Latest News

 #GIT


#Constipation approach :

āĻĒā§āϰāĻĨāĻŽā§‡ āĻĻ⧇āϖ⧇ āĻ¨ā§‡ā§ŸāĻž āĻāϟāĻž constipation āĻāϰ criteria fulfill āĻ•āϰ⧇ āĻ•āĻŋāύāĻžāĨ¤


āĻāϟāĻž  āĻšāϤ⧇ āĻĒāĻžāϰ⧇ functional (80%)

→āĻ…āύ⧇āĻ• āĻĻāĻŋāύ āϧāϰ⧇ āϏāĻŽāĻ¸ā§āϝāĻžāĨ¤ fever,wt loss,anaemia,per rectal bleeding  āύāĻžāχ

āĻšāϤ⧇ āĻĒāĻžāϰ⧇ organic cause(20%) 

--features of obstruction,wt loss,anaemia,fever,per rectal bleeding āĻĨāĻžāĻ•āϤ⧇ āĻĒāĻžāϰ⧇āĨ¤ 


āϝāĻĻāĻŋ functional āĻšā§Ÿ āĻšāϤ⧇ āĻĒāĻžāϰ⧇ āσ


Normal Transit constipation (IBS Type)

āĻāĻĻ⧇āϰ defecation frequency normal. Dx criteria ↓

(āύāĻŋāĻšā§‡ āĻ›āĻŦāĻŋ   āĻĻā§‡ā§ŸāĻž āφāϛ⧇)


Slow Transit constipation 

(Young aged female, 5- 6 āĻĻāĻŋāύ āĻĒāϰ āĻĒāϰ āϟ⧟āϞ⧇āϟ āĻšā§Ÿ, 

āϟ⧟āϞ⧇āĻŸā§‡āϰ āϕ⧋āύ urge āĻĨāĻžāϕ⧇ āύāĻž, hard, dry stool)


Pelvic floor dyssynergia

(Straining āĻĨāĻžāϕ⧇,persistent urge āĻĨāĻžāϕ⧇, hard pillet shape stool,āĻŽāĻžāĻā§‡ āĻŽāĻžāĻā§‡   manual evacuation āĻ•āϰāϤ⧇ āĻšā§Ÿ)

Functional āϗ⧁āϞāĻžāϕ⧇ āĻ•āĻŋāĻ­āĻžāĻŦ⧇ differentiate āĻ•āϰāĻŦ?

1 āϟāĻž sign āφāϰ 1āϟāĻž symptom 

Urge  āϕ⧇āĻŽāύ āσ 

Normal transit – normal urge

Slow transit – no urge(almost)

Pelvic floor dyssynergia- persistant urge


DRE:

āĻĒ⧇āĻļ⧇āĻ¨ā§āϟ  bear Down āĻ•āϰāϞ⧇ anal sphincter paradoxically contract āĻ•āϰāϞ⧇⧎⧎⧎  āĻāϟāĻž pelvic floor dyssynergia 

Secondaary āĻ•āĻŋāϛ⧁ causes :Hypothyroid, hypercalcemia, DM. Slow transit constipation āĻāϰ āύāϤ feature āύāĻŋā§Ÿā§‡ āφāϏāϤ⧇ āĻĒāĻžāϰ⧇āĨ¤ 

 


#Management 


IBS type constipation /Slow transit constipation 


Non pharmacological: (Common for all)

Lifestyl change 

Regular food habit

āĻĒāĻ°ā§āϝāĻžāĻĒā§āϤ āĻĒāĻžāύāĻŋ,āĻļāĻžāĻ• āϏāĻŦāϜāĻŋ(20-40g/day) āĻ–āĻžāĻŦ⧇

āϞāĻžāχāĻĢ style modifications, Wt loss  āĻ•āϰāϤ⧇ āĻšāĻŦ⧇āĨ¤

Gastro-colic reflex āϕ⧇ āĻ•āĻžāĻœā§‡ āϞāĻžāĻ—āĻžāĻŦ⧇āĨ¤ 

āĻ–āĻžāĻŦāĻžāϰ⧇āϰ 20- 30āĻŽāĻŋāύāĻŋāϟ āĻĒāϰ āϟ⧟āϞ⧇āĻŸā§‡ āĻŦāϏ⧇ āĻĨāĻžāĻ•āĻŦ⧇ 5- 10 āĻŽāĻŋāύāĻŋāϟ āϏāĻ•āĻžāϞ⧇ āĻāĻŦāĻ‚ āϰāĻžāϤ⧇( mainly slow transit constipation āĻ āĻ­āĻžāϞ benifit āĻĒāĻžāĻ“ā§ŸāĻž āϝāĻžā§Ÿ) 


