SPONDYLOSIS AND GASTROENTERITIES

SPONDYLOSIS AND GASTROENTERITIES
INTRODUCTION:-
Spondylosis (spinal osteoarthritis) is a degenerative disorder
It may affect the cervical(neck), thoracic(mid-back), lumbar(low-back) regions of the spine
It may cause loss of normal spinal shape and function
Commonly seen in individuals after the age of 40 years
Spondylosis refers to the degenerative changes in the spine such as bone spurs and degenerating intervertebral discs
Spondylosis changes in the spine are frequently referred to as osteoarthritis
Degeneration of cervical intervertebral disc and the secondary degeneration of cervical intervertebral joints, leads to injury of spinal cord, nerve roots and vertebral artery, and shows corresponding signs and symptoms

Lumbar spondylosis:-
Lumbar spondylosis is a medical condition in which chronic pain is experienced by the patient in the lumbar region (lower back) due to compression of the intervertebral discs
Age:- The discs are dehydrate, become thinner and become harder, then provide less support to the vertebrae resting on the discs
Repetitive strain injury (RSI) caused to lifestyle like driving, travelling, intense work in farm, who carry loads on their head
Congenital deformity:- stenosis of cervical spinal canal
Genetics:- if family has history
Mental health :- depression, anxiety

1. CASE PRESENTATION ON SPONDYLOSIS AND GASTROENTERITIES PRESENTED BY:- CHANDANA C III PHARM D 06 - SSCP

2. SPONDYLOSIS INTRODUCTION:- Spondylosis (spinal osteoarthritis) is a degenerative disorder It may affect the cervical(neck), thoracic(mid-back), lumbar(low-back) regions of the spine It may cause loss of normal spinal shape and function Commonly seen in individuals after the age of 40 years

3. DEFINITION:- Spondylosis refers to the degenerative changes in the spine such as bone spurs and degenerating intervertebral discs Spondylosis changes in the spine are frequently referred to as osteoarthritis

4. Cervical spondylosis:- Degeneration of cervical intervertebral disc and the secondary degeneration of cervical intervertebral joints, leads to injury of spinal cord, nerve roots and vertebral artery, and shows corresponding signs and symptoms Lumbar spondylosis:- Lumbar spondylosis is a medical condition in which chronic pain is experienced by the patient in the lumbar region (lower back) due to compression of the intervertebral discs

5. ETIOLOGY:- Age:- The discs are dehydrate, become thinner and become harder, then provide less support to the vertebrae resting on the discs Repetitive strain injury (RSI) caused to lifestyle like driving, travelling, intense work in farm, who carry loads on their head Congenital deformity:- stenosis of cervical spinal canal Genetics:- if family has history Mental health :- depression, anxiety

6. PATHOGENESIS :- Degeneration of intervertebral disc Narrowing of intervertebral disc Unstable of the spine Hypertrophy of vertebral body, facet joints, ligaments Compression of spinal cord, nerve roots, vertebral artery Bulge or extrusion of IVD

7. CLINICAL FEATURES:- CERVICAL SPONDYLOSIS:- Chronic neck pain may spread into the shoulder or down the arm Chronic neck stiffness Upon compression of spinal cord or nerve roots:- tingling, numbness, weakness in the arms, hands Migraine, dizziness, or vertigo

8. RADICULOPATHY:- i. compression of the cervical roots leads to ischemic changes that cause sensory dysfunction(radicular pain) or / and motor dysfunction(weakness) ii. Pain, weakness, numbness in the distribution of a nerve root MYELOPATHY:- i. Numbness, tingling of the hands ii. Balance and coordination difficulty iii. Bowl/Bladder disturbance

9. 2. LUMBAR SPONDYLOSIS:- Pain and morning stiffness Pain in the back, legs, thighs and buttocks that worsens the standing and walking Muscle weakness Leg weakness and numbness

10. DIAGNOSIS:- X-RAY:- shows loss of disk height or bone spurs Magnetic resonance imaging (MRI):- This study can create better images of soft tissues such as muscles, discs, nerve, the spinal cord Computed tomography(CT) scan:- This specialised X-ray study allows careful evaluation of the bone and spinal canal

