Functional and infective pathology of the lower GI tract: diarrhoea and constipation

Question 1

What is the suggested definition of diarrhea according to the World Health Organization?

Answer 1

‘The passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual).’

Question 2

How is acute diarrhea defined?

Answer 2

Diarrhea lasting 0-14 days.

Question 3

What is the definition of persistent diarrhea?

Answer 3

Diarrhea lasting 14 days to 4 weeks.

Question 4

How is chronic diarrhea defined?

Answer 4

Diarrhea lasting 4 or more weeks.

Question 5

Why is diarrhea considered one of the most common symptoms people seek medical attention for?

Answer 5

Because it is one of the most common symptoms people experience and consider significant enough to consult a healthcare professional.

Question 6

What is the estimated number of cases of acute diarrhea per year in the UK?

Answer 6

Approximately 17 million cases of acute diarrhea occur each year in the UK, potentially affecting up to 25% of the UK population.

Question 7

How many annual GP consultations are attributed to acute diarrhea in the UK?

Answer 7

There are approximately 1 million GP consultations per year in the UK related to acute diarrhea.

Question 8

What percentage of the US population is estimated to have chronic diarrhea?

Answer 8

Chronic diarrhea is estimated to affect 7-14% of the US population.

Question 9

What are the potential consequences of diarrhea in terms of morbidity and mortality?

Answer 9

Diarrhea can cause a significant amount of morbidity (illness) but generally has low mortality (death) rates.

Question 10

What is a major concern associated with diarrhea?

Answer 10

Dehydration is a significant concern due to the fluid loss caused by diarrhea.

Question 11

Which populations are at an increased risk of life-threatening illnesses due to diarrhea?

Answer 11

Young children and older adults are at an increased risk of developing life-threatening illnesses as a result of diarrhea.

Question 12

What are some potential effects of diarrhea on electrolyte balance?

Answer 12

Diarrhea can lead to electrolyte imbalances, including sodium (Na), potassium (K), and bicarbonate (HCO3) levels.

Question 13

How can diarrhea contribute to acidosis?

Answer 13

Prolonged diarrhea can lead to acidosis, an imbalance in the body’s acid-base equilibrium.

Question 14

How can chronic diarrhea impact individuals’ well-being?

Answer 14

Chronic diarrhea can have negative effects on well-being, mental health, daily activities, dietary choices, and may contribute to social isolation.

Question 15

What is the mechanism of action for osmotic diarrhea?

Answer 15

Osmotic diarrhea occurs when non-absorbed hypotonic compounds in the lumen of the intestine increase fluid loss. Examples include ingestion of magnesium-containing antacids, sorbitol, general malabsorption (e.g., pancreatic insufficiency), and specific absorptive defects (e.g., lactose intolerance).

Question 16

What is the mechanism of action for secretory diarrhea?

Answer 16

Secretory diarrhea is characterized by increased secretion of substances and ions into the intestinal lumen, coupled with decreased uptake. Examples include enterotoxins (Cholera, E. coli, C. difficile), VIP (Vasoactive Intestinal Peptide), and colonic bile salts and fatty acids following ileal resection.

Question 17

What is the mechanism of action for inflammatory diarrhea?

Answer 17

Inflammatory diarrhea occurs when there is an inflamed mucosa, leading to the loss of fluid and blood into the intestinal lumen and decreased absorption of fluid and ions. Examples include Shigella infection, Crohn’s disease, and ulcerative colitis.

Question 18

What is the mechanism of action for abnormal motility diarrhea?

Answer 18

Abnormal motility diarrhea is characterized by increased gastrointestinal motility. It can be caused by functional disorders, diabetes, and hyperthyroidism.

Question 19

What is the mechanism of action for overflow/mechanical diarrhea?

Answer 19

Overflow/mechanical diarrhea occurs when an obstructing body allows liquid to pass through while solid feces accumulate. Examples include chronic constipation, impaction, and neoplasms.

Question 20

What are some common viral causes of acute diarrhea?

Answer 20

Viral causes of acute diarrhea include norovirus and rotavirus.

Question 21

Which bacterial pathogens can cause acute diarrhea?

Answer 21

Bacterial causes of acute diarrhea include Salmonella, Campylobacter, Clostridium difficile, and cholera.

Question 22

What are some examples of parasitic causes of acute diarrhea?

Answer 22

Parasitic causes of acute diarrhea include Giardia lamblia and Cryptosporidium parvum.

Question 23

Which medications can potentially cause diarrhea?