1 āĻŽāĻžāϏ āĻĒāϰ if Not improved 

→pharmacoloical treatment 


synthetic bulk forming agent[Ispaghula husk(āϭ⧁āϏāĻŋ)⧎  ]

āĻ•āĻŋāĻ­āĻžāĻŦ⧇ āĻ–āĻžāĻŦ⧇āύ: āĻāĻ• āĻ—ā§āϞāĻžāϏ āĻĒāĻžāύāĻŋāϰ āϏāĻžāĻĨ⧇ 1 sachet āϭ⧁āϏāĻŋ āĻŽāĻŋāĻļāĻŋā§Ÿā§‡ āϏāĻžāĻĨ⧇ āϏāĻžāĻĨ⧇ āĻ–ā§‡ā§Ÿā§‡ āĻĢ⧇āϞāϤ⧇ āĻšāĻŦ⧇āĨ¤  āĻŦ⧇āĻļāĻŋāĻ•ā§āώāύ āϭ⧁āϏāĻŋ āĻĒāĻžāύāĻŋāϰ āϏāĻžāĻĨ⧇ āĻ­āĻŋāϜāĻŋā§Ÿā§‡ āϰ⧇āϖ⧇ āϖ⧇āϞ⧇ āĻ•āĻžāϜ āĻšāĻŦ⧇ āύāĻž āϤ⧇āĻŽāύāĨ¤ āĻ•āĻžāϰāύ āϏ⧇ already āĻĒāĻžāύāĻŋ absorb āĻ•āϰ⧇ āĻŦāϏ⧇ āĻĨāĻžāĻ•āĻŦ⧇ gut āĻ āĻ—āĻŋā§Ÿā§‡ āφāϰ āĻĒāĻžāύāĻŋ absorb āĻ•āϰāϤ⧇ āĻĒāĻžāϰāĻŦ⧇ āύāĻžāĨ¤


→if not improved 

Osmotic laxative (lactulose)

Syp.avolac 6tsf @night or 3/4 tsf tds


→If not improved 

Cl channel activator (lubiprostone)- Gut āĻ āĻĒāĻžāύāĻŋ āϧāϰ⧇ āϰāĻžāĻ–āĻŦ⧇-stool āϕ⧇ soft āĻ•āϰāĻŦ⧇

Tab.lubigut 24mcg 1+0+1


→if not improved 

5HT4 agonist(Prucalopride) -Colon āĻāϰ motility āĻŦāĻžā§œāĻžāĻŦ⧇

tab.caloprid 1 or 2mg  0+0+1


āĻāχ āĻĒāĻ°ā§āϝāĻ¨ā§āϤ āĻāĻ• āχāĨ¤ IBS type /slow transit type āĻāϰ āĻ•ā§āώ⧇āĻ¤ā§āϰ⧇āĨ¤ 


→if not improved 


In IBS variety constipation :

Tab.Duloxatine 30-60mg 0+0+1


Abdominal boating āĻĨāĻžāĻ•āϞ⧇:

Gluten free food(āĻŦ⧇āĻ•āĻžāϰāĻŋ āĻ–āĻžāĻŦ⧇ āύāĻž)

Tab.Rifagut 600mg daily -14 days


In slow transit constipation :

Stimulant drug(Bisacodyl)

Tab.Duralax 5mg 0+0+1 āĻāϰ āĻĒāϰ āĻ“ āĻ­āĻžāϞ āύāĻž āĻšāϞ⧇

tab.Neostigmine  āĻāϰāĻĒāϰāĻ“ āĻ­āĻžāϞ āύāĻž āĻšāϞ⧇ surgery















In pelvic floor dyssynergia :

Biofeedback mechanism apply  āĻ•āϰāĻŦ⧇ (āĻ­āĻžāϞ outcome)


Constipation āϝāĻĻāĻŋ secondary āϕ⧋āύ cause āĻŦāĻž obstructive pathology(stricture/mass lesion/fissure/harmirrhoid) āĻāϰ āϜāĻ¨ā§āϝ āĻšā§Ÿ  āσ

Management :Treatment of the cause


Digest medicine 🍂

0 Comments:

Post a Comment

:) :)) ;(( :-) =)) ;( ;-( :d :-d @-) :p :o :>) (o) [-( :-? (p) :-s (m) 8-) :-t :-b b-( :-# =p~ $-) (b) (f) x-) (k) (h) (c) cheer
Click to see the code!
To insert emoticon you must added at least one space before the code.

 
Top
Blogger Template