7djtK7kw4

CONSTIPATIONRecognise the patient with constipation needing urgent attention:• No stools or wind in the last 24 hours plus abdominal pain and vomitingRefer same day to hospital.Approach to the patient who is constipated and not needing urgent attention:• Review diet, fluid intake and medication (amitriptylline, codeine/morphine and antacids can cause constipation). Ask about chronic use of enemas or laxatives.• Exclude pregnancy. If pregnant 93.• Try non drug approaches before prescribing laxatives:--Advise a high fibre diet (vegetables, fruit, coarse mielie meal, bran and cooked died prunes) and adequate fluid intake.--Advise moderate regular exercise (20 minutes walk daily).--Stop chronic use of laxatives or enemas.No response• Give sennosides A and B 7.5mg 2 tablets at night for 3 days.• If no improvement increase to 4 tablets.• Refer if no response after 1 week, recent change in bowel habits or uncertain cause for constipation.ResolvedAdvise to continue with diet and exercise and avoid chronic use of laxativesand enemas.ANAL SYMPTOMSRecognise the patient with an anal symptom needing urgent attention:• Unable to sit because of anal symptoms• Unable to pass stool because of anal symptomsRefer same dayAnal pain and/or bleedingAnal ItchCrack/s or lump/pileRed/raw skin in patientwith chronic diarrhoeaUlcer/sPerianal wartsWormsDermatitis• Treat constipation as above.• Apply bismuth subgallate compoundointment 2–4 times a day or lignocaine2% cream after each bowel action.• Refer if pile cannot be reduced or isthrombosed.• Apply zinc and castoroil ointment.• To manage diarrhoea21.• Treat as for genitalulcer 26.• Refer if noimprovement.Treat as forgenital warts27.Givemebendazole500mg stat.• Advise good hygiene• Wash with aqueous cream.• Apply 1% hydrocortisone creamtwice a day for 5 days.22TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERSWOMEN'S HEALTH