GIT Flashcards

Question

what is constipation

Answer 1

▪ Constipation is defined as difficult or infrequent passage of stool, at times associated with straining or a feeling of incomplete defecation. ▪ Causes: inappropriate diet, insufficient fluid intake, insufficient fiber intake, lack of physical activity, malignant disease, drugs. ▪ Diagnosis: if the frequency of bowel movements is less than once in 2 or 3 days. ▪ Alternating diarrhea and constipation is a symptom of irritable bowel syndrome.

Answer 2

✓ Bulk forming laxative: act mainly via physicochemical effects within the bowel lumen. ✓ Stimulant laxative (purgatives), which act directly on the mucos a of the GI tract

Answer 3

Are the most commonly recommended initial treatments for constipation. ▪ Bulk-forming laxatives may work as quickly as 12 hours after use or take as long as 3 days to be effective. ▪ They contain a high percentage of fiber and are often rich in polysaccharides (mucilage), which swell in the GI tract and produce lubrication. They influence the composition of food material in the GI tract, especially via the colonic bacteria, which are provided with nutrients for proliferation. ▪ This in turn influences the composition of the GI flora and the metabolism of the food in the tract (including an increase in gas, or flatus). ▪ Preparations of bulk-forming laxatives are always taken with plenty of water. They are not absorbed from the intestines into the body and are safe for long-term use. They are also safe for elderly patients to use. ▪ Bulk laxatives are considered safe during pregnancy. ▪ Contraindications: ✓ Bedridden patients and those with altered cognition. ✓ Bowel obstruction, and stenotic lesions of the GIT contraindicate the use of bulk-forming laxatives ✓ Can they be taken with loperamide? no

Answer 4

▪ Scientific name: Linum usitatissimum. ▪ Part used: the ripe seeds. ▪ The seed must be ground so that it can absorb fluid and swell. ▪ Constituents: mucilages. ▪ Dose: 3-6 capsules, each containing 1,000 mg oil. ▪ Drug-herb interaction: ✓ It may be reduced absorption of oral drugs, such as antibiotics ..etc, if administered concomitantly with linseed. ✓ This is due to adsorption of drugs on the polysaccharide mucilage. ✓ For this reason it should be taken 0.5 – 1 hr after taking ot her drugs.

Answer 5

Scientific name: Triticum aestivum. ▪ Part used: outer layer of wheat kernel. ▪ Constituents: 46% of non-starch polysaccharides. ▪ Caution: should not be used in patients with gluten- induced enteropathies

Answer 6

High in fiber. ▪ Contain 10 to 30% mucilage (polysaccharides). ▪ Studies have shown that psyllium fiber is more effective than lactulose and other laxatives, and causes more frequent and bulkier bowel movements. It has also been documented to result in a lower incidence of adverse effects.

Answer 7

▪ Stimulant laxatives increase motor activity of the bowels by directly stimulating the nerve plexus in the intestinal wall, causing increased movement and the stimulation of local reflexes, (chloride channel). ▪ Stimulant laxatives should only be used when osmotic laxatives have been ineffective, or in preparation for rectal or bowel examinations. Results occur in 6 to 10 hours.

Answer 8

▪ Scientific name: Cassia senna. ▪ Part used: leaves. ▪ Constituents: dianthrone glycosides, particularly sennosides A, B, C, and D. ▪ Mechanism: senna is a stimulant laxative that acts directly on the intestinal mucosa. ▪ The laxative effect is due to: increase peristalsis of the colon, reducing transit time and, consequently, reducing the re-absorption of water from the colon. Adverse effects: ✓ Abdominal pain, flatulence, nausea, bloating, changes in heart rhythm. ✓ Electrolyte disturbances (e.g., hypokalemia). ✓ Renal excretion of the compounds may cause abnormal coloration of the urine (yellowish brown that turns red with increasing pH). Another drawback includes their tendency to promote overemptying and reduction of spontaneous bowel function, thus leading to development of the so-called laxative habit. For this reason, chronic use of stimulant laxatives should be discouraged and use beyond one week should be avoided. ▪ Rebound constipation. Melanotic pigmentation of the colonic mucosa (melanosis coli) has been observed. This is reversible and thought to be benign. ▪ In recent years, evidence has been reported that several anthraquinones are mutagenic in the Ames test. Some have been found to induce genotoxic effects in cultured mammalian cells and to behave as possible tumor promoter. Drug-herb interaction: ✓ Because of the loss of potassium (hypokalemia), the effect of digitalis cardiac glycosides may be potentiated. ✓ Laxative activity of senna can aggravate loss of potassium associated with use of thiazide diuretics and licorice root. ✓oral drugs absorption less Contraindication: ✓ Intestinal obstruction, stomach inflammation and intestinal inflammatory diseases, such as irritable bowel, ulcerative colitis, and Crohn’s disease. ✓ Children under age of 10 or 12 due to water and electrolyte loss. ✓ Pregnancy and nursing mothers. Dose: ✓ Adults and children over 10 years: standardized daily dose equivalent to 10- 30 mg sennosides (calculated as sennoside B).Dose:

