GI tract

The Dr. started this lecture with a little revision about peptic ulcer. Peptic ulcer is a disease caused by an infection caused by (H.pylori ), which is treated by triple therapy (Omeprazole or
Lanzoprazole + Amoxicillin + Clarithromycin.)

High acid secretion is treated by either : a- Drugs that neutralize hyper-acidity ( known as antacids ) b- Drugs that inhibit gastric acid secretion : 1- Proton pump inhibitors, which are highly effective drugs. 2- H2 receptor blockers, they block histamine receptors in the stomach. 3- Muscarinic receptor blockers (work mainly on receptors in the gastric mucosa). Mucosal protective mechanism is increased by using Sucralfate or Misoprostol.
The Dr. also mentioned that vomiting is treated using Anti-emetic drugs.

Diarrhea
It is the frequent passage of liquid feces, due to an Increase in intestinal motility, decrease in the transit time, decrease in water and nutrient absorption in the intestine, and increase in secretion of fluid into the GIT lumen

Causes of Diarrhea:

1- Maybe due to an infection: Bacterial, as in salmonella. Virus, increases gastroenteritis. Amoebiasis, which is caused by entamoeba histolytica. 2- Maybe due to toxins, poisoning, or food poisoning. 3- Maybe due to drugs: Parasympathetic agonist( it increases the intestinal motility) Magnesium containing antacids.

Treatment :

1. Oral rehydration: We should maintain fluid and electrolyte balance, this is an important step especially in children. Fluid replacement is highly important to avoid dehydration.
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2. We should treat the infection by using anti-infective drugs, this depends on the cause : If the cause is viral it cant be treated by an anti-bacterial agent, gastroenteritis is mostly self-limited. 3. Using Non-antimicrobial Antidiarrheal agents, they are responsible for reducing intestinal motility. Anti-muscarinic drugs. Opioids (S/T they suppress intestinal motility causing constipation )
Loperamide( 2 tablets initially , if the diarrhea persists you take an extra tablet after each defecation )

Constipation
It is infrequent passage of hard stool due to a decrease in the intestinal motility time which will induce an increase in the transit time and increased water absorption from the intestine.

Causes of Constipation :
1. Age (commonly seen in elderly people) 2. Pregnancy (hormonal effect, high levels of progesterone during pregnancy may induce constipation) 3. Dietary content (low fiber containing diets) 4. Drugs that reduce intestinal motility:
Opioid Aluminum containing antacids Muscarinic antagonist Anti-motility agents Iron containing drugs and iron supplements ( which are used for the treatment of anemia)
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Treatment:
1- non-pharmacological treatment
Increase the fluid intake Increase the intake of fiber containing diets ( fruits & vegetables ) Doing exercise Remove the cause ( if it was a side effect of a drug we should stop taking it, if possible)

2- Drugs that initiate intestinal motility ( Laxatives ) Osmotic laxatives: by the effect of osmosis it will drain water and they stimulate water secretion inside the intestines. Ex:(Lactulose) Stimulant purgatives: they stimulate the secretion of water inside the intestine. Ex:(Bisacodyl) Continuous use of laxatives is discouraged as they may induce atonic intestine, having bowel movements may come to be dependent upon their use.

Note: This is the End of the GI lecture and the 2nd exam, the rest of the lecture is about the endocrine system and I will continue the script after the exam inshallah Good luck in the exam and forgive me for any mistakes if found

Done By: Yazan Ashhab