Emollients
Emollients (surfactants) are stool softeners (surface-acting drugs) and lubricants
used to prevent constipation and decrease straining during defecation by lower-
ing surface tension and promoting water accumulation in the intestine and stool.
Emollients are frequently prescribed for patients after a myocardial infarction
(heart attack) or surgery and are also given prior to administration of other laxa-
tives in treating fecal impaction. Docusate calcium (Surfak), docusate potassium
(Dialose), docusate sodium (Colace), and docusate sodium with casanthranol
(Peri-Colace) are examples of stool softeners.
Lubricants such as mineral oil increase water retention in the stool. Mineral
oil absorbs essential fat-soluble vitamins A, D, E, and K. Some of the minerals
can be absorbed into the lymphatic system. Side effects include nausea, vomit-
ing, diarrhea, and abdominal cramping. They are not indicated for children,
the elderly, or patients with debilitating conditions because they can aspirate the
mineral oil, resulting in lipid pneumonia.
Emollients are contraindicated in patients with inflammatory disorders of the
GI tract, such as appendicitis, ulcerative colitis, undiagnosed severe pain that
could be due to an inflammation of the intestines (diverticulitis, appendicitis),
pregnancy, spastic colon, or bowel obstruction.A list of stimulant drugs is provided in the Appendix. Detailed tables show
doses, recommendations, expectations, side effects, contraindications, and more;
available on the book’s Web site (see URL in Appendix).PEPTIC ULCER
A peptic ulcer is a sore or hole in the lining of the stomach or duodenum and is
a term used to describe a lesion in the esophagus, stomach, or duodenum. More
specific names are used to describe an ulcer located at a specific site. Duodenal
ulcers (the first part of the small intestine) are more common than other types of
peptic ulcers. Peptic ulcers are caused by hypersecretion of hydrochloric acid
and pepsin that erode the GI mucosal lining.
Anyone can get an ulcer. Most ulcers are caused by an infection with the bac-
teriumHelicobacter pylori—not spicy food, acid, or stress—and can be cured
with antibiotics in about two weeks. The most common ulcer symptom is burn-
ing pain in the stomach:^1 / 2 –1^1 / 2 hours after eating with gastric ulcers; 2–3 hours
for a duodenal ulcer.
Gastric secretions in the stomach maintain a pH between 2 and 5. Pepsin, a
digestive enzyme, activates at pH 2 and the acid-pepsin complex of gastric(^340) CHAPTER 18 Gastrointestinal System