Dr. Waqas Nawaz PMAS Arid Agriculture University Rawalpindi.Pakistan

1. Diarrhea & Constipation
ASSIGNMENT # 1
PATH-202
Submitted to: Dr. Imtiaz Ahmed Khan
Submitted by: Waqas Nawaz
11-arid-975
DVM 4th semester
Headache
Sense of
rectal
Symptoms of Abdominal
bloating
fullness constipation
Low back
pain
Faculty of Pharmacy - Alexandria University
(Egypt)

2. CONSTIPATION
Constipation, costiveness, or irregularity is a condition of the digestive system in
which a person experiences difficulty in defecation. Obstipation is used for severe
constipation that prevents passage of both stools and gas.
Common among children and pregnant women; Constipation refers to infrequent or hard
stools. It is the passage of dry and hard stools, usually fewer than 3x a week. People with
this condition may find bowel movement painful and difficult.
1-SIGN & SYMPTOMS:
 A desire to defecate
 Pain and intestinal discomfort
 Swelling in the abdomen, cramps and colic
 In some cases up to several days without being able to defecate with grave harm and
body poisoning
 Constipation is one of the main causes of hemorrhoids and appendicitis, as well as
acne and general intoxication of the body.
 Difficulty in starting or completing a bowel movement
 Infrequent and difficult passage of stool
 Passing hard stool after prolonged straining in the toilet
 Excessive gas & Sense of bloating
 Intestinal obstruction
 Vomiting
 Headaches
 Loss of appetite
 Coated (furred) tongue
 Offensive breath
 Bad taste in your mouth

3. You are considered constipated if you have two or more of the following for at least
3 months:
 Straining during a bowel movement more than 25% of the time.
 Hard stools more than 25% of the time.
 Incomplete evacuation more than 25% of the time.
 Two or fewer bowel movements in a week
Types of stool:
 Type 1: Separate hard lumps, like nuts (hard to pass)
 Type 2: Sausage-shaped, but lumpy
 Type 3: Like a sausage but with cracks on its surface
 Type 4: Like a sausage or snake, smooth and soft
 Type 5: Soft blobs with clear cut edges (passed easily)
 Type 6: Fluffy pieces with ragged edges, a mushy stool
 Type 7: Entirely liquid
Type 1 and 2 indicate constipation, with 3 and 4 being the "ideal stools" especially the
latter, as they are the easiest to pass, and 5–7 being further tending towards diarrhea or
urgency.
2-CAUSES:
 Poor diet
 Poor bowel habits
 Medications
 Painkillers
 Travel
 Age
 Pregnancy
 Laxative abuse
 Irritable bowel syndrome
 Intestinal obstruction
 Inadequate fiber and fluid intake
 Environmental changes

4. 1-CONSTIPATION CYCLE:
2-PATHOLOGY OF CONSTIPATION:
 depression;
 impaired cognitive function;
 spinal cord compression;
 cerebral tumour;
 hypercalcaemia;
 hypokalaemia;
 hypothyroidism;
 Abdominal tumour (intestinal tumour, or compression from tumour external
to bowel).
 Painful ano-rectal conditions.
CONSTIPATION DURING PREGNANCY :
 Constipation is among the top three most uncomfortable complaints listed by
pregnant women.

5. What causes constipation during pregnancy:
 In the first trimester it is caused by progesterone which slows down
intestinal activity
 In the later part of pregnancy the pressure of your uterus on your intestines
and rectum makes your system sluggish
 Iron supplement that you need for anemia has a constipating effect.
 Stress and tension contributes to constipation
 You are more susceptible to constipation if you had this problem in your
prepregnancy days
 You lead a sedentary lifestyle
3-PATHOPHYSIOLOGY OF CONSTIPATION:
 Medications
 Opioids
 Calcium-channel blockers
 Anticholinergic
 Decreased motility
 Ileus
 Mechanical obstruction
 Metabolic abnormalities
 Spinal cord compression
 Dehydration
 Autonomic dysfunction
 Malignancy
4-TREATMENT & CURE:
Drink 8 to 10 glasses of water per day (drink them before meals and never during or
after meals it affects digestion).
Eat one carrot a day (don’t forget to drink a lot of pure water). Exercise preferably
before going to bed.
Eat high fiber diet to provide natural bulk in daily food intake and help move food to
the rectum; increase quantity of fruits & vegetables
Take bulk-forming laxatives to absorb water in the intestines and acts as stools
softener; this can be in the form of fiber supplements & Daily exercise
For people with severe symptoms, surgical removal of colon may be an option

