Tratamentul constipatiei

Question 1

Constipatia

Answer 1

> 3 scaune/saptamana

disconfort abdominal, pierderea apetitului, defecatie dificila sau dureroasa

Question 2

Constipatia cronica

Answer 2

> 3 luni

Question 3

Constipatie secundara

Answer 3

Cancer colo-rectal sau ovarian
Obstructii mecanice
hTir, DZ
Neuro: lez MS, Parkinson
colagenoze
anxietate, stres emotional
sarcina

Question 4

Medicamente care induc constipatie

Answer 4

opioide
m-colinolitice
antiacide - saruri de Al si Ca
X canale de Ca (verapamil)
saruri de Fe
antidepresive triciclice
fenotiazine

Question 5

Tratamentul constipatiei

Answer 5

Masuri igieno-dietetice - aoirt de fibre (legume, fructe, paine integrala), hidratare suficienta, exercitii fizice
Tratament simptomatic - laxative

Question 6

Laxative si purgative - mecanism de actiune

Answer 6

Grabesc tranzitul +/- cresc cant de apa din scaun

Question 7

Laxative - efect

Answer 7

inmuierea scaunului

Question 8

Purgative - efect

Answer 8

elim de scaune lichide

Question 9

Laxative si purgative - indicatii

Answer 9

Constipatie cronica idiopatica
Evitare ef de defecatie - boli CV, AVC, hernie, fisuri ano-rectale, hemoroizi
pregatirea interventiilor chirurgicale, ex Rx

Question 10

Boala laxativelor

Answer 10

manifestari de colita severa cu pierdere de apa si electroliti si vitamine datorita abuzului de laxative

Question 11

Laxative si purgative - CI

Answer 11

abdomen acut de etiologie necunoscuta
obstacole intestinale, ileus mecanis
suspiciune de perforatie sau abces abd
CUH

Question 12

Laxativele de volum - mecanism de actiune

Answer 12

fibre alimentare nedigerabile si coloizi hidrofili
- fibre fermentate de flora intest - 2 efecte: prod AG cu lant scurt (rol trofic pt epit colic) si creste masa bact
- fibre nefermentate - atrag apa in intest, cresc vol cont si + peristaltismul
Nu au toxicitate sistemica

Question 13

Laxative de volum - reprezentanti

Answer 13

metilceluloza, carboximetilceluloza
triticum (tarate de grau)
psyllum
seminte de in
agar

Question 14

Laxative de volum - RA

Answer 14

balonare, flatulenta

Question 15

Laxative de volum - CI

Answer 15

obstructii mecanice
megacolon, megarect
! admin cu o cant suficienta de apa

Question 16

Purgative osmotice

Answer 16

retin apa in intestin prin mec osmotic si + peristaltismul

Question 17

Sulfatul de Mg

Answer 17

Purgativ salin

RA: greturi, varsaturi, deshidratare, intox cu Mg - deprimare centrala (copii mici, IR, BAV, diuretice)

Question 18

Lactuloza

Answer 18

dizaharida sintetica (gal+fru) -> scindata de flora microbiana in gal si fru, greu absorbabile -> fermentate la ac acetic si lactic

Question 19

Lactuloza - indicatii

Answer 19

constipatie cronica idiopatica
contipatia prod de opioide si vincristina
encefalopatie hepatica

Question 20

Lactuloza - RA

Answer 20

greata, flatulenta, colici, diaree, tul h-e

Question 21

Macrogolul

Answer 21

polietilenglicol cu lant lung
nu se absoarbe
laxativ osmotic care nu modif ech h-e

Question 22

Macrogol - indicatii

Answer 22

constipatie cr idiopatica

pregatirea pt Rx, endoscopie, interv chirurgicale (Fortrans - 4 L sol timp de 3 h cu cel putin 4 h inaintea procedurii)

Question 23

Macrogol - RA

Answer 23

diaree, colici intest

Question 24

Surfactantii

Answer 24

Inmoaie scaunul (emulsionarea grasimilor)
I: varstnici in stare terminala, afect anale acute, combaterea efortului de defecatie
Repr: docusat sodic, ulei de parafina

Question 25

Purgative iritante

Answer 25

Ulei de ricin Purgative antrachinonice - crusin, senna. suc de aloe Bisacodil - deriv de difenilmetan

Question 26

Purgative antrachinonice - mecanism de actiune

Answer 26

hidroliz de flora microbiana -> deriv antrachinonici -> abs -> + plex mienteric

Question 27

Purgative antrachinonice - RA

Answer 27

``` Colici, 2-3 zile de contipatie post purgatie, obisnuinta, dependenta, leziuni intestinale, melanosis coli Diaree grava (sugari) ```

Question 28

Purgative antrachinonice - CI

Answer 28

Abdomen acut Rectoragii Sarcina, lactatie

Question 29

Bisacodil - indicatie

Answer 29

Constipatia cronica idiopatica

Question 30

Bisacodil - RA

Answer 30

leziuni inflamatorii ale mucoasei colonului

Question 31

Prucaloprid - clasa si mecanism

Answer 31

Prokinetic agonist selectiv R 5-HT4, faciliteaza transmiterea colinergica - scurteaza timpul de tranzit intest si creste frecventa scaunelor

Question 32

Metilnaltrexona, almivopan - clasa si mecanism de actiune

Answer 32

Antagonisti ai R opioizi (R miu periferici) -> nu limiteaza actiunea analgezica a opioidelor

Question 33

Antagonisti ai R opioizi - indicatii

Answer 33

Constipatia produsa de opioide la pacientii oncologici | Ileus post-operator

Question 34

Lubiprostona - clasa si mecanism de actiune

Answer 34

Secretagog colic, analog de PGE1 -> + canalele de Cl => creste secretia de H2O in lumenul intestinal -> acceleareaza tranzitul, inmoaie scaunul

Question 35

Lubiprostona - indicatii

Answer 35

Constipatia idiopatica | SII

Question 36

Lubiprostona - RA

Answer 36

Diaree tranzitorie, greata

Question 37

Linaclotida - clasa si mecanism

Answer 37

Agonist al guanilatciclazei C -> + secretia si motilitatea intestinala

Question 38

Linaclotida - indicatii

Answer 38

Constipatie cronica idiopatica | SII cu constipatie (reduce durerea abdominala)

Question 39

Glicerina intrarectal

Answer 39

Lubrifiant si agent higroscopic -> prod scaun in mai putin de o ora RA: iritatii si discomfort local

Question 40

Clismele

Answer 40

Ant interventiilor chirugicale sau proc dg Cu solutii saline, solutii osmotic active, iritante Distensia colonului ii declanseaza reflex evacuarea RA: hiponatremie la clisme repetate cu solutii hipotone