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25 Cards in this Set
- Front
- Back
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What are the criteria for constipation?
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Two of the following:
Straining Hard stools Sensation of incomplete evacuation Use of digital maneuvers Decrease in stool frequency (<3/week) *Must have criteria for at least 3 months |
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What are the risk factors for developing constipation?
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Female
Physical inactivity Poor education Low income Concurrent med use History of depression Older adults |
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What are some ways in which the bowel can become obstructed and cause constipation?
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Colorectal cancer
Inflammatory - IBD, Diverticulitis Stricture Anal narrowing - stricture, fissure, carcinoma Slow transit - smooth muscle or neuronal innervation dysfunction |
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What are some metabolic/endocrine disorders than can cause constipation?
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Diabetes (60% of patients)
Pregnancy Hypothyroidism |
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Which medications are most likely to cause constipation as a side effect?
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Opiates
Antihypertensives Iron preparations Tricyclic antidepressants |
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When are idiopathic causes of constipation most often seen?
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In the elderly and in children
Elderly have multifactorial: mental confusion, immobility, inadequate toilet arrangements Children: Painful bowel movement may lead to voluntary withholding of feces |
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What is rectosphincteric dyssynergia?
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Failure of the puborectalis muscle and external anal sphincter to relax
Form of idiopathic, behavioral constipation in children |
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What are the neurological causes of constipation?
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Parkinson's
MS Spinal cord lesions |
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What should be asked about when taking a history in a constipation case?
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Current medical problems
Medications Family history Length of problems Coexistant problems (ab pain, fever, diarrhea, nausea) |
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What should be checked during a physical exam of a patient presenting with constipation?
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Abdominal exam including anorectal exam
Look for fissures, hemorrhoids, mass, tone of sphincter, hemoccult testing Skin and nails exam Neurological exam Pelvic exam - Rectocele |
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What types of work up should be done in a patient with constipation?
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Studies as indicated by evaluation
CBC if blood in stool Fasting blood sugar if diabetic TSH if hypothyroid Plain film xray Endoscopy |
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How is constipation treated in hyopthyroid, diabetes, pregnancy, and from medication?
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Hypothyroid: thyroid replacement
Diabetes: Control blood sugar Pregnancy: Increase fluid and fiber Meds: Change or eliminate offending med |
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How is idiopathic constipation treated?
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Diet - increase fiber intake both soluble and insoluble
Increase water consumption Behavioral approach |
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What are the pharmacologic therapy options for patients with constipation?
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Bulk forming laxatives such as psyllium and methylcellulose
Mineral oil Osmotic laxatives such as sorbitol and lactulose Magnesium containing laxatives Stimulant laxatives Prokinetic agents |
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When is surgery warranted to relieve constipation?
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Hirschsprung's disease
Resect the bowel |
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What is Hirschsprung's disease?
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Congenital aganglionic megacolon caused by failure of neural crest cells to migrate completely
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What happens to the bowel in Hirschsprung's disease?
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Sustained contraction of the aganglionic segment causing the proximal bowel to become dilated leading to functional blockage
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How does a patient with Hirschsprung's in the neonatal period present?
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Bilious emesis
Abdominal distension Failure to pass stool - explosive expulsion of gas and stool after digital rectal exam - squirt or blast sign |
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How is Hirschsprung's disease diagnosed?
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Barium enema - not useful after infancy
Abdominal radiograph - decreased or absent air in rectum with dilated loops of bowel Anorectal manometry Rectal biopsy - gold standard for up to 3 years old - look for lack of ganglionic cells |
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What is anorectal manometry?
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Inflate balloon in internal anal sphincter and it should cause relaxation of sphincter, if not, suggests Hirschsprung's
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How is Hirschsprung's disease treated?
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Surgery
Goal is to resect aganglionic portion and move ganglionic bowel close to anus to preserve sphincter function |
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What is melanosis coli?
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Deposition of dark pigment in the colonic mucosa after long use of anthraquinone containing laxatives
Benign and reversible |
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What is the pathophysiology of melanosis coli?
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Anthranoid laxatives activated in large intestine
Active compounds cause damage to myenteric plexus --> decreases peristalsis Excessive fluid loss Hypertrophy of mucosa --> decreased secretion |
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How does a patient with melanosis coli present?
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Constipated
Taking anthranoid laxatives |
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How is melanosis coli diagnosed and treated?
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Diagnosed by colonoscopy or biopsy showing lipofuscin laden macrophages
Treated by stopping anthranoid laxatives |
