Diarrhoea

Question 1

What does peristalsis do?

Answer 1

-It moves contents through the GI tract

Question 2

What occurs when there is an increased transit time?

Answer 2

-Leads to increased absorption of water which leads to constipation

Question 3

What occurs when there is decreased transit time?

Answer 3

-Decreased water and nutrient absportion which leads to diarrhoea

Question 4

The lower the motility, the longer it takes for goods to move from mouth to anus. TRUE OR FLASE?

Answer 4

TRUE

Question 5

What is diarrhoea?

Answer 5

A failure of fluid handling in a normal adults small intestine

Question 6

How much fluid is input into the colon per day?

Answer 6

1.5-2.0 litres

Question 7

How much fluid is output in faeces?

Answer 7

100-200 ml/ per day

Question 8

What is the major function of the colon?

Answer 8

To absorb fluids

Question 9

What are the two major types of diarrhoea?

Answer 9

• Osmotic

- Secretory

Question 10

What occurs in osmotic diarrhoea?

Answer 10

-Excess of osmotically active particles in the gut lumen

Question 11

What occurs in secretory diarrhoea?

Answer 11

-Bowel mucosa secretes excess water into the lumen

Question 12

What causes osmotic diarrhoea?

Answer 12

• Osmotic laxatives
• Excessive solutes in the lumen
• Inflammation within the mucosa
• Motility disorders

Question 13

What occurs in secretory diarrhoea?

Answer 13

• Cholera toxin
• Other infective causes
• Specific electrolytes transport defects

Question 14

How can osmotic diarrhoea be treated?

Answer 14

-By removing the source of the osmotically active particles e.g fasting

Question 15

In secretory diarrhoea, fasting does not alter the mechanisms and therefore does not halt diarrhoea. TRUE OR FALSE?

Answer 15

TRUE

Question 16

Diarrhoea is defined as the increase in stool frequency or water content. TRUE OR FALSE?

Answer 16

TRUE

Question 17

Give examples of some of the agents that cause infections leading to diarrhoea?

Answer 17

-Shigella, salmonella , E.Coli

Question 18

How does infection cause diarrhoea?

Answer 18

• They damage the mucosa e.g rotavirus

- The toxins produced by the infectious agent e.g cholera

Question 19

What does CFTR stand for?

Answer 19

Cystic fibrosis transmembrane conductance regulator

Question 20

What occurs in cystic fibrosis?

Answer 20

-The protein is mutated

Question 21

CFTR is the only ATPase that pumps ions downhill. TRUE OR FALSE?

Answer 21

TRUE

Question 22

Clostridium difficile is the major cause of diarrhoea and colitis in patients exposed to antibiotics. TRUE OR FALSE?

Answer 22

TRUE

Question 23

Describe the stages of infection from C. difficile?

Answer 23

• Alteration of normal colonic flora
• Colonic colonization
• Growth and production of toxins
• Infection can lead to fromation of colitis

Question 24

How can an infection from C. Difficle be treated?

Answer 24

• Discontinue offending antibitotics
• Metronidazole (contraindicated in paients with liver or renal impairment
• Vancomycin (contraindicated with patients with renal impairment)

Question 25

Diarrhoea can be good, as it removes irritating substances for gut. TRUE OR FALSE?

Answer 25

TRUE

Question 26

Diarrhoea can lead to significant fluid and salt loss which can be lethal. TRUE OR FALSE?

Answer 26

TRUE

Question 27

What are treatment measures to treat diarrhoea?

Answer 27

- identify cause of diarrhoea - Restore fluids/electrolytes by oral rehydration therapy - Elimination of infection may be necessary e.g by using abosrbent agents such as kaolin and anti-diarrhoeal drugs

Question 28

When are antidiarrheal drugs indicated?

Answer 28

- Severe or prolonged diarrhea - Severe diarrhea in young children and older adults - When specific causes of diarrhoea have been determined - In chronic inflammatory diseases of the bowel e.g ulcerative colitis and crohn's disease - In ileostomies

Question 29

What are the contraindications for the use of antidiarrhoeal drugs and what can occur if this is given to patients?

