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Case 14.4. Constipation and Diarrhea

A 7- y/o boy in previous good health was admitted to the hospital with bloody diarrhea

and dehydration 4 days after attending a children’s birthday party. He was treated with IV fluids

and nothing given by mouth. The day after admission to hospital, a colonoscopy revealed

hemorrhagic colitis. His diarrhea seemed to be improving up to day 5 when he experienced ageneralized convulsion following which he was transferred to an intensive care bed. He was

irritable, pale, and hypertensive, and an emergency lab report revealed thrombocytopenia,

hyponatremia, and hyperkalemia.

Salient Features

S

Patient Details: male, 7 y/o, pediatric patient, non-working

Chief Complaints: bloody diarrhea (dysentery) and dehydration

History of Present Illness: The patient attended a birthday party 4 days earlier

Review of Systems: tiredness, anorexia, nausea, light-headedness, and indicates the

presence of an invasive organism such as Campylobacter, Salmonella, Shigella, or E.

coli O157

O

PPE: Colonoscopy → hemorrhagic colitis 

Lab report: thrombocytopenia, hyponatremia, hyperkalemia

A

Diagnosis: Hemolytic Uremic Syndrome

*Uremia: ↑creatinine (since it is not excreted by the kidneys) 

P

Treatment

ORS-45

Na+  70mmoles

K+ 

HCO3- 

Glucose - activates glut-4 which is also a Na+

 channel

Zinc

  Pediatric patient

  Dehydration caused by malabsorption

  Helps in the repair of GI mucosa

  Aids in the absorption of electrolytes

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DehydrationLow blood

flow

Formation of

too much

renin

High blood

pressure

*Oral route promotes repair of GIT. In case of vomiting, it is given via oro gastric tube

(OGT).

*IV fluids can be given when computed by weight.

Drugs

  Do not give penicillin.

  You can give macrolides.

  Ciprofloxacin depresses the bone marrow.

 

Co-trimoxazole (Trimethoprim + Sulfamethoxazole)

 

Penicillin G, Penicillin Na + Gentamycin

Monitoring

o 

Thirst Mechanism- Hydration

o  Urinalysis: check for specific gravity (normal range = 1.003-1.03)

o  Skin turgor (skin's ability to resist a change in shape and use elasticity to return to

normal)

o  Urine output

o 

BUN (Blood Urea Nitrogen): 7-20mg/dL

Hypertension

Macula Densa: renin production

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Case 12.2. Peptic Ulcer Disease

A 57-y/o woman (Mrs. MG) presents with symptoms of epigastric pain which has

interfered with her normal activities over the previous few weeks. Medication history reveals that

she takes no prescribed medicines and occasional paracetamol as an analgesic for minor

ailments. Although she has occasional heartburn, this is not the predominant symptom. Mrs. MG

has not vomited and does not have difficulty or pain on swallowing. She has not lost weightrecently and has normal stools with no evidence of bleeding. The pain is not precipitated by

exercise and does not radiate to the arms and neck. Mrs. MG is a non-smoker and only takes a

small quantity of alcohol on social occasions. She has an allergy to penicillin.

CLO Test- also known as rapid urease test

-Biopsy test used to detect Helicobacter pylori 

**NSAIDs (administered any route) can cause gastritis. The oral causes earlier gastritis.

H. pylori  GERD- heartburn

  From dog saliva Laryngopharyngeal reflux (LPR)- cough

  Triple therapy

o 

Omeprazole- 20mg for mucosal healing

o 

Metronidazole- PPI; no 400mg in the PH

o 

Clarithromycin- 250mg or 500mg

**Mesoprazole can be an alternative.

**Esomeprazole- given to patients in the ICU for stress ulcers

**Pepto-bismol (Bismuth Subsalicylate) + PPI →ulcers 

**Pylorid= Ranitidine + Bismuth Citrate

Drugs for GERD

  prokinetics + PPI

Cisapride (with macrolides- treatment for H. pylori): synergistic effect

(Propulsid was withdrawn from the market by Janssen in 2000

due to fatal arrhythmias ADR)

Domperidone- Motilium

 

Mosapride- Gasmotin