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COMMON GASTRO-INTESTINAL DISORDERS How to care your self ?. 28 March 2010-Common Gastrointestinal Disorders-Mahmoud El Ghazali. Primary care…..WHO??. Across most of Europe & North America, primary care is a specific specialty that exists within a range of healthcare systems & cultures

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COMMON GASTRO-INTESTINAL DISORDERSHow to care your self ?

28 March 2010-Common Gastrointestinal Disorders-Mahmoud El Ghazali


Primary care who
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


Primary care who1
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.



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


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


From here we start the git
From prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)here we start the GIT


Anatomic considerations
Anatomic considerations prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)


Gi overview
GI overview prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

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


Clinical approach
Clinical approach prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

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


Here we will talk about
Here we will talk about:- prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • Gastroesophageal Reflux Disease(GERD, Acid Reflux, Heartburn)

  • Peptic & duodenal ulcer

  • Nausea & vomiting

  • Diarrhea

  • Constipation

  • Irritable bowel syndrome


Gastro esophageal reflux disease
Gastro-esophageal reflux disease prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • 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


Gastro esophageal reflux disease1
Gastro-esophageal reflux disease prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

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.


Gastro esophageal reflux disease2
Gastro-esophageal reflux disease prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

What causes GERD?

  • Lower esophageal sphincter

  • Hiatal hernia

  • Esophageal contractions

  • Emptying of the stomach


What are the symptoms of uncomplicated gerd
What are the symptoms of uncomplicated GERD? prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • Heartburn

  • Regurgitation

  • Nausea

    What are the complications of GERD?

  • Ulcers

  • Strictures

  • Inflammation of the throat and larynx


Gastro esophageal reflux disease3
Gastro-esophageal reflux disease prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • Life style modifications

  • Drug therapy


Antacids prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

Anti histaminic

PPI


Antacids
Antacids: prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • Mg-Antacids

  • Al-Antacids

  • AL*Mg-Antacids

  • Ca carbonate-Antacids

  • Na bicarbonate-Antacids


Antihistaminic ppi
Antihistaminic & PPI prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • Ranitidine & famotidine

  • Omeprazole,lansoprazole & pantoprazole


Peptic ulcer disease
Peptic ulcer disease prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

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


What are the causes of peptic ulcers
What are the causes of prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)peptic ulcers?

  • "Helicobacter pyloricus" (H. pylori).

  • NSAIDs (nonsteroidal anti-inflammatory drugs).

  • Cigarette smoking.

  • Alcohol !!!


  • Note:- prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

    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.


Peptic ulcer disease1
Peptic ulcer disease prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • 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).


What treatments are available for peptic ulcers
What treatments are available for peptic ulcers? prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • 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).


Nausea vomiting
NAUSEA & VOMITING prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • 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.


What causes nausea or vomiting
What causes nausea or vomiting? prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • 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


Nausea vomiting1
NAUSEA & VOMITING prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

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


Nausea vomiting2
NAUSEA & VOMITING prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

Antiemetic agents include:

  • 5-HT3 antagonists: ondansetron & others

  • D-2 antagonists: domperidone &

    Metoclopramide

  • H-1 antagonists: diphenhydramine & meclizine


Diarrhea dysentery
Diarrhea & dysentery prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

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).


Diarrhea dysentery1
Diarrhea & dysentery prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

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.


Viral gastroenteritis prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

Food poisoning

Traveler's diarrhea

Bacterial enterocolitis

Parasites

Drugs


Diarrhea dysentery2
Diarrhea & dysentery prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

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 .


When should the doctor be called for diarrhea? prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • 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


Diarrhea dysentery3
Diarrhea & dysentery prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • 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.


Constipation
CONSTIPATION prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)


Constipation1
constipation prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

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


Constipation2
constipation prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

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.


What treatments are available for constipation? prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • 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.


IBS is a functional disease prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work), 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.


IBS prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • 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.


IBS prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • 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.


How to solve your problems in the bathroom
How to solve your problems in the bathroom??????? prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)

  • Peppermint

  • Bran

  • Sulprid

  • Mebeverine

  • Trimebutine


Thank You prevalence, direct costs (fees, hospital charges, pharmaceutical costs), and indirect costs (time loss from work)


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