6. DIARRHEA
Diarrhea describes bowel movements (stools) that are loose and watery. It
is very common and usually not serious. Many people will have diarrhea once or twice each
year. It typically lasts two to three days and can be treated with over-the-counter (OTC)
medicines. Some people have diarrhea often as part of irritable bowel syndrome or other
chronic diseases of the large intestine.
The World Health Organization defines diarrhea as the passing of liquid or watery stools at
least 3 times in a 24-hour period. However, it is the consistency rather than the number of
stools that is important. Frequent passing of formed stools is not diarrhea.
Breastfed babies normally passes loose or pasty stools. The mother can tell if her baby has
an abnormal stool. We call it “mother’s definition”.
TYPES OF DIARRHEA:
Acute Diarrhoea
sudden onset and lasts less than two weeks
90% are infectious in etiology
10% are caused by medications, toxin ingestions, and ischemia
Viral, Bacterial, Protozoa (90%)
Medications
Laxatives or diuretic abuse
Ingestion of environmental preformed toxin such as seafood
Ischemic Colitis
Chronic Diarrhoea
Diarrhoea which lasts for more than 4 weeks
Most of the causes are non-infectious
Irritable Bowel Syndrome
Diverticular disease
Colorectal Cancer
If stools contain blood or mucus, it is called dysentery. If diarrhea persists for 14 days or
longer, it is called persistent diarrhea.

7. COMMON DIARRHEAS
1-SIGN & SYMPTOMS:
 Age <2 years: Rotavirus
 Abdominal bloating or cramps
 Age 2-5 years: Cholera; E. coli;
 Thin or loose stools
Shigellosis
 Watery stool
 Sense of urgency to have a bowel movement  All ages: E.coli; Campylobacter
 Nausea and vomiting
 In addition to the symptoms described above,  Immunocompromized: Amebiasis;
the symptoms of complicated diarrhea include: Cryptosporidium
1. Blood, mucus, or undigested food in the stool
2. Weight loss
3. Fever
2-CAUSES:
 MALNUTRITION
o Alcohol
o Caffeine in soda, tea, coffee & chocolate
o Food that cause gas such as beans & apples
o Nicotine
o Spicy foods
o Foods high in acids such as orange
o Fatty foods such as sausage & butter
o Dairy products, particularly for those who are lactose intolerant
 BACTERIA
o E.coli
o Salmonella
o Shigella
o Campylobacter
o Vibrio
Diarrhea
o Yersini
o Clostridium difficle
Watery Persistent
o S.aureus Dysentery
o B.cereus
o C.botulinum Rotavirus E. coli Cholera Amoebic Bacillary
Multiple
cause
 VIRUS
o Rotavirus
o Adenoviruses
o Caliciviruses
o Astroviruses
o Norwalk agents and Norwalk-like viruses

