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17 Cards in this Set
- Front
- Back
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Decreased stool frequency
Straining with defecation Passage of hard stool Incomplete evacuation ... all are what? - gender predom? - age predom? |
specific sx associated with impaired defecation
--> constipation - women - elderly |
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Rome III consensus criteria state that to dx constipation, you must have at least ___ of the following:
Fewer than 3 defecations or BMs per week Straining with at least 25% of BMs Hard, lumpy stools with at least 25% of BMs Sense of incomplete evacuation with at least 25 % of BMs Sense of anorectal blockage with at least 25% BMs Manual assistance with at least 25% of BMs w/o loose stools w/o evidence for IBS w/ 6m hx |
2 or more with the end conditions met
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Constant bent forward posture can compress which nerve roots? Why does this related to constipation?
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S2/S3, S4 roots to pudendal
--> they innervate the puborectalis and the external anal sphincter. |
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In a normal person, how does stool get from the proximal colon to the rectosigmoid?
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several times a day by specialized, high-amplitude, prolonged duration pressure waves
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Hypothyroidism
Diabetes Mellitus Pregnancy Hypercalcemia Hypokalemia Uremia ... what type of causes of constipation are these? |
metabolic
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Metabolic
Neurogenic Medication Associated Hirschsprung’s disease Pelvic Floor Dyssynergia Anatomic Variations .... these have what to do with constipation? |
they are the categories of etiologies of constipation
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What are some common categories of medications associated with constipation?
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Narcotics
Antidepressants Anticholinergics Antihypertensives Diuretics Antihistamines Antiparkinson’s drugs Anticonvulsants |
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Metabolic and neurogenic disorders are often associated with ______ colonic transit time.
Medications often cause ____ colonic transit. |
prolonged
delayed. |
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Poop that looks like separate hard lumps, like nuts, has had a ____ transit time.
Watery w/ no solid pieces? |
long
fast. |
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What imaging test can help dx constipation? What are the categories of results?
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Radiopaque marker ingestion; Ab X-ray 120hrs later.
Normal motiliy: less than 5 markers remain Slow: Rings are scattered throughout Functional Outlet obstruction: rings are gathered in the rectosigmoid. |
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What is Hirschsprung's Dz?
What areas does it affect? |
Congenital motor disorder
Due to failure of appropriate migration of neural crest cells to the distal rectum May extend proximally for varying lengths |
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What is the RAIR?
Absence suggests what? |
Rectoanal Inhibitory Reflex - measured with manometry
- Relaxation of the internal anal sphincter with rectal balloon distention Hirschsprung's Dz |
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What is pelvic floor dyssynergia?
What can help dx? Findings? |
Paradoxical contraction of the pelvic floor with defecation leading to outlet obstruction
--> simply put, they have an inability to relax the anal sphincter. Manometry - increase in intra-abdominal pressure is met by a paradoxical increase in anal sphincter pressure. |
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What is a rectocele? Main causes?
enterocele? Grading system? |
A rectocele results from a tear in the rectovaginal septum (which is normally a tough fibrous sheet like divider between the rectum and vagina). Rectal tissue bulges through this tear, into the vagina, as a hernia. There are two main causes of this tear: childbirth and hysterectomy.
small intestine falling into the pelvic / large intestinal area. 0 = no enterocele, 1 = enterocele extends into distal half of vagina, 2 = enterocele reaches to perineum, and 3 = enterocele protrudes out of anal canal |
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How do you manage slow transit constipation?
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laxatives;
Polyethylene glycol, lactulose, sorbitol, magnesium sulfate, magnesium citrate, magnesium phosphate or lubiprostone may be used |
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How do we tx Pelvic floor dyssynergia?
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pelvic floor biofeedback.
Individuals are taught to isolate and appropriately relax the puborectalis muscle with a rectal sensor in place while watching their pelvic floor activity on a computerized screen |
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What causes of constipation might require surgical correction?
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Selected anatomic defects such as non-emptying rectoceles and enteroceles that descend into the pelvis and obstruct defecation may require surgical correction.
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