Answer 9

Hepatoprotective medicines and dietary supplements are used as additional treatment for toxic liver damages, acute and chronic viral hepatitis, cirrhosis, and other liver disease. ▪ Hepatoprotectives are remedies which help to reduce the damage caused to the liver from hepatic stressors and diseases. ▪ Herbs can be assumed to have a hepatoprotective effect if they can maintain liver cell function and help accelerate healing.

Answer 10

Scientific name: Silybum marianum. ▪ Part used: seeds. ▪ Constituent: a flavolignan known as silymarin: ▪ Silybin A, B. ▪ Isosilybin A , B. ▪ Silychristin. ▪ Silydianin. Anti‐inflammatory and immuno‐modulation activity: ✓ A number of studies have shown that silymarin exerts anti‐inflammatory action via suppression of the release of cytokines such as tumor necrosis factor‐α (TNF‐α), adhesion molecules, suppression of nuclear factor kappa (NF‐κB) and 5‐lipoxygenase pathway. Enhanced protein synthesis: ✓ Regeneration of liver cells is necessary for the hepatic recovery from acute or chronic injury. ✓ Silybin have been shown to stimulate hepatic regeneration in partially hepatectomized rat livers. ✓ The intraperitoneal administration of silybin has been shown to cause a marked increase in the ribosomal protein synthesis. ▪ Antioxidant activity: ✓ The possible antioxidant mechanisms of silymarin include: A. prevention of free radical formation via inhibition of reactive oxygen species (ROS)‐producing enzymes; B. direct scavenging of free radicals actions; C. promotion of the synthesis of protective molecules (e.g., heat shock proteins); D. activation of antioxidant enzymes such as superoxide dis mutase. Anti-fibrotic Actions: ✓ Hepatoprotective properties of silymarin may include anti- fibrotic activity, thereby interfering with the process that occurs in the hepatocytes secondary to injury and inflammation when collagen invades the normal structure of the hepatocyte.

Answer 11

The Amanita phalloides (the so‐called death cap) mushroom poisoning is associated with a severe morbidity and a high mortality rate due to progressive fulminant hepatic failure. ▪ The main toxic agents of Amanita phalloides are amatoxins, that is, DNA‐dependent RNA polymerases II inhibitors that dysregulate protein synthesis causing liver necrosis . The human lethal dose is approximately 0.1 mg/kg body weight. ▪ There are no worldwide accepted guidelines on the treatment of amatoxins‐induced liver failure. ▪ Several case reports describe successful treatment with an intravenous silybin administration, even in the severely poisoned patient.. Empiric experience suggests the administration of milk thistle after mushroom ingestion in association with N‐acetylcysteine and multiple‐dose activated charcoal.

Answer 12

Scientific name: Curcuma longa. ▪ Part used: rhizome. ▪ Constituents: curcuminoids, the chief of which is curcumin. ▪ Mechanism: the protective effects of curcumin on liver mainly attributed to its antioxidant properties. ▪ The curcumin is found to be 10 times more antioxidant than vitamin E. ▪ Curcumin increases activity of glutathione peroxidase and superoxide dismutase enzymes. Curcumin has been confirmed as a “generally recognize d as safe” compound by FDA, and it is stated not to have any toxic effect. ▪ A healthy individual with a 70 kg body weight can consume 4–10 g turmeric powder in accordance with JECFA and EFSA’s suggestion that curcumin’s ADI value should be 0–3 mg/kg. ▪ Up to 12 g/day intake of curcumin has been shown to have no harmful effects on individuals. Turmeric is well tolerated but the bioavailability is poor and daily doses of at least 2g are normal. ▪ Hydroalcoholic fluid extracts or tinctures of the herb or encapsulated powders are the formulations employed. ▪ Contraindicated in patients with gallstones or blockage of the bile duct

GIT Flashcards

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