Answer 29

-When diarrhoea is caused by - toxic materials -Microorganisms that penetrate intestinal mucosa -Antibiotic - associated colitis Antidiarrheal agents that slow peristalsis may aggravate and prolong diarrhoea

Question 30

Opiates (morphine and codeine) are contraindicated in chronic diarrhoea because of possible opiate dependence. TRUE OR FALSE?

Answer 30

TRUE

Question 31

Difenoxin and loperamide are not contraninidcated in children younger than 2 years of age. TRUE OR FALSE?

Answer 31

FALSE

Question 32

How do anti-motiltiy agents work?

Answer 32

-They reduce persistalsis by stimulating opiod receptors in the bowel, which decreases GI motility and increase absorption of water from the bowel

Question 33

Adsorbents and bulk forming drugs can be useful in some form of low grade chronic diarrhoea. TRUE OR FALSE?

Answer 33

TRUE

Question 34

What are adsorbents such kaolin not recommended for?

Answer 34

Acute diarrhoea

Question 35

Describe the mechanism of action of opiods?

Answer 35

- Intestinal motility of micro receptors - Intestinal secretion of delta receptors - Intestinal absorption of micro and delta receptors

Question 36

Commonly used opiod receptors act via peripheral receptors. TRUE OR FALSE?

Answer 36

TRUE

Question 37

Loperamide is 40-50 times more potent than morphine as an anti-diarrheal drug. TRUE OR FALSE?

Answer 37

TRUE

Question 38

How does loperamide (imodium) work?

Answer 38

- Increase the small instine and mouth to cecum transit time, increases anal sphincter tone - Contains anti secretory activity against cholera toxin and some forms of E. Coli toxin

Question 39

What is the half life of Loperamide?

Answer 39

11 hours

Question 40

What are some of the ADRs for Imodium?

Answer 40

-Adbominal cramping, dizziness, drowsiness

Question 41

Codeine is a weak opiate that is metabolised to morphine. TRUE OR FALSE?

Answer 41

TRUE

Question 42

What are the ADRs for codeine?

Answer 42

-Drowsiness, long list of opoid related minor side effects can cause physical dependence

Question 43

What are the contranindications for codeine?

Answer 43

-Acute respiratory depression, paralytic ileus

Question 44

Morphine is not a strong opiate and is not used as kaolin and morphine mixture. TRUE OR FALSE?

Answer 44

FALSE

Question 45

Morphine has a greater risks for dependence than codeine. TRUE OR FALSE?

Answer 45

TRUE

Question 46

What is Co-Phenotrope a combination of and which one is the opiate?

Answer 46

- Diphenoxylate and atropine | - Diphenoxylate - opiate

Question 47

Atropine is not a antiperistaltic. TRUE OR FALSE?

Answer 47

FALSE

Question 48

Co-Phenotrope can cross BBB which can lead to euphoria, respiratory depression, drowsiness, diziness. TRUE OR FALSE?

Answer 48

TRUE

Question 49

What group of patients should be not be given Co-Phenotrope?

Answer 49

-Patients with acute inflammatory disease of the bowel (ulcerative colitis, crohn's disease) can cause acute toxic megacolon

Question 50

Adsorbents are not recommended for use in acute diarrhoea. TRUE OR FALSE?

Answer 50

TRUE

Question 51

Adsorbents non selectively absorbs intestinal fluid. TRUE OR FALSE?

Answer 51

TRUE

Question 52

What do adsorbents do?

Answer 52

- Regulates stool texture and viscosity | - Bind bacteria toxins and bile salts

Question 53

What do probiotics do?

Answer 53

- They replace normal colonic microflora | - restores instenial function and supresses the growth of pathogenic bacteria

Question 54

Provide some examples of probiotics?

Answer 54

- Diary products e.g lactose | - Lactobacillus acidophilus