hunger pain one to
  three hours after meals and in the middle of the
  night.

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Peptic ulcer disease

• Complications include ulcer bleeding, ulcer
  perforation, and gastric obstruction.
• Patients with ulcer bleeding may report black
  tarry stools (melena), weakness, a sense of
  passing out upon standing (orthostatic syncope),
  and vomiting blood (hematemesis).

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What treatments are available for peptic ulcers?

• Antacids neutralize existing acid in the stomach.
• Histamine antagonists (H2 blockers) are drugs
  designed to block the action of histamine on
  gastric cells.
• Proton-pump inhibitors such as omeprazole (Omez).

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NAUSEA VOMITING

• Nausea and vomiting are symptoms of an underlying
  disease and not a specific illness.
• Nausea is the sensation that the stomach wants
  to empty itself.
• vomiting (emesis) or throwing up, is the act of
  forcible emptying of the stomach.

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What causes nausea or vomiting?

• Acute gastritis
• Central causes (signals from the brain)
• Association with other illnesses remote from the
  stomach
• Medications and medical treatments
• Mechanical obstruction of the bowel

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NAUSEA VOMITING

• 2. Systemic causes
• Elevated intra-cranial pressure (benign or
  neoplastic)
• Inner ear disease
• Medications (act locally on the stomach NSAIDs,
  erythromycin, or cardiac anti-arrhythmics or
  systemically like chemotherapeutics and opiates)
• Pregnancy
• Radiation therapy

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NAUSEA VOMITING

• Antiemetic agents include
• 5-HT3 antagonists ondansetron others
• D-2 antagonists domperidone
• Metoclopramide
• H-1 antagonists diphenhydramine meclizine

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Diarrhea dysentery

• What is diarrhea?
• Diarrhea is an increase in the frequency of bowel
  movements or a decrease in the form of stool
  (greater looseness of stool).

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Diarrhea dysentery

• What are common causes of acute diarrhea?
• The most common cause of acute diarrhea is
  infection--viral, bacterial, and parasitic.
• Bacteria also can cause acute food poisoning.
• A third important cause of acute diarrhea is
  starting a new medication.

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• Viral gastroenteritis
• Food poisoning
• Traveler's diarrhea
• Bacterial enterocolitis
• Parasites
• Drugs

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Diarrhea dysentery

• What are the complications of diarrhea?
• Dehydration
• Adult
• 
  children
• Hypotension with syncope (fainting upon standing
  due to a reduced volume of blood.
• Thirst , dry mouth and irritation of the anus .

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• When should the doctor be called for diarrhea?
• High fever
• Moderate or severe abdominal pain or tenderness
• Bloody diarrhea
• Prolonged vomiting that prevents intake of fluids
  orally
• Acute diarrhea in pregnant women
• Diarrhea that occurs during or immediately after
  completing a course of antibiotics
• 
  C. difficile

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Diarrhea dysentery

• Oral rehydration solutions (ORS) are liquids that
  contain a carbohydrate (glucose or rice syrup)
  and electrolyte (sodium, potassium, chloride, and
  citrate or bicarbonate).
• Absorbents. (attapulgite polycarbophil)
• Anti-motility medications.
• Antibiotics.
• Antiprotozoal.

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CONSTIPATION
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constipation

• Constipation means hard stools, difficulty
  passing stools (straining), or a sense of
  incomplete emptying after a bowel movement.

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constipation

• What causes constipation?
• Medications
• (Narcotic pain medications)
• (Antidepressants such as amitriptyline)
• (Anticonvulsants such as phenytoin)
• (Calcium channel blocking)
• Habit- Diet-Laxatives-Hormonal disorders-Central
  nervous system diseases.

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• What treatments are available for constipation?
• Dietary fiber (bulk-forming laxatives)
• Lubricant laxatives
• Emollient laxatives (stool softeners)
• Saline laxatives
• Stimulant laxatives
• Enemas
• Most herbal laxatives contain stimulant-type
  laxatives and should be used, if at all, as a
  last resort.

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• IBS is a functional disease, that is, a disease
  in which the intestine (bowel) functions
  abnormally.
• Theories of the cause of IBS include abnormal
  input from intestinal sensory nerves and abnormal
  stimulation of the intestines by the motor
  nerves.

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IBS

• What causes IBS?
• As described previously, IBS is believed to be
  due to the abnormal function (dysfunction) of the
  muscles of the organs of the gastrointestinal
  tract or the nerves controlling the organs.

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IBS

• The symptoms of slowed transportation are nausea,
  vomiting, abdominal bloating (the sensation of
  abdominal fullness), and abdominal distention
  (enlargement).
• The symptom of rapid transportation usually is
  diarrhea.

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How to solve your problems in the bathroom???????

• Peppermint
• Bran
• Sulprid
• Mebeverine
• Trimebutine

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Thank You