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24 Cards in this Set
- Front
- Back
What are the three subsets of constipation?
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1. Mechanical - Obstructive Defecation
2. Functional - Slow colonic transit 3. IBS |
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What are the 6 categories of constipation causes?
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1. Meds (Narcotics)
2. Congenital (Hirschsprung's) 3. Obstruction (Cancer) 4. Neurogenic 5. Endocrine (hypothyroidism) 6. Idiopathic (IBS) |
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What age group does IBS affect?
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Young
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What gender is more affected by IBS?
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Female (in the US)
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What is the main symptom of IBS?
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Abdominal pain/discomfort that is relieved with defecation, associated with change in form or frequency of stool
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What are the other important symptoms of IBS?
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diarrhea, constipation, bloating, distention
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What is more common in IBS constipation or diarrhea?
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Constipation?? I had diarrhea in my notes?
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What is defined as abnormal stool frequency?
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<3 BM/week or >3/day
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Is there a motility difference seen in IBS?
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Yes (see increased motility / cramping after a meal in IBS)
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What are some reasons that IBS may be considered an infectious disease?
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Visceral hypersensitivity after gut infection
Increased lymphocytes on biopsy Response to change in gut flora |
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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) |
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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 |
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What is the second line of treatment for IBS?
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Bulking agents (can be used for both diarrhea and constipation) or laxatives
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What must be ruled out in diagnosing IBS?
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Celiac
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What else can sometimes be used to treat IBS?
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Antidepressant meds (SSRIs, Tricyclics)
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How is constipation defined?
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12 weeks in preceding 12 months of straining, hard stools, incomplete evacuation, manual maneuvers, less than 3 BM/wk
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What are the 6 diagnostic tools for constipation?
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1. Digital Exam
2. Colonic exam 3. Defecography 4. EMG recruitment 5. Manometry 6. Transit Study |
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What are the two categories of constipation?
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Functional (SLow transit, anismus)
Mechanical (tumor, rectocele) |
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What is Paradoxical puborectalis syndrome (anismus)?
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Functional obstruction due to puborectalis contraction when it should be relaxed during defecation
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What is Paradoxical puborectalis syndrome commonly associated with?
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solitary rectal ulcers
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What is defecography?
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Give pt a barium enema then have pt strain/push on a radiolucent toilet
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What is the treament of anismus (paradoxical puborectalis syndrome)?
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Biofeedback
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How do you measure colonic transit time?
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Sitzmark study (radio-opaque markers in capsule then x ray on day 5, 7, etc)
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What is normal for a sitzmark study?
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Pass 80% by day 5, 100% by day 7
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