Answer 23

More than 700 medications can cause diarrhea, including laxatives, antibiotics (especially macrolides), and allopurinol.

Question 24

What is meant by “acute presentation of chronic pathology” in the context of diarrhea?

Answer 24

It refers to cases where an underlying chronic condition presents with acute episodes of diarrhea, such as in acute appendicitis, intestinal ischemia, or after radiotherapy.

Question 25

What are some other factors that can cause acute diarrhea?

Answer 25

Other causes of acute diarrhea include anxiety, food allergies, and gastrointestinal inflammation (e.g., acute appendicitis, intestinal ischemia, and radiotherapy).

Question 26

What is the most common cause of infectious diarrhea?

Answer 26

Most infectious diarrhea cases are caused by viral infections and are self-limiting.

Question 27

How long does the majority of infectious diarrhea cases last?

Answer 27

Approximately 50% of infectious diarrhea cases last less than 1 day.

Question 28

What is the typical duration of viral infectious diarrhea?

Answer 28

Viral infectious diarrhea typically lasts for 2-3 days.

Question 29

How long does untreated bacterial infectious diarrhea typically last?

Answer 29

Untreated bacterial infectious diarrhea usually lasts for 3-7 days.

Question 30

What is the expected duration of untreated protozoal infectious diarrhea?

Answer 30

Untreated protozoal infectious diarrhea can persist for weeks to months.

Question 31

Is it always necessary to conduct investigations for acute diarrhea?

Answer 31

Investigations may not be needed if the patient is well and the symptoms are short-lived or quickly resolving.

Question 32

When is stool testing (faecal MC&S) typically recommended?

Answer 32

Stool testing, such as faecal microscopy, culture, and sensitivity (MC&S), is particularly useful if the patient is vulnerable, there may be an unusual cause of diarrhea, or there is a need to exclude an infectious cause for public health reasons.

Question 33

What blood tests are commonly performed to investigate acute diarrhea?

Answer 33

Blood tests such as a complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), liver function tests (LFTs), urea and electrolytes (U&Es), and iron studies are often conducted to rule out other acute causes of diarrhea.

Question 34

What is the general management approach for acute diarrhea?

Answer 34

In most cases, no specific treatment is needed for acute diarrhea. Supportive measures focus on maintaining hydration.

Question 35

How can hydration be maintained in cases of acute diarrhea?

Answer 35

Hydration can be maintained by using solutions such as hypertonic saline/glucose solution (e.g., Dioralyte) to replenish electrolytes and fluids lost through diarrhea.

Question 36

When might hospitalization be necessary for acute diarrhea?

Answer 36

Hospitalization may be required if the patient is significantly unwell or at risk of dehydration.

Question 37

When are subsequent diagnostics usually performed for acute diarrhea?

Answer 37

Further diagnostic tests are typically conducted once the acute episode of diarrhea has settled, if deemed necessary.

Question 38

Are antibiotics commonly prescribed for acute diarrhea, even if it is proven to be an infection?

Answer 38

Antibiotics are seldom needed for acute diarrhea, including cases caused by proven infections, unless the diarrhea is severe.

Question 39

What is the most common concern in managing acute diarrhea?

Answer 39

Dehydration is the most common concern in the management of acute diarrhea.

Question 40

How can diet contribute to chronic diarrhea?

Answer 40

Chronic diarrhea can be caused by factors such as malabsorption, artificial sweeteners (with excessive sorbitol), as well as the consumption of caffeine and alcohol.

Question 41

What are some bowel diseases that can cause chronic diarrhea?

Answer 41

Chronic diarrhea can be associated with bowel diseases such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), microscopic colitis, coeliac disease, pancreatic insufficiency, absorption problems, pancreatic and colorectal cancer, small bowel overgrowth, mesenteric ischemia, fistulae, short gut syndrome, Whipple’s disease, tropical sprue, amyloidosis, and radiation enteropathy.

Question 42

How can constipation and impaction lead to chronic diarrhea?

Answer 42

Chronic diarrhea can be a result of underlying constipation and impaction, where liquid stool bypasses the impacted stool.

Question 43

What are some common drugs that can cause chronic diarrhea?

Answer 43

Chronic diarrhea can be caused by various drugs, including macrolides, ACE inhibitors, NSAIDs, metformin, DPP4 inhibitors, proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), oncology drugs, theophyllines, antiarrhythmics, and furosemide.

Question 44

Besides drugs, what are some other causes of chronic diarrhea?