11. GASTROENTERITIS DEFINITION:- Gastroenteritis is a medical condition characterized by inflammation of the gastrointestinal tract and small intestine resulting in some combination of diarrhoea , vomiting , and abdominal pain Transmission may occur due to consumption of contaminated food and water or via contact with infected individuals

12. ETIOLOGY:- Ingestion of contaminated food or water Non-infectious causes like food allergies, drug side effects Infections caused by virus ( adenovirus, rota virus ); Bacterial ( Salmonella, Shigella, E.coli ); Parasitic ( Entameoba hystolitica, Giardia lamblia )

13. ETIOLOGY:- This may be due to:- Decreased electrolyte and water absorption Increased secretion by intestinal mucosa Increased luminal osmotic load Inflammation of mucosa and exudation into lumen

14. RISK FACTORS:- Age - mainly in infants and geriatrics contact with an infected persons Ingesting contaminated food or water People with weak immune system

15. SYMPTOMS:- Nausea and vomiting Diarrhoea loss of appetite Fever Headache Abdominal pain Bloody stools Dehydration Lethargic

16. DIAGNOSIS:- It is typically diagnosed clinically , based on persons signs and symptoms like : dehydration - include excessive thirst , dry mouth, severe weakness , dizziness Vomiting for more than 2 days Other Diagnostic methods include : Medical history Endoscopy USG Physical examination Blood tests Stool tests

17. DEMOGRAPHIC DETAILS:- NAME:- Ann…. AGE:- 50 years GENDER:- FEMALE IP No:- 19120047 WARD :- GNW DOA:- 4/12/19 DOD:- 5/12/19

18. SUBJECTIVE EVIDENCE:- C/O Vomiting since 1 week (3-4 episodes /day) Loose stools since 1 week (4-5 episodes /day) Fever since 5 days Headache , backache , left side neck pain, left side shoulder pain since 10years.

19. HISTORY:- P ast medical history:- k/c/o type II DM since 10 years, typhoid 15 days back Past medication history:- glycomet GP 1 (1/2 -0-1/2) Social history:- NS Family history:- NS Allergies :- NKA Diet :- vegetarian

20. GENRAL PHYSICAL EXAMINATION:- BP:- 130/80 mmHg HR:- 74 b pm TEMP:- febrile RR:-20bpm SPO 2 :-99% on RA CVS:-S 1 S 2 positive CNS:- Conscious and oriented RS:- B/L NVBS PA:- soft , distention

21. PROVISIONAL DIAGNOSIS:- Acute gastroenteritis Cervical spondylosis

22. OBJECTIVE EVIDENCE:- PARAMETERS OBSERVED VALUE Haemoglobin 11.1g/dl RBC 3.87 milli/cumm Neutrophils 76.9% lymphocytes 13.1%

23. OBJECTIVE EVIDENCE CONTINUED….. MRI of left shoulder:- Supraspinatus tendon shows diffuse thickening and increased signal s/o moderately severe. Minimal glinohmeral joint infusion Degenrative changes in acromioclavicular joint with capsular thickening and hypertrophy.

24. MRI of cervical spine:- C 4 -C 5 disc shows dessication, mild disc bulge causing compression of anterior thecal sac C 5 -C 6 and C 6 -C 7 discs shows dessication , disc bulge causing compression of anterior thecal sac and indenting on anterior cord surface MRI of lumbar spine:- L 3 -L 4 disc shows mild dessication L 4 -L 5 disc shows dessication ,asymmetrical disc bulge causing compression of anterior thecal sac L 5 -S 1 disc shows dessication, mild disc bulge causing compression of anterior thecal sac

25. FINAL DIAGNOSIS:- Acute Gastroenteritis with dehydration Cervical and Lumbar spondylosis with radiculopathy K/C/O Type-2 Diabetes mellitus

26. ASSESSMENT:- The patient is having :- Acute gastroenteritis with dehydration Cervical and lumbar spondylosis with radiculopathy Type -2 diabetes mellitus Typhoid fever, 15 days back Eye problem (cataract)