8.  FUNGI
o Yeast
o Candida
 PARASITE
o Entameba histolytica
o Giardia lamblia
o Cryptosporidium
o Isospora
DIARRHEA DUE TO MICROBES:
Transmission:
 Most of the diarrheal agents are transmitted by the fecal-oral route
 Cholera: water-borne disease; transmitted through water contaminated with feces
 Some viruses (such as rotavirus) can be transmitted through air
 Nosocommial transmission is possible
 Shigellosis (blood dysentery) is mainly transmitted person-to-person
 Shigellosis is a water-washed disease; transmitted more when there is scarcity of
water
 Food and water contaminated directly or indirectly with feces or vomitus of infected
persons are the principal mode of transmission. Ingestion of raw or inadequately
cooked seafood or eating shelfish from coastal and estuarine waters can cause
outbreaks of diarrhea. Person-to-person transmission occurs by hand-to-mouth
transfer of the agent from feces of an infected individual. Respiratory spread is
possible for rotavirus.
3-PATHOPHYSIOLOGY OF DIARRHEA:
 Osmotic Diarrhea
 Malabsorption/Maldigestion/Fatty
 Secretory Diarrhea
 Inflammatory Diarrhea
 Abnormal Motility Diarrhea

9. 1-Osmotic Diarrhea:
Mechanism:
– retention of water in the bowel as a result of an
accumulation of non‐absorbable water‐soluble
compounds
– non absorbed substance exert osmotic pressure
– -cease with fasting, discontinue oral agents
Causes:
o Purgatives like magnesium sulfate or
magnesium containing antacids
o Especially associated with excessive
intake of sorbitol and mannitol.
o Disaccharide intolerance
o Generalized malabsorption
o Lactose intolerance
2-Malabsorption Diarrhea
Mechanism:
– Luminal Phase (Intraluminal maldigestion) Normal Ilium
– Mucosal Phase (Mucosal loss & Mucosal disease)
– Transport Phase (Fat malabsorption=Streatorrhea)
Causes:
o Bacterial outgrowth
o Pancreatic insufficiency
o Mucosal disease (Crohn’s disease & Celiac sprue)
Celiac Sprue:
Celiac sprue
Gluten sensitive enteropathy
Reaction against gluten in diet
Epidemiology: Whites (European)

10. Diarrhea & malabsorption

11. 3-Secretory Diarrhea
Mechanism:
– Active intestinal secretion of fluid and electrolytes as well as decreased
absorption.
– Large volume, painless, persist with fasting
– Abnormal ION transport in intenstinal epithelial cells
– Abnormal mediators
– Diffuse mucosal disease
Causes:
o Cholera enterotoxin, heat labile E.coli enterotoxin
o Vasoactive Intestinal Peptide hormone in Verner-Morrison syndrome
o Bile salts in colon following ileal resection
o Laxatives like docusate sodium
o Carcinoid tumours
4-Inflammatory Diarrhea
Mechanism:
– Damage to the intestinal mucosal cell leading to a loss of fluid and blood
– Pain, fever, bleeding, inflammatory manifestations
Causes:
Immunodeficiency patient
o Infective conditions like Shigella dysentary
o Inflammatory conditions
Ulcerative colitis and Crohn’s disease

12. 5-Abnormal Motility Diarrhea
Mechanism:
– Increased frequency of defecation due to underlying diseases
– -large volume, signs of malabsorption (steatorrhoea)
– Diabetic diarrhea
– Hyperthyroidism
– Bloating & gas
Causes:
o Diabetes mellitus- autonomic neuropathy
o Post vagotomy
o Hyperthyroid diarrhoea
o Irritable Bowel Syndrome

13. 4-TREATMENT & CURE:
 Inj. Ciprofloxacin
 Inj. Metronidazole
 Inj.Ranitidine
 C. Bifilac
 T.Paracetamol
 Non-specific treatment
o hydration
o Absorptions (Kaopectate®)
o Bismuth
o Antiperistaltics/opiate derivatives
o Fiber supplementation
 ORS (Oral Rehydration Solution)
 Antibiotics choice
o E. coli
Quinolone
o Shigella
Quinolone or TMP-SMX
o Vibrio cholera
Tetracycline or quinolone
o Salmonella
Quinolone or TMP-SMX
o Campylobacter
Erythromycin or quinolone
o Yersinia
tetracycline, TMP-SMX, or quinolone