Answer 44

Other causes of chronic diarrhea include infections, endocrine disorders, cystic fibrosis, lymphoma, hormone-secreting tumors (e.g., VIPoma, gastrinoma, carcinoid), autonomic neuropathy, and factitious diarrhea (diarrhea intentionally induced).

Question 45

What are the common tests performed to investigate chronic diarrhea?

Answer 45

The same tests used for investigating acute diarrhea are also conducted for chronic diarrhea. These include stool microscopy, culture, and sensitivity (MC&S), with the addition of parasitology testing to identify potential parasitic causes.

Question 46

Which blood tests are often performed to explore a wider differential diagnosis in chronic diarrhea?

Answer 46

Blood tests such as CA 125, thyroid function tests (TFTs), tissue transglutaminase (tTG) antibody, vitamin B12/folate levels, calcium levels, ferritin levels, and gut hormone levels may be conducted to aid in the evaluation of chronic diarrhea.

Question 47

What additional stool tests may be performed depending on the case of chronic diarrhea?

Answer 47

Additional stool tests that may be considered include quantitative fecal immunochemical test (qFIT) for possible malignancy, fecal calprotectin for suspected inflammatory bowel disease (IBD), and fecal elastase to assess pancreatic exocrine function.

Question 48

What imaging modalities are useful in investigating chronic diarrhea?

Answer 48

Depending on the presentation, imaging modalities such as ultrasound, CT/MRI scans, or endoscopy may be utilized. MRI scans are particularly beneficial for evaluating the small bowel.

Question 49

What is the significance of the quantitative fecal immunochemical test (qFIT)?

Answer 49

qFIT is considered the first-line investigation for evaluating a change in bowel habit and is useful in ruling out bowel cancer.

Question 50

What is the risk of bowel cancer based on the qFIT results?

Answer 50

If the qFIT result is normal (less than 10μg Hb/g of feces), the risk of bowel cancer is approximately 0.4%. If the qFIT result is above 10, the risk increases to 6%, and if it exceeds 150, the risk further rises to 31%.

Question 51

How does qFIT benefit the diagnostic process?

Answer 51

The qFIT test reduces the need for invasive investigations by providing valuable information about the risk of bowel cancer. It helps to identify individuals who may require further investigations and supports appropriate referral decisions.

Question 52

What is the definition of Irritable Bowel Syndrome (IBS) according to NICE?

Answer 52

According to NICE, IBS is characterized by abdominal pain that is either related to defecation or associated with altered stool frequency or appearance. To diagnose IBS, at least two of the following criteria must be met: altered stool passage (straining, urgency, incomplete evacuation), bloating or distension, symptoms worsened by eating, and passing rectal mucus. Additionally, alternative conditions must be excluded.

Question 53

What is the estimated prevalence of IBS in the global population?

Answer 53

The prevalence of IBS in the global population is estimated to be between 5% and 20%, although it is likely underreported.

Question 54

Which age group is most commonly affected by IBS?

Answer 54

IBS most commonly affects individuals between the ages of 20 and 30.

Question 55

Is IBS more common in men or women?

Answer 55

IBS is more common in women.

Question 56

What are some potential factors contributing to the development of IBS?

Answer 56

The exact cause of IBS is unknown, but it may involve genetic factors, dietary factors, gut infections, and psychosocial factors.

Question 57

What is the initial approach to managing IBS?

Answer 57

The initial approach to managing IBS involves ruling out alternative or sinister causes for the symptoms and providing reassurance to the patient.

Question 58

What dietary manipulations can be beneficial for IBS management?

Answer 58

For diarrhea-predominant IBS, reducing insoluble fiber intake (bran, wholemeal flour/bread) and avoiding food triggers such as caffeine, alcohol, and carbonated drinks may be helpful. For constipation-predominant IBS, consuming soluble fiber supplements or foods high in soluble fiber and maintaining adequate fluid intake are recommended. The low FODMAP diet (avoiding fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) can also be effective.

Question 59

Can probiotics be beneficial for managing IBS?

Answer 59

Probiotics may be helpful in managing IBS symptoms.

Question 60

What is a commonly used medication for managing diarrhea-predominant IBS?

Answer 60

Loperamide, an antimotility agent, is commonly used to manage diarrhea in IBS. However, its common side effect is constipation, and higher doses can potentially lead to cardiac arrhythmias.

Question 61

What are antispasmodic drugs used for in IBS management?

