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 childrens 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 a
generalized 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

Dehydration
Low 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














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 weight
recently 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