Diarrhoea, Constipation, Worm Infestation, Haemorrhoids

Question 1

What do the following cause, diarrhoea or constipation: calcium, magnesium, aluminium, bismuth subsalicylate

Answer 1

Constipation: calcium, aluminium, bismuth subsalicylate
Diarrhoea: magnesium

Question 2

Do hypotensive drugs cause diarrhoea or constipation (e.g. ACEi, BB, CCB like verapamil, diuretics like thiazides)?

Answer 2

Constipation

Question 3

Types of fibre, examples and how they work?

Answer 3

• soluble fibre (oats, psyllium fibre, beans, citrus fruits, laxatives): dissolves in water to form a gel like substance in the colon
• insoluble fibre (beans, nuts, leafy vegetables): increases stool bulk, retention of stool water & rate of transit of stool thru the intestine -> increase frequency of defecation

Question 4

Should you refer if someone has constipation for >7 days

Answer 4

Yes

Question 5

What is preferred and to avoid for constipation during pregnancy?

Answer 5

Preferred: bulk-forming laxative
Avoid: stimulant

Question 6

Classification of diarrhoea?

Answer 6

• acute (<14D)
• persistent (>14D)
• chronic (>4w)

Question 7

What are the 2 main viruses that cause diarrhoea?

Answer 7

Rotavirus, norovirus

Question 8

What are some bacteria that can cause diarrhoea?

Answer 8

Staphylococcus, Campylobacter, Salmonella, shigella, pathogenic E coli, Bacillus cereus, Listeria monocytogenes

Question 9

How is bacterial diarrhoea spread?

Answer 9

Food-borne

Question 10

How is viral diarrhoea spread?

Answer 10

Faecal oral route (rotavirus), contact (norovirus)

Question 11

What is recommended and not recommended to treat bacterial diarrhoea?

Answer 11

Recommended: fluid replacement
Not recommended: antibiotics

Question 12

Which strains of probiotics can help with diarrhoea?

Answer 12

Lactobacillus rhamnosus, Saccharomyces boulardii

Question 13

What Chinese supplement has been used for diarrhoea?

Answer 13

Po Chai pills

Question 14

What are the types of laxatives? and forensic classification

Answer 14

• bulk forming: GSL
• lubricant: GSL
• saline: GSL for enema, P-only for oral
• hyperosmotic: GSL
• stimulant: GSL
• chloride channel activators: POM

Question 15

What are the types of laxatives and examples?

Answer 15

• bulk forming: psyllium aka Fybogel
• lubricant: liquid paraffin
• saline: Fleet
• hyperosmotic: glycerin supp & enemas (glycerol, sato minica glycerin gel), macrogol (folax), lactulose (duphalac)
• stimulant: sennosides (Senna, EX-LAX), bisacodyl (dulcolax)
• chloride channel activators: lubiprostone

Question 16

Onset of effect of laxatives?

Answer 16

• bulk forming: 12-24h, up to 72h
• lubricant: 6-8h
• saline: 30min-3h after PO, 2-5min after PR
• hyperosmotic: 24-48h after PO, 15-60min after PR
• stimulant: 6-12h after PO, 15-60min after PR
• chloride channel activators: within 24h

Question 17

Which laxatives requires adequate water intake for them to work?

Answer 17

Bulk-forming, hyperosmotic

Question 18

How do saline laxatives work?

Answer 18

Presence of non-absorbable cations and anions in small intestines increases intraluminal pressure -> exert stimulus that increase intestinal motility

Question 19

Minimum age for using Macrogol, Fybogel, liquid paraffin, lactulose, glycerin, Senna, bisacodyl, lubiprostone

Answer 19

Macrogol: 8 years
Fybogel: 6 years
Liquid paraffin, Senna: 12 years
Lactulose & glycerin: <1y
Bisacodyl: 4 years (PO & PR)
Lubiprostone: adults

Question 20

What should be avoided if patient has intestinal obstruction?

Answer 20

Bulk-forming, stimulant

Question 21

What are Po Chai Pills used for?