Answer 61

Antispasmodic drugs such as hyoscine butylbromide (buscopan), which has antimuscarinic properties, are used to relieve abdominal cramps in IBS.

Question 62

How are constipation-predominant IBS symptoms managed with medication?

Answer 62

Laxatives, particularly bulk-forming agents like ispaghula husk, are used to alleviate constipation in IBS. Lactulose should be avoided as it can cause excessive bloating. Additionally, a low dose of tricyclic antidepressant (such as amitriptyline) can be tried for a 4-week trial, as it has shown to have a positive response in over 90% of patients with varying levels of success.

Question 63

How can constipation be categorized based on time?

Answer 63

Constipation can be categorized as acute when it lasts for 0-3 months and chronic when it persists for 3 months or more.

Question 64

What are the two main causes of constipation?

Answer 64

Constipation can be categorized as primary (functional) or secondary (organic) based on its underlying causes.

Question 65

What is primary (functional) constipation?

Answer 65

Primary constipation refers to constipation that does not have an identifiable organic cause. It is usually due to factors such as diet, lifestyle, inadequate fluid intake, lack of physical activity, or an issue with the functioning of the colon.

Question 66

What is secondary (organic) constipation?

Answer 66

Secondary constipation refers to constipation that is caused by an identifiable organic or structural abnormality. It may be the result of conditions such as intestinal obstruction, hormonal disorders, neurological disorders, or medication side effects.

Question 67

What blood tests are commonly performed to investigate constipation?

Answer 67

Blood tests often include a full blood count (FBC), inflammatory markers, iron studies, liver function tests, thyroid function tests, HbA1c (glycated hemoglobin), calcium, and B12/folate levels.

Question 68

What stool tests are conducted in the investigation of constipation?

Answer 68

Stool tests commonly include the quantitative fecal immunochemical test (qFIT) and calprotectin to assess for potential underlying conditions.

Question 69

What imaging modalities can be used in the investigation of constipation?

Answer 69

Abdominal x-ray is often performed, especially in the acute setting, while a CT scan may be used for more detailed evaluation. Endoscopy, such as colonoscopy or virtual colonoscopy, may also be performed to examine the colon and rectum.

Question 70

What are some special investigations that can be conducted for constipation?

Answer 70

Special investigations for constipation may include a bowel transit study, which assesses the movement of stool through the digestive system, and pelvic floor investigations to evaluate the function of the pelvic floor muscles.

Question 71

What are some common causes of acute constipation?

Answer 71

Acute constipation can be caused by factors such as functional constipation (related to dehydration, diet, and stress), medication use (e.g., opiates, loperamide, iron supplements), and acute presentation of underlying chronic pathology.

Question 72

How can dehydration contribute to acute constipation?

Answer 72

Dehydration can lead to decreased fluid content in the stool, making it harder and more difficult to pass.

Question 73

Which medications can cause acute constipation?

Answer 73

Medications such as opiates (e.g., codeine, morphine), loperamide (antidiarrheal agent), and iron supplements are known to cause constipation as a side effect.

Question 74

What does the term “acute presentation of chronic pathology” mean in the context of constipation?

Answer 74

It refers to cases where a person with an underlying chronic condition experiences an acute episode of constipation, which may indicate a worsening or complication of their existing condition. In some cases, bowel obstruction can be the underlying cause.

Question 75

How do opiates cause constipation?

Answer 75

Opiates exert their effects through various opioid receptors, predominantly the μ receptors in the gastrointestinal (GI) tract. Activation of μ receptors, particularly μ2, leads to reduced GI motility and increased sphincter tone, resulting in constipation. The binding of loperamide to μ receptors specifically promotes constipation.

Question 76

What are some common causes of chronic constipation?

Answer 76

Chronic constipation can be caused by factors such as functional constipation (related to dehydration, diet, stress, IBS, pregnancy, and withholding), medication use (including opiates, loperamide, iron supplements, calcium channel blockers, and antimuscarinics), colonic conditions (cancer, IBD with stricturing, diverticular disease, extrinsic compression), pelvic floor/defecatory disorders (rectal prolapse, rectocele, pelvic floor dyssynergia, megarectum), endocrine disorders (hypothyroidism, hypercalcemia, diabetes mellitus, porphyria), and neurological conditions (MS, spinal cord lesions, Parkinson’s disease, Hirschsprung’s disease).

Question 77

What are some colonic causes of chronic constipation?

Answer 77

Colonic causes of chronic constipation include conditions such as cancer, inflammatory bowel disease (IBD) with stricturing, diverticular disease, extrinsic compression (rare), and painful conditions like anal fissures.

