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Non-
infectious
diarrhoea: Loperamide (Imodium) is an OTC antidiarrheal
that can be used for symptom management in
Approach adult patients with acute non-infectious
diarrhoea in the absence of bloody stools or
to fever.
Loperamide is administered as a 4-mg dose,
Managem followed by 2 mg after each unformed stool,
with a maximum total dose of 16 mg/d.
ent cont.
Infectious diarrhoea
• Infectious diarrhoea is defined as diarrhoea due to infectious
aetiology, which is commonly associated with symptoms of nausea,
abdominal cramps, and vomiting.
Abdominal and
Vital signs Volume status
rectal exam.
Good history
blood in the
is enough for Duration Frequency Consistency weight loss
stool
most cases
Laxative use
Diet Exercise Toilet habits other drugs
(what)
•CBC,
Basic •Electrolytes,
laboratory
•Urea & Creatinine
tests:
•TSH
Diagnosis
•Barium enema,
Imaging: •Sigmoidoscopy,
•Colonoscopy
PREVENTION
• High fibre diet - beans, whole grains, cereals, fresh fruits (contain the
natural laxative sorbitol), vegetables
• Limit foods with no fibre (cheese, meat, sweets, processed foods)
• Minimum fluid consumption of 1500mL daily
• Regular, private toilet routine
• Use of a laxative if using constipating medication or in presence of
diseases associated with constipation
Treatment
Treatment options
• Two approaches to consider:
• Non-drug Approach
• Drug Approach
Non-drug Approach
• Initial treatment: Lifestyle modification
• ↑fluid intake
• >25 g of fibre/day
• Fiber-bulk/distension-stool propulsion/ Effect may take weeks/ Adverse
effects: bloating, flatulence
• Exercise
• Regular bowel regimen pattern
Therapeutic options: Drug Measures
• Bulk-forming Agents
• Emollients/Stool Softeners: Provide moisture to stool
• Osmotics: Draw water into colon
• Hyper-osmotics
• Stimulants: Cause muscle contractions in intestines
Drug classes
• Those causing water evacuation in 1-6 hr
• Caster oil, Saline cathartics, PEG lavage solutions
Bisacodyl Anthraquinones ( C-
Glycerin suppository Sorbitol powder
(Dulcolax) lax)
If laxative treatment
Saline laxative is required for > 1
Tap-water enema
(MOM) week, refer to a
physician
Most common in
bedridden or
geriatrics
Consider neurological,
metabolic or
Constipation anatomical
abnormalities
in infants &
children If No:
Approach as adults
Cisapride (also
for Parkinson's
chronic disease)
idiopathic
constipation
Erythromycin
Summary
• Underlying causes of constipation should be considered
• Foundation of treatment is diet and psyllium
• Acute constipation may be treated with tap-water enema or glycerin
suppository, if needed, oral sorbitol, low dose bisacodyl or C-Lax
• Approach for chronic constipation is use of psyllium and if needed,
intermittent low-doses of other drugs
Thank You For Listening