Answer 21

Diarrhoea, vomiting, motion sickness, indigestion

Question 22

What can be used for diarrhoea? and examples and forensic classification

Answer 22

• probiotics (Lactoel Forte) GSL
• Po Chai pills GSL
• adsorbents: activated charcoal (ultracarbon, norit), smecta, kaolin (kaomix) GSL
• ORS
• anti-motility agents: loperamide (Imodium), diphenoxylate/atropine (dhamotil, lomotil) P-only
• anti-secretory agents: racecadotril (Hidrasec) POM

Question 23

Minimum age for smecta, activated charcoal, lactoel forte, loperamide, diphenoxylate/atropine, racecadotril?

Answer 23

Smecta: 2 years
Activated charcoal: can use in children
Lactoel forte: can use in infants
Loperamide: 6 years
Dhamotil: 12 years
Racecadotril: 3 months

Question 24

Dose of loperamide? and max dose

Answer 24

> 12y: 4mg initially, then 2mg after every loose stool, max 16mg/day

Question 25

Dose of diphenoxylate/atropine? and max dose

Answer 25

>12y: 2 tab QDS, max 8 tab/day

Question 26

What is the purpose of atropine in dhamotil?

Answer 26

Discourage abuse of diphenoxylate (opioid agonist) thru anticholinergic side effects

Question 27

How are pinworm infestations spread?

Answer 27

- Faecal-oral (directly by hand or indirectly through contaminated bed sheets or clothing) - inhalation of airborne eggs -> swallow - retro infection: pinworm hatches on anal verge and renters host

Question 28

How are pinworm and roundworm infestations spread?

Answer 28

Faecal-oral (infected pets pass faeces into soil/sand/plant -> human go touch)

Question 29

How are tapeworm infestations spread?

Answer 29

Ingestion of raw or undercooked beef/pork

Question 30

How are hookworm infestations spread?

Answer 30

Penetrate unprotected skin -> contact with contaminated soil or sand

Question 31

Symptoms of pinworm infestations?

Answer 31

Perianal itch at night (lay eggs at night)

Question 32

Should patients shower or use bathtub to wash anal area during pinworm infestation?

Answer 32

Shower Bathtub risk reinfection from bath water

Question 33

Treatment option for worm infestations? MOA? Forensic classification?

Answer 33

Albendazole (P-only): destroy microtubules in intestinal and tegmental cells of intestinal helminths

Question 34

How should albendazole be administered and why?

Answer 34

Localised GIT infections: empty stomach Systemic infections: with meals (esp high-fat) -> increase absorption

Question 35

Albendazole SE?

Answer 35

Common: HA, dizzy, N/V/D, abd pain Rare: rash, agranulocytosis, bone marrow suppression, hepatitis, acute liver & renal failure

Question 36

Dose and duration of albendazole?

Answer 36

>2y: 400mg (1 tablet) 1-2y: 200mg (half tablet) Duration: 1 day (can repeat in 2 weeks)

Question 37

How long to space apart adsorbents from other medications?

Answer 37

2h

Question 38

Treatment options for haemorrhoids? MOA? Forensic classification?

Answer 38

- Diosmin 450mg + Hesperidia 50mg (Daflon, Diosper) (GSL): reduce swelling, inflammation & pain by increasing venous distensibility & venous stasis, normalise capillary permeability and reinforce capillary resistance - Piles Ointment (GSL): anti-inflammatory, antibacterial, anti-hemorrhoidal properties - Preparation H Clear Gel/Ointment (GSL): temporarily shrinks swollen haemorrhoids tissue, provide relief from pain, itch & discomfort - Yunnan Baiyao Haemorrhoidal Ointment (GSL): resolve stasis, stop bleeding, disperse swelling - Proctosedyl Ointment (exemption): local anaesthetic, steroid (hydrocortisone), broad spectrum antibiotic (neomycin B sulfate), improve capillary permeability (esculin) - Proctosdyl suppository (exemption): local anaesthetic, steroid (hydrocortisone)

Question 39

Definition of constipation? Using what criteria?

Answer 39

Rome criteria: functional constipation ≥3m with ≥2 sx - straining (25% of the time) - hard stools (25% of the time) - incomplete evacuation (25% of the time) - ≤2 bowel movements/week

Question 40

Definition of diarrhoea?

Answer 40

>3 unformed stools in 24h