27. PHARMACEUTICAL CARE PLAN:-

28. GOALS OF THERAPY:- To reduce the signs and symptoms of patients To maintain normal blood sugar level To control further complication To maintain laboratory parameters To reduce the risk of morbidity and mortality To improve the quality of life

29. TREATMENT OPTION:- Antidiarrheal:- Metronidazole, Tinidazole Antiemetic:- Ondansetron Topical NSAIDs:- Diclofenac 1% gel, Ibuprofen 10% gel Analgesic and antipyretic:- Paracetamol, Ibuprofen, Diclofenac Antineuropathic drugs:- Pregabalin, Gabapentin, Amitriptyline Proton pump inhibitor:- Pntoprazole

30. TREATMENT CHART:- BRANDNAME GENERIC NAME DOSE FREQUENCY ROA DAY-1 DAY-2 Inj.Microtaz Piperacillin+Tazobactum 4.5g 1-1-1 IV . . Inj.Metrogyl Metronidazole 400mg 1-1-1 IV . . Inj.Pan Pantoprazole 40mg 1-0-1 IV . . Inj.Emeset Ondansetron 4mg 1-1-1 IV . . Inj.PCT Paracetamol 1g 1-1-1-1 IV . . Inj.Nervigen Pregabalin+nortriptyline+methylcobalamine In 100mlNS 1-0-0 IV . . Tab.Sporolac Lactic acid bacilli - 1-1-1 PO . . Inj.Pregabalin Pregabalin 75mg 0-0-1 IV . . IVF NS Normal saline 100ml/hr - IV . . Inj.H.Actrapid Soluble insulin - - SC . . Cap.Redotil Racecadotril 100mg 1-1-1 PO . . Inj.Tramadol Tramadol 50mg 1-0-1 IV . . Fentanyl patch Fentanyl 25mcg Once in 72hrs . .

31. PROGRESS REPORT:- DAY-1:- H/o vomiting (3-4 episodes), loose stools (4-5 episodes) since 1week; Headache,neckpain,shoulder pain, with difficulty in breathing HR:-72bpm BP:-130/80mmHg SPO2:-99% RR:-20bpm GRBS:-252mg/Dl CVS:-conscious and oriented PA:-soft distension(+), tenderness(+)

32. DAY-2:- C/o vomiting (2 episodes from morning) loose stools (3 episodes from morning) headache, neck pain, shoulder pain No fresh complaints HR:-83bpm BP:-140/80mmHg RR:-20bpm GRBS:- 202mg/dL RS:-B/L NVBS (+) CVS:-S1S2 (+) CNS:- Conscious and oriented PA:- soft and tenderness (+) Patient attenders are not willing for admission, they want to go against medical advice and discharged

33. MONITORING PARAMETERS:- Glucose test Electrolytes MRI scan Hematology Eye test widal test

34. PROBLEMS IDENTIFIED:- Patient is having cataract, it is not diagnosed Patient is having typhoid fever, 15 days back but there is no diagnosing test conducted Fentanyl and tramadol may result in increased risk of respiratory and CNS depression

35. PHARMACIST INTERVENTION:- Advice to diagnose about cataract Advice to diagnose about typhoid fever

36. PATIENT COUNSELLING:- ABOUT DISEASE:- Explain the nature of condition Explain the role of relevant risk factors such as obesity ,heredity and trauma The patient should be informed that established structural changes are permanent and that, although cure is not possible at present, pain and function can often be improved

37. ABOUT MEDICATION:- Fentanyl patch may cause abuse or opioid addiction If hypersensitivity reactions occurs by any medicines immediately informed to health care professionals If any ADR occurs by any medicines informed to health care professionals Never take in greater amounts or more often than prescribed

38. LIFESTYLE ADVICE:- Strengthening exercises to improve muscle strength and aerobic fitness training Advice to loss weight Decrease stress level Use soft collars (neck immobilization) Avoid prolonged sitting or standing Cervical mechanical traction Heat and cold therapy

39. DIET:- Avoid white potato and coffee as it increase acid load in the body Use garlic, turmeric and ginger in food, it shows anti-inflammatory Avoid spicy, hot, salty oily foods Replace rice with wheat Add more bitter vegetables like bitter guard and drum stick in the routine food

40. THANK YOU