Question 78

What are some pelvic floor/defecatory disorders that can lead to chronic constipation?

Answer 78

Pelvic floor/defecatory disorders such as rectal prolapse, rectocele, pelvic floor dyssynergia, and megarectum can contribute to chronic constipation.

Question 79

What are some endocrine and neurological conditions associated with chronic constipation?

Answer 79

Endocrine disorders such as hypothyroidism, hypercalcemia, diabetes mellitus, and porphyria, as well as neurological conditions like multiple sclerosis (MS), spinal cord lesions, Parkinson’s disease, and Hirschsprung’s disease, can cause chronic constipation.

Question 80

What is the initial step in managing chronic constipation?

Answer 80

The initial step is to remove any identifiable insults or underlying causes contributing to constipation. However, this is not always possible.

Question 81

How can the environment be made favorable for bowel movements in chronic constipation management?

Answer 81

Measures can be taken to create a favorable environment for bowel opening, including ensuring adequate fiber and fluid intake, increasing physical activity, discontinuing constipating medications, and promoting correct toilet behavior (such as not ignoring the urge to defecate, which is common in children).

Question 82

What should be addressed first if fecal impaction is present in chronic constipation?

Answer 82

If fecal impaction is present, it should be resolved first. This can be achieved through enemas, suppositories, and in rare cases, manual evacuation may be necessary.

Question 83

What role do laxatives play in the management of chronic constipation?

Answer 83

Laxatives are commonly used to alleviate constipation. They help soften the stool and promote bowel movements.

Question 84

What are some advanced treatment options for chronic constipation?

Answer 84

Advanced treatment options for chronic constipation include neuromodulation, such as sacral nerve stimulation, and surgical interventions like (sub)total colectomy or stoma creation.

Question 85

What is diverticular disease?

Answer 85

Diverticular disease refers to the protrusion of mucosal pouches through the muscular wall of the bowel.

Question 86

What is the relationship between diverticular disease and constipation?

Answer 86

Diverticular disease is intimately linked with constipation, although it is unclear whether constipation is the cause or the effect of diverticular disease, or if both conditions influence each other.

Question 87

What is the role of dietary fiber in diverticular disease?

Answer 87

Poor dietary fiber intake is implicated in the development and progression of diverticular disease. Insufficient fiber intake can contribute to both constipation and the formation of diverticula.

Question 88

Where is the highest incidence of diverticular disease seen?

Answer 88

Diverticular disease has the highest incidence in Western countries. In the UK, over 60% of people over the age of 70 have diverticula.

Question 89

In which anatomical location of the colon is diverticular disease most commonly found?

Answer 89

Diverticular disease is most commonly found in the sigmoid colon, which has the highest intra-luminal pressure in the colon.

Question 90

What percentage of people with diverticular disease experience symptoms?

Answer 90

More than 90% of people with diverticular disease have no symptoms and are considered asymptomatic.

Question 91

What is the characteristic feature of proximal bowel obstruction?

Answer 91

In proximal bowel obstruction, the bowels may still be functional despite the obstruction. This can make the patient’s history misleading.

Question 92

What is meant by “absolute constipation” in the context of bowel obstruction?

Answer 92

“Absolute constipation” refers to the absence of passage of stool or flatus. It is often indicative of a distal mechanical obstruction of the colon.

Question 93

Why is it important to establish the cause of bowel obstruction quickly?

Answer 93

Establishing the cause of bowel obstruction quickly is crucial as it helps determine if spontaneous resolution is possible or if surgical intervention is necessary. Timely management is essential for the best outcome.

Question 94

Can adhesional small bowel obstruction resolve without surgery?

Answer 94

Yes, adhesional small bowel obstruction can resolve without surgery in over 90% of cases. Spontaneous resolution is possible, but close monitoring and medical management are needed.

Question 95

What are some common causes of bowel obstruction?

Answer 95

Common causes of bowel obstruction include extrinsic factors such as abdominal masses, adhesions/scar tissue, hernias, and neoplasia, as well as intrinsic factors such as inflammatory strictures/narrowing and luminal causes like bezoars or foreign bodies.

Question 96

What is the initial management approach for suspected bowel obstruction?

Answer 96

If a patient is unwell, immediate resuscitation is required. Early investigation is essential, and computed tomography (CT) is highly sensitive and specific for diagnosing bowel obstruction.

