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Lower Gastro-intestinal system Summary

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In depth summary of lower GI conditions and associated medications for the gastrointestinal system.

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  • July 22, 2023
  • 7
  • 2022/2023
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rosiemalley
Lower GI Conditions and Pharmacology
Constipation




 What is it: the passage of hard stools less frequent than normal. Typically, less than 3
bowel movements per week.
 Symptoms: abdominal pain, cramps, bloating, nausea and difficulty passing the stool.
 Most common in women (especially pregnant) and older people.
 How do we measure it in practice: Bristol stool chart types 1-7




 Type 1-2 is constipation.
 Types 5-7 are diarrhoea.
 Causes of Constipation:
o No cause (functional)
o Medication
o Non-medical factors e.g., diet and dehydration
o Medical conditions e.g., IBS, IBD etc.
 Non-pharmacological advice:
o Increase fluid intake.
o Exercise
Red Flags for Constipation
 Loss of weight
 Blood in stools or vomit
 Bleeding from rectum
 Family history

,  Obstruction signs
 Nausea and vomiting
 Aged>40
 No cause but, persistent for >14 days

Bulk-forming Laxatives



 Insoluble polysaccharide polymers that are not digested by the upper GI tract.
 They expand when taking up water in the small intestine making a bulky mass.
 Due to the walls expanding this promotes peristalsis (contractions in the GI tract)
 They take several days to work but have no serious or unwanted effects.
 Makes it easier for faecal matter to pass.
 Examples: methylcellulose, the brand fybogel.
 Safe in pregnant and the elderly for long-term medication.

Osmotic laxatives




Example: lactulose
 These are poorly absorbed solutes made of salts such as magnesium sulfate and
magnesium hydroxide.
 Once these agents enter the intestine the concentration of solutes increases: known
as an osmotic load.
 So, water is drawn in via osmosis.
 So, the stool volume increases and so does the flow of stools in the intestines.
 And the Walls of the intestine expand so peristalsis occurs.
 Distention (swollen stomach) and purgation (evacuation of the faecal matter) occurs
when the laxatives take their effect.
 Lactulose on the other hand takes 2-3 days to act.
 Abdominal cramps are common.
 Magnesium should be avoided in small children and patients with poor renal
function as it can cause heart block and have other effects on the CNS.



Stimulant Laxatives

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