Gi_Pm_Clinmed_Constipation

Front 1

What is most common GI complaint

Back 1

Constipation
-less than 3x per week

Various meanings to others?

Hint 1

Too hard
Too small
Too difficult
Too infrequent

Front 2

In whom is Constipation (CTP) most commen

Back 2

Women
Non-caucasian
Over age 60
Little Dialy Excercise
Low Income
Poor Eduction

Front 3

What are 2 categories of Obstruction of Outflow from colon in CTP

Back 3

1. Obstructing Lesions causeing constipation are usually advanced and DISTALLY located:
proximal colonic malignancies generally DO NOT cause CTP, proximally still liquid.
2. Strictures: diverticulitis, ischemia, IBD

Front 4

What can the following cause as a cause of CTP:
Strictures
Fissures
Cx
Foreing bodies
Hemorrhoids

Back 4

Anal Narrowing

Front 5

What is most common endocrine cause of CTP

Back 5

Dieabtetes--destroy nerves in colon
--other Metab/Endo Dzo that cause:
-Preggers
Hypothyroidism--(hypo = slower metabolism)

Front 6

Which 2 Hyper/o___ can cause CTP

Back 6

Hypercalcemia
Hypokalemia

---affect smooth mm. contractility

Front 7

No demonstrable Str of Fxn cause of CTP
-esp elederly?

Back 7

Idiopathic Constipation

Front 8

cuases of fecal impaction

Back 8

Mental Confusion--dont know they need to go
-Immobility--just hold it

Front 9

Idiopathic CTP in Children

Back 9

--Painful bowel mvmt with resultant w/hold of feces by child to avoid unpleasant defecation .
Causes:
-Rectosphincteric dyssynergia -- = Learned behaviour =Failure of puborectalis mm to relax = CTP

Front 10

CTP in young to middle aged adults

Back 10

Typically Women
Pscychosocial stress (IBS)
May have motility Dzo

Front 11

Sustained contraction of an aganglionic segment?

Back 11

Hirschsprung's Dz
-abs of Nn. in the Submucosal and Myenteric Plexi of the distal colon
-Proximal Bowel dilates

Front 12

What is initial test to rule out Hirschsprungs?

Back 12

Barium enema
--NOT useful after infancy

Front 13

Hirschrprungs on Radiograph

Back 13

Decreased or absent air in the distal colon with dilated loops of bowel proximall

Front 14

What is gold standard for Hirschs diagnosis

Back 14

Rectal biopsy

Front 15

What is Anorectal manometry

Back 15

inflation of balloon in the internal anal sphincter should cause a relaxation of the sphincter. Absent in Hischsprungs

Front 16

What are other Neurological Cuases of CTP?

Back 16

Parkinson's Dz
Dementia
Multiple Sclerosis
Spinal Cord Lesions

Front 17

Tx for CTP in Spinal Cord Lesions ABOVE the Conus Medullaris

Back 17

L1-L2= Upper Motor Neuron: Institute a Bowel Regimen. Use Suppositories THEN Digital Stimulation

High Spinal Cord Lesion-digital stimulation can trigger defecation

What if It's Below?

Hint 17

Suppositories/Enamas and Digital Stimulation WILL NOT Work

--Must Disimpact with Finger

Front 18

Deposition of dark pigmentation in the colonic mucosa after long standing use of Antraquinone containing laxatives

Back 18

Melanosis Coli
-benign condition
-Reversible

Note, with Laxatives

Hint 18

Taking more Laxative exacerbates the CTP via Melanosis coli

-hypertrophy of mucosa = less water put in= hard stool & CTP

Front 19

With Chronic Anthraquinone as the cause of Melanosis coli
What are it's 3 effects

Back 19

Damage to the myenteric plexus in the colon whch dec. peristalsis.
Excessive loss of fluids and electros out of the lumen
Hypertrophy of the mucosa which causes dec secretion into the lumen

Hint 19

basically bad fluid absorption, bad peristalsis and bad fluid secretion

Front 20

What to include in CTP workup

Back 20

Medications--laxs
-Lenght of Problems
-Other Sx: bleeding, anemai
Endocrin: skin, hair, nail changes
-Diabetes?

Front 21

What to look at in CTP Physical

Back 21

Include Neurologic Eval
-Anorectal Exam: fissures, hemorrhoids, mass; tone of anal sphincter--ask PT to try to poop with finger in ass
-Guaiac Test --
-Pelvic Exam in Women

What is Guaiac Test?

Hint 21

=FOBT - fecal occult blood (test)
Tests to make sure there's no blood in the stool
--could indicated masses, fissures or hemorrhoids that were otherwise not seen

Front 22

Why pelvic exam in women

Back 22

Rectocele
--rectum protrudes into vagina

Front 23

Labs/Tests for CTP

Back 23

CBC
Fasting Blood GLc
-Calcium
-TSH (for hypothryoirdism)
-Imaging: occasionally needed-

Front 24

For which Dzo is endoscopy needed

Back 24

Endoscopy for Obstruction or Melanosis Coli

Front 25

Tx for CTP if Hypothyroidism

Back 25

Thyroid Replacement

Front 26

Tx for DM

Back 26

Secondary to Neuropathy
-Control Blood Sugars

Front 27

Tx for Preggers

Back 27

Hormones cause decreased transit time
-Plenty of fiber and water

Front 28

If Pt complians of CTP and high cholesteroal, what do yo put them on

Back 28

Soluble Fiber-
--Combines to fatty substances and promote their excretion
-regulate blood sugars and lowers cholesterol

Front 29

Sources of Soluble Fiber

Back 29

Oat bran, pectin, beans, nuts, seeds

Front 30

What are some Insoluble Fiber sources?
What do they do for you

Back 30

Insol: Cellulose, wheat bran, whole grains
-Don't Dissolve and attract and hold onto water
-move waste trhough the intestines
-ADD bulk to Stools

Front 31

Amount of dietary fiber intake?

Back 31

20-30gm/day

About Fiber:
Dietary fiber or sometimes roughage is the indigestible portion of plant foods having two main components:

Hint 31

1. Soluble: prebiotic/viscous that is readily fermented in the colon into gases and physiologically active byproducts, and

2. Insoluble fiber: metabolically inert, absorbing water as it moves through the digestive system, easing defecation

Front 32

Tx for CTP for idiopathic causes

Back 32

Increased water consumption
--eight glasses daily

Front 33

Behavioral Approach for CTP

Back 33

Daily Diary
Attempt defecation after a meal
Get in, Get out
Excercise (increases colonic activity)

Front 34

4 Types of Pharms for CTP

Back 34

Bulk-Forming Laxatives
Mineral Oil
Osmotic Laxatives: sorbitol, lactulose
Mg-Containing Laxatives (inc. water content intralumenally)

Two Types of Bulk-Forming Laxatives?

Hint 34

Psyllium
Methylcellulose

Front 35

What are the Stimulant Laxatives?

Back 35

Castor Oil, Antraquinones (senna, cascara )

-Watch use of these--esp in elderly

Front 36

What are the ProKinetic Agents:

Back 36

Cisapride
Metoclopromide

-Watch use in Elderly and others

Front 37

When is Surgery Indicated?

Back 37

Treatment of Choice for :
Hirschsprung's Dz
--Resection