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24 Cards in this Set

  • Front
  • Back
What are the three subsets of constipation?
1. Mechanical - Obstructive Defecation

2. Functional - Slow colonic transit

3. IBS
What are the 6 categories of constipation causes?
1. Meds (Narcotics)

2. Congenital (Hirschsprung's)

3. Obstruction (Cancer)

4. Neurogenic

5. Endocrine (hypothyroidism)

6. Idiopathic (IBS)
What age group does IBS affect?
Young
What gender is more affected by IBS?
Female (in the US)
What is the main symptom of IBS?
Abdominal pain/discomfort that is relieved with defecation, associated with change in form or frequency of stool
What are the other important symptoms of IBS?
diarrhea, constipation, bloating, distention
What is more common in IBS constipation or diarrhea?
Constipation?? I had diarrhea in my notes?
What is defined as abnormal stool frequency?
<3 BM/week or >3/day
Is there a motility difference seen in IBS?
Yes (see increased motility / cramping after a meal in IBS)
What are some reasons that IBS may be considered an infectious disease?
Visceral hypersensitivity after gut infection

Increased lymphocytes on biopsy

Response to change in gut flora
What is SIBO?

What may it cause?

What abnormal test is seen with it?
Small intestinal bacterial growth

May cause IBS

See abnormal hydrogen breath test, (sign something wrong with gut flora)
What is the treatment fro SIBO?

What is the first line treatment for IBS?
SIBO = Rifaximin antibiotic

IBS = Diet modifications (like fiber) and stress reduction
What is the second line of treatment for IBS?
Bulking agents (can be used for both diarrhea and constipation) or laxatives
What must be ruled out in diagnosing IBS?
Celiac
What else can sometimes be used to treat IBS?
Antidepressant meds (SSRIs, Tricyclics)
How is constipation defined?
12 weeks in preceding 12 months of straining, hard stools, incomplete evacuation, manual maneuvers, less than 3 BM/wk
What are the 6 diagnostic tools for constipation?
1. Digital Exam

2. Colonic exam

3. Defecography

4. EMG recruitment

5. Manometry

6. Transit Study
What are the two categories of constipation?
Functional (SLow transit, anismus)

Mechanical (tumor, rectocele)
What is Paradoxical puborectalis syndrome (anismus)?
Functional obstruction due to puborectalis contraction when it should be relaxed during defecation
What is Paradoxical puborectalis syndrome commonly associated with?
solitary rectal ulcers
What is defecography?
Give pt a barium enema then have pt strain/push on a radiolucent toilet
What is the treament of anismus (paradoxical puborectalis syndrome)?
Biofeedback
How do you measure colonic transit time?
Sitzmark study (radio-opaque markers in capsule then x ray on day 5, 7, etc)
What is normal for a sitzmark study?
Pass 80% by day 5, 100% by day 7