Question 97

What decision needs to be made in the management of bowel obstruction?

Answer 97

The decision is whether the obstruction will settle on its own or if intervention is necessary. “Closed loop” large bowel obstruction, in particular, is considered an emergency situation.

Question 98

What is the significance of a competent ileocaecal valve in bowel obstruction?

Answer 98

A competent ileocaecal valve, which prevents reflux into the ileum, is present in about 50% of cases and can help determine the management approach.

Question 99

What should be considered when a patient presents with right lower abdominal pain and an obstructed colon?

Answer 99

When encountering a patient with right lower abdominal pain and an obstructed colon, caution should be exercised as this presentation may suggest a potential surgical emergency.

Question 100

What are some key features to consider in the context of bowel cancer?

Answer 100

Bowel cancer can present with vague or no gastrointestinal symptoms. It is important to assess any changes from a person’s normal bowel habits. Iron deficiency anemia and an elevated quantitative fecal immunochemical test (qFIT) increase concerns for bowel cancer.

Question 101

What is the incidence of colorectal cancer in the UK?

Answer 101

In the UK, there are approximately 40,000 new cases of colorectal cancer each year.

Question 102

What is the incidence of anal cancer in the UK?

Answer 102

In the UK, there are approximately 1,000 new cases of anal cancer per year.

Question 103

What is the 5-year survival rate for both colorectal and anal cancers?

Answer 103

The 5-year survival rate for both colorectal cancer and anal cancer is approximately 60%.

Question 104

What are examples of bulk laxatives?

Answer 104

Examples of bulk laxatives include Ispaghula husk (brand name Fybogel) and Methylcellulose. These indigestible polysaccharides increase luminal volume, stimulate the enteric reflex, and promote peristalsis.

Question 105

What are examples of osmotic laxatives?

Answer 105

Examples of osmotic laxatives include Lactulose, macrogols (brand name Movicol), and phosphate enemas (brand name Cleen). These substances, when poorly absorbed, increase water content in the lumen, soften the stool, and stimulate peristalsis through the enteric reflex.

Question 106

What are examples of stimulant laxatives?

Answer 106

Examples of stimulant laxatives include Senna, co-danthramer, bisacodyl, sodium picosulfate, and glycerol enema. These laxatives increase peristalsis by acting on mucosal nerves. Co-danthramer is potentially carcinogenic and is often used in palliative care, while glycerol acts as a stimulant and lubricant.

Question 107

What are examples of faecal softeners/lubricants?

Answer 107

Examples of faecal softeners/lubricants include Docusate sodium (brand name Docusate) and Arachis oil or liquid paraffin enema. Docusate sodium acts as a surfactant, increasing water and lipid absorption into the stool to soften it. Arachis oil and liquid paraffin lubricate the stool.

Question 108

What is Linaclotide?

Answer 108

Linaclotide is a medication that acts as a guanylate cyclase-C receptor agonist. It increases intestinal fluid secretion (chloride and bicarbonate) into the lumen, thereby increasing intestinal volume. Linaclotide is used in the treatment of irritable bowel syndrome (IBS) and can help decrease visceral pain.

Question 109

What is Prucalopride?

Answer 109

Prucalopride is a selective serotonin 5HT4 receptor agonist. It functions as a prokinetic agent rather than a true laxative. Prucalopride is primarily used for the treatment of slow transit constipation, helping to enhance gut motility.

Question 110

What is the role of Erythromycin as a laxative?

Answer 110

Erythromycin, which is a macrolide antibiotic, possesses prokinetic qualities. It can stimulate gut motility and is sometimes used as a prokinetic agent in cases of constipation.

Question 111

What are some common side effects of laxatives?

Answer 111

Common side effects of laxatives include diarrhea or excessive flatus (gas), bloating (particularly with bulk-forming and osmotic laxatives), cramps (seen with osmotic and stimulant laxatives), and rarely electrolyte imbalances.

Question 112

Which type of laxatives is most commonly associated with electrolyte imbalances?

Answer 112

Purgative laxatives, particularly those used for bowel preparation such as Picolax or Moviprep, can cause large fluid and electrolyte losses, potentially leading to electrolyte imbalances. This is less common with other types of laxatives.

Question 113

What should be considered when using laxatives in cases of suspected partial bowel obstruction?

Answer 113

Caution should be exercised when using laxatives in cases of suspected partial bowel obstruction, as they can potentially worsen the obstruction or lead to bowel perforation. A thorough evaluation is needed before initiating laxative use in such cases.