COMMON GASTRO-INTESTINAL DISORDERS How to care your self ?

2. COMMON GASTRO-INTESTINAL DISORDERSHow to care your self ? 28 March 2010-Common Gastrointestinal Disorders-Mahmoud El Ghazali

3. Primary care…..WHO?? Across most of Europe & North America, primary care is a specific specialty that exists within a range of healthcare systems & cultures It is at the forefront of care of most patients

4. Primary care…..WHO?? Gastrointestinal disease In developed countries gastrointestinal problems are a common reason for attendance at the primary care clinic as well as the outpatient clinic of the hospital.

5. In developing countries, poor hygiene and malnutrition allow the spread of infective organisms. • The clinician's main role here is to treat infections promptly and to help with prevention by encouraging improved sanitation and education.

6. Diseases of the gastrointestinal tract & liver together account for about 10% of the total burden of illness, 20 million office visits, and nearly 10 million hospital admissions annually in Egypt

7. The cost of gastrointestinal diseases depends on their prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

8. From here we start the GIT

9. Anatomic considerations

10. GI overview The major function of the gastrointestinal tract is to absorb water & nutrients. Food moves physically from mouth to colon where non-absorbable wastes are stored for periodic elimination

11. Clinical approach The diagnosis of gastrointestinal diseases derives predominantly from the patient’s history and, to lesser extent, from the physician’s examination

12. Here we will talk about:- • Gastroesophageal Reflux Disease(GERD, Acid Reflux, Heartburn) • Peptic & duodenal ulcer • Nausea & vomiting • Diarrhea • Constipation • Irritable bowel syndrome

13. Gastro-esophageal reflux disease • GERD is one of the most prevalent diseases in the western world . • Recurrent heartburn (which is the hallmark of GERD) enables a diagnosis of GERD to be made by history alone

14. Gastro-esophageal reflux disease Gastroesophageal reflux disease, commonly referred to as GERD or acid reflux, is a condition in which the liquid content of the stomach regurgitates (backs up or refluxes) into the esophagus.

15. Gastro-esophageal reflux disease What causes GERD? • Lower esophageal sphincter • Hiatal hernia • Esophageal contractions • Emptying of the stomach

16. What are the symptoms of uncomplicated GERD? • Heartburn • Regurgitation • Nausea What are the complications of GERD? • Ulcers • Strictures • Inflammation of the throat and larynx

17. Gastro-esophageal reflux disease • Life style modifications • Drug therapy

19. Antacids Anti histaminic PPI

20. Antacids: • Mg-Antacids • Al-Antacids • AL*Mg-Antacids • Ca carbonate-Antacids • Na bicarbonate-Antacids

21. Antihistaminic & PPI • Ranitidine & famotidine • Omeprazole,lansoprazole & pantoprazole

22. Peptic ulcer disease What is a peptic ulcer? A peptic ulcer is a hole in the gut lining of the stomach, duodenum, or esophagus. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum, a duodenal ulcer

23. What are the causes of peptic ulcers? • "Helicobacter pyloricus" (H. pylori). • NSAIDs (nonsteroidal anti-inflammatory drugs). • Cigarette smoking. • Alcohol !!!

24. Note:- Contrary to popular belief, alcohol, coffee, colas, spicy foods, and caffeine have no proven role in ulcer formation. What are symptoms of an ulcer? • Upper abdominal burning or hunger pain one to three hours after meals and in the middle of the night.

25. Peptic ulcer disease • Complications include ulcer bleeding, ulcer perforation, and gastric obstruction. • Patients with ulcer bleeding may report black tarry stools (melena), weakness, a sense of passing out upon standing (orthostatic syncope), and vomiting blood (hematemesis).

27. What treatments are available for peptic ulcers? • Antacids neutralize existing acid in the stomach. • Histamine antagonists (H2 blockers) are drugs designed to block the action of histamine on gastric cells. • Proton-pump inhibitors such as omeprazole (Omez).

29. NAUSEA & VOMITING • Nausea and vomiting are symptoms of an underlying disease and not a specific illness. • Nausea is the sensation that the stomach wants to empty itself. • vomiting (emesis) or throwing up, is the act of forcible emptying of the stomach.

30. What causes nausea or vomiting? • Acute gastritis • Central causes (signals from the brain) • Association with other illnesses remote from the stomach • Medications and medical treatments • Mechanical obstruction of the bowel

31. NAUSEA & VOMITING 2. Systemic causes: • Elevated intra-cranial pressure (benign or neoplastic) • Inner ear disease • Medications: (act locally on the stomach; NSAIDs, erythromycin, or cardiac anti-arrhythmics or systemically like chemotherapeutics and opiates) • Pregnancy • Radiation therapy

32. NAUSEA & VOMITING Antiemetic agents include: • 5-HT3 antagonists: ondansetron & others • D-2 antagonists: domperidone & Metoclopramide • H-1 antagonists: diphenhydramine & meclizine

33. Diarrhea & dysentery What is diarrhea? • Diarrhea is an increase in the frequency of bowel movements or a decrease in the form of stool (greater looseness of stool).

34. Diarrhea & dysentery What are common causes of acute diarrhea? • The most common cause of acute diarrhea is infection--viral, bacterial, and parasitic. • Bacteria also can cause acute food poisoning. • A third important cause of acute diarrhea is starting a new medication.

35. Viral gastroenteritis Food poisoning Traveler's diarrhea Bacterial enterocolitis Parasites Drugs

36. Diarrhea & dysentery What are the complications of diarrhea? • Dehydration Adult children • Hypotension with syncope (fainting upon standing due to a reduced volume of blood. • Thirst , dry mouth and irritation of the anus .

37. When should the doctor be called for diarrhea? • High fever • Moderate or severe abdominal pain or tenderness • Bloody diarrhea • Prolonged vomiting that prevents intake of fluids orally • Acute diarrhea in pregnant women • Diarrhea that occurs during or immediately after completing a course of antibiotics • C. difficile

39. Diarrhea & dysentery • Oral rehydration solutions(ORS) are liquids that contain a carbohydrate (glucose or rice syrup) and electrolyte (sodium, potassium, chloride, and citrate or bicarbonate). • Absorbents. (attapulgite – polycarbophil) • Anti-motility medications. • Antibiotics. • Antiprotozoal.

40. CONSTIPATION

41. constipation Constipation means hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement.

42. constipation What causes constipation? • Medications (Narcotic pain medications) (Antidepressants such as amitriptyline) (Anticonvulsants such as phenytoin) (Calcium channel blocking) • Habit- Diet-Laxatives-Hormonal disorders-Central nervous system diseases.

43. What treatments are available for constipation? • Dietary fiber (bulk-forming laxatives) • Lubricant laxatives • Emollient laxatives (stool softeners) • Saline laxatives • Stimulant laxatives • Enemas • Most herbal laxatives contain stimulant-type laxatives and should be used, if at all, as a last resort.

44. IBS is a functional disease, that is, a disease in which the intestine (bowel) functions abnormally. Theories of the cause of IBS include abnormal input from intestinal sensory nerves and abnormal stimulation of the intestines by the motor nerves.

45. IBS • What causes IBS? As described previously, IBS is believed to be due to the abnormal function (dysfunction) of the muscles of the organs of the gastrointestinal tract or the nerves controlling the organs.

46. IBS • The symptoms of slowed transportation are nausea, vomiting, abdominal bloating (the sensation of abdominal fullness), and abdominal distention (enlargement). • The symptom of rapid transportation usually is diarrhea.

47. How to solve your problems in the bathroom??????? • Peppermint • Bran • Sulprid • Mebeverine • Trimebutine

48. Thank You