Module 7 Basic GI Flashcards by Diana Hallis

Constipation guideline

less than 3 stools per week

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5 causes of constipation

low fiber diet, lack of exercise, slowed peristalsis, obstruction, or diverticulitis

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firm immovable mass obstructs lower GI tract

impaction

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someone with an impaction may have continuous

oozing or diarrhea around the impaction

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other signs and symptoms of an impaction are…

loss of appetite, nausea, vomiting, abdominal distention, cramping and pain

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Acute diarrhea usually results from

viral or bacterial infection, impaction, emotional stress, medications (such as chemo)

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diarrhea is chronic when is lasts for more than

4 weeks

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episodic diarrhea is

food allergy or irritant

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chronic diarrhea results from

chronic GI infection, immobility, malabsorption, endocrine disorders

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diarrhea that has increase in active solutes

osmotic diarrhea

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osmotic diarrhea typically associated with

magnesium sulfate, epsom salt

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Sodium and water rush into the colon when ingesting mag sulfate or epsom salt

osmotic diarrhea

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Caused by some type of bacteria or toxin that increases the reabsorption of water in the colon

secretory diarrhea

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Osmotic diarrhea common with

tube feeding

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Bacterias associated with

vibrio cholerae and staph aureus

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Active sites of inflammation within the bowel lumen that results in exudation of mucus, blood, and proteins

exudative diarrhea

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Causes of exudative diarrhea

Crohn’s disease or ulcerative colitis

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diarrhea that results from decreased absorption in the small intestine

diarrhea related to motility disturbances

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causes of diarrhea related to motility disturbances

dumping syndrome after a gastrectomy and IBS

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3 reasons why diarrhea is a problem

skin breakdown, fluid/electrolyte imbalance, nutrition concerns

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3 groups of anti-diarrheals

absorbants, antimotility, probiotics

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bismuth subsalicylate aka

Pepto-Bismol

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bismuth subsalicylate is an

adsorbant

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MOA for bismuth subsalicylate

Coats the wall of the GI tract and binds the causative agent for elimination

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bismuth subsalicylate is a form of

aspirin

another adsorbant

activated charcoal, given in drug overdoses

loperamide aka

Imodium

diphenoxylate with atropine

Lomotil

MOA for loperamide and diphenoxylate with atropine

Slows peristalsis and has a drying effect (anticholinergic)

loperamide and diphenoxylate with atropine can be used combination with

adsorbants and opiates

adverse effects of loperamide and diphenoxylate with atropine

urinary retention, headache, dizziness, bradycardia and hypotension, dry skin, flushing

Lactobacillus organism probiotics

Bacid or Culturelle

Sacchromyces boulardii probiotic

Florastor

used specifically in treatment of c diff

Sacchromyces boulardii (Florastor)

Laxative treatment is individualized for

age, severity, and contributing factors

Treatment for constipation

Diet (increasing fiber), behavioral interventions such as walking, and then add on pharmacologic treatment for constipation

5 groups of laxatives

bulk-forming, emollient, hyperosmotic, saline, stimulant

Most misused OTC

laxatives

misuse of laxatives can lead to

dependence, inability to have a BM without the laxative

laxatives are not meant for

long term

psyllium aka

Metamucil

Bulk forming laxative

psyllium (Metamucil)

psyllium acts similar to

Acts similar to dietary fiber, absorbs water into the intestine increasing bulk, distends bowel to initiate reflex bowel activity and bowel movement

must take psyllium with a lot of water to prevent

impaction above strictures and esophageal blockage

psyllium and most all laxatives are contraindicated in patients with

fecal impaction or intestinal obstruction

two emollient laxatives

docusate sodium and mineral oil

docusate sodium aka

Colace

docusate sodium MOA

lubricates fecal material and walls, promotes fat absorption into fecal mass

docusate sodium is primarily used to prevent

opioid-induced constipation, like during post-op

docusate sodium is only given

mineral oil MOA

lubricates intestines

mineral oil route

PO or PR

mineral oil is used to relieve

fecal impactions

both mineral oil and docusate sodium

prevent water from moving out of intestines

adverse effects of docusate sodium and mineral oil laxatives

skin rashes and decreased absorption of vitamins

3 hyperosmotic laxatives

glycerin, polyethylene glycol, and lactulose

MOA of glycerin, polyethylene glycol, and lactulose

Increases water content in feces, promotes distention, peristalsis, and evacuation

adverse effects of hyperosmotic laxatives

Abdominal bloating, rectal irritation, electrolyte imbalance

very mild and most common used in children experiencing constipation

glycerin

glycerin is typically given as a

suppository

lactulose is digested in the large intestine creating this hyperosmotic environment

therefore it draws water into the colon

lactulose helps to

reduce blood ammonia levels

lactulose commonly used in patients with

liver disease and hepatic encephalopathy

given before diagnostic or bowel procedures

polyethylene glycol (bowel prep/go lightly)

extremely potent and induces total cleansing of the bowel

polyethylene glycol

polyethylene glycol is reconstituted in a

water

4 saline laxatives

mag citrate, mag hydroxide, mag sulfate, and sodium salts

magnesium citrate aka

citroma

magnesium hydroxide aka

Phillips milk of magnesia

magnesium sulfate aka

epsom salts

sodium salts aka

Fleet enema

saline laxative MOA

Increase osmotic pressure and draw water into colon

Careful use of saline laxatives in patients with

renal disease because may cause magnesium toxicity

2 stimulant laxatives

bisacodyl and senna

bisacodyl aka

Ducolax

senna aka

Senokot

bisacodyl (Ducolax) route

PO or PR

senna route

stimulant laxative MOA

induce intestinal peristalsis

stimulant laxative indication

constipation or whole bowel evacuation

stimulant laxative adverse effects

Nutrient malabsorption, GI irritation, electrolyte imbalance

stimulant laxatives are the most likely to cause

dependence