Constipation And Megacolon

Front 1

Define constipation:

Back 1

CHANGE IN PATTERN => DISCOMFORT

Front 2

What does the motor function of colon depend on contraction of? How many patterns of contraction?

Back 2

Front 3

Where do stationary motor contractions present? What do they cause? How long do they last?

Back 3

Front 4

Directions that long duration travels? What does it assist in? Migrates toward what?

Back 4

Front 5

What is the type of movements?

Back 5

Giant migrating complexes of the colon

Front 6

What causes increased segmental activity? Gastrocolic reflux may be mediated by what? What is the response proportional to?

Back 6

Gastrocolic reflux = stimulation of colon after a meal.

Front 7

What causes increased frequency and amplitude of segmental contractions? What stimulates longitudinal muscle contraction? What inhibits circular muscle contraction? What mediates intestinal peristalsis and secretion in GI tract as well as modulation of pain perception?

Back 7

Front 8

What is an important neurotransmitter in brain-gut interaction? What is it released by? (where)

What receptor antagonists can alleviate pain in IBS and functional dyspepsia?

What receptor against have prokinectic effect in human?

Back 8

Front 9

Back 9

Front 10

How common is constipation? More common in which individuals?

Ages? Sex?

Back 10

Front 11

Look over for exam.

Think about whether constipation is primary or secondary.

Back 11

Don't just give fiber and forget about it...think about other possible causes.

Primary = colon is not working (muscles not working)

Secondary = systemic disease and nerve problems

1. Identify

2. Rule out secondary causes.

Front 12

Separate primary (idiopathic) from secondary

Back 12

Rule out secondary causes => move to idiopathic.

Front 13

Back 13

Front 14

What is overwhelmingly the most common cause of pediatric constipation?

Back 14

Front 15

What ages encounter functional constipation? How long? Describe stool?

What is functional fecal retention?

Back 15

Fear of toilet encounters...

Front 16

What should you rule out first in constipation diagnosis? What steps do you move to next?

Back 16

Front 17

What are you always trying to rule out?

Back 17

Secondary causes.

Front 18

When do you order lab tests? Think dangerous symptoms. What labs should you get?

Back 18

Front 19

What is the purpose of colonoscopy?

Back 19

To rule out malignancy

Front 20

Back 20

Front 21

What are sitzmarks?

Back 21

Take capsule and get Xray five days later. See how many are left. If 80% passed you're ok, less than 80% not good.

KNOW THESE THREE PATTERNS!

Front 22

Blow up balloon in rectum and measure pressure changes during defecation.

Where should pressure increase and decrease?

Back 22

Rectal pressure should go up!

Anal (sphincters) pressure should decrease!

Abnormal = rectal pressure goes up but sphincter pressure does not relax.

Front 23

What sex experiences severe idiopathic chronic constipations? What are the symptoms?

Back 23

Front 24

Three types of sitz marker results?

Back 24

Front 25

What muscle acts like a sling, makes an acute angle and prevents defecation in resting state?

Back 25

Puborectalis => should relax during defecation.

Front 26

Describe the process of defecation. What muscles relax?

What is dysynergic defecation

Back 26

Three muscles fail to relax or inappropriate contraction

Front 27

What does treatment of constipation always start with?

Next level?

Pharmacologic therapies?

Back 27

Prucalopride not available in US yet. Know definition of lubiprostone.

Front 28

What are some fiber options available?

Name of stool softener?

What are the two osmotic agents?

What are the two stimulant laxative?

Back 28

Osmotic agents have fewer side effects and better compliance than stimulant laxatives

Front 29

Back 29

Front 30

What is a locally acting chloride channel activator that enhances chloride-rich intestinal fluid secretion? What is a prostaglandin analog?

What drugs is a 5HTA4 pro kinetic agent? Available in the US?

Back 30

Front 31

What is a congenital disorder (so seen in kids) characterized by obstipation from birth and colonic dilatation proximal to spastic, non-relaxing and non propulsive segment of distal bowel?

Back 31

Front 32

Is Hirshsprung common? Other name? Male or female? Seen with what other congenital condition? Are most cases sporadic?

What is the pathogenesis?

What genes are affected? Leads to defects in what?

Back 32

Front 33

What is missing in the ganglia in submucosa? What part of GI tract is always involved? Initial hypertrophy.

In later stages what outruns hypertrophy?

What are two causes of mortality?

Back 33

Front 34

Hirshsprung:

Failure to pass ______.

Obstructive ______, occasional passage of ______.

Bouts of ____, abdominal distention.

Back 34

Front 35

What is the gold standard for Hirshsprung diagnosis?

Back 35

Front 36

What disease?

Back 36

Massive dilated colon = Hirshsprung disease

Front 37

What is a big indicator of HS?

Back 37

Inappropriate sphincter contraction during defecation.

Front 38

What is the treatment for HS?

Back 38

Remove and reconnect

Front 39

Acquired megacolon causes: What causes?

1. bacteria

2. Diseases

3. Blockage

4. Psychiatric

5. Trypanosomes

Back 39

Always want to rule out tumor!

Front 40

What is the condition?

Back 40

Chronic volvulus

Front 41

What are the four major causes of intestinal obstruction? Most common type?

Back 41

Adhesions from surgery, PID, etc. are the MOST COMMON!

Front 42

What is the most common cause of bowel obstruction in pregnant women? Third leading after cancer and diverticulitis?

Back 42

Colonic volvulus.

Front 43

What medication could be causing the pain

Back 43

OPiate

Front 44

Back 44

?? No right answer

Front 45

Back 45

No right answer... Just think. Depends on lots of other factors.

Front 46

Judgement call..

Back 46

Glycerin suppository was actually given... works fast.

PEG could also be an option.

They could all work.