GIT - Approach for Constipation

<p> #GIT</p><p><br /></p><p>#Constipation approach :</p><p>প্রথমে দেখে নেয়া এটা constipation এর criteria fulfill করে কিনা।</p><p><br /></p><p>এটা  হতে পারে functional (80%)</p><p>→অনেক দিন ধরে সমস্যা। fever,wt loss,anaemia,per rectal bleeding  নাই</p><p>হতে পারে organic cause(20%) </p><p>--features of obstruction,wt loss,anaemia,fever,per rectal bleeding থাকতে পারে। </p><p><br /></p><p>যদি functional হয় হতে পারে ঃ</p><p><br /></p><p>Normal Transit constipation (IBS Type)</p><p>এদের defecation frequency normal. Dx criteria ↓</p><p>(নিচে ছবি   দেয়া আছে)</p><p><br /></p><p>Slow Transit constipation </p><p>(Young aged female, 5- 6 দিন পর পর টয়লেট হয়, </p><p>টয়লেটের কোন urge থাকে না, hard, dry stool)</p><p><br /></p><p>Pelvic floor dyssynergia</p><p>(Straining থাকে,persistent urge থাকে, hard pillet shape stool,মাঝে মাঝে   manual evacuation করতে হয়)</p><p>Functional গুলাকে কিভাবে differentiate করব?</p><p>1 টা sign আর 1টা symptom </p><p>Urge  কেমন ঃ </p><p>Normal transit – normal urge</p><p>Slow transit – no urge(almost)</p><p>Pelvic floor dyssynergia- persistant urge</p><p><br /></p><p>DRE:</p><p>পেশেন্ট  bear Down করলে anal sphincter paradoxically contract করলে৷৷৷  এটা pelvic floor dyssynergia </p><p>Secondaary কিছু causes :Hypothyroid, hypercalcemia, DM. Slow transit constipation এর নত feature নিয়ে আসতে পারে। </p><p> </p><p><br /></p><p>#Management </p><p><br /></p><p>IBS type constipation /Slow transit constipation </p><p><br /></p><p>Non pharmacological: (Common for all)</p><p>Lifestyl change </p><p>Regular food habit</p><p>পর্যাপ্ত পানি,শাক সবজি(20-40g/day) খাবে</p><p>লাইফ style modifications, Wt loss  করতে হবে।</p><p>Gastro-colic reflex কে কাজে লাগাবে। </p><p>খাবারের 20- 30মিনিট পর টয়লেটে বসে থাকবে 5- 10 মিনিট সকালে এবং রাতে( mainly slow transit constipation এ ভাল benifit পাওয়া যায়) </p><p><br /></p><p>1 মাস পর if Not improved </p><p>→pharmacoloical treatment </p><p><br /></p><p>synthetic bulk forming agent[Ispaghula husk(ভুসি)৷  ]</p><p>কিভাবে খাবেন: এক গ্লাস পানির সাথে 1 sachet ভুসি মিশিয়ে সাথে সাথে খেয়ে ফেলতে হবে।  বেশিক্ষন ভুসি পানির সাথে ভিজিয়ে রেখে খেলে কাজ হবে না তেমন। কারন সে already পানি absorb করে বসে থাকবে gut এ গিয়ে আর পানি absorb করতে পারবে না।</p><p><br /></p><p>→if not improved </p><p>Osmotic laxative (lactulose)</p><p>Syp.avolac 6tsf @night or 3/4 tsf tds</p><p><br /></p><p>→If not improved </p><p>Cl channel activator (lubiprostone)- Gut এ পানি ধরে রাখবে-stool কে soft করবে</p><p>Tab.lubigut 24mcg 1+0+1</p><p><br /></p><p>→if not improved </p><p>5HT4 agonist(Prucalopride) -Colon এর motility বাড়াবে</p><p>tab.caloprid 1 or 2mg  0+0+1</p><p><br /></p><p>এই পর্যন্ত এক ই। IBS type /slow transit type এর ক্ষেত্রে। </p><p><br /></p><p>→if not improved </p><p><br /></p><p>In IBS variety constipation :</p><p>Tab.Duloxatine 30-60mg 0+0+1</p><p><br /></p><p>Abdominal boating থাকলে:</p><p>Gluten free food(বেকারি খাবে না)</p><p>Tab.Rifagut 600mg daily -14 days</p><p><br /></p><p>In slow transit constipation :</p><p>Stimulant drug(Bisacodyl)</p><p>Tab.Duralax 5mg 0+0+1 এর পর ও ভাল না হলে</p><p>tab.Neostigmine  এরপরও ভাল না হলে surgery</p><div class="separator" style="clear: both; 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GIT - Approach for Constipation

 #GIT #Constipation approach : প্রথমে দেখে নেয়া এটা constipation এর criteria fulfill করে কিনা। এটা  হতে পারে functional (80%) →অনেক দিন ধরে ...

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