A General Medical presentation and assessments

Question 1

Chronic abdominal pain

Answer 1

Question 2

Constipation: Eitology?

How do you break up causes?

Symptoms?

Answer 2

Constipation (non-post-op)

• Def - infrequent hard stools with straining (<3x/week)

Etiology

• GI - obstruction
• Metabolic - hypokalemia, hypercalcaemia
• Endocrine - DM, hypothyroidism
• Neurological
• General causes
• Insufficient water & fibre
• Medications - opioids, anti-depressants
• Bowel obstruction - hernias, cancer, strictures etc.
• Metabolic - DM, hypothyroidism, hypercalcaemia, hypokalaemia
• Neurological - Parkinson’s, MS

ClinicalSx

• Infrequent hard stools with straining
• Abdominal pain & distention - relieved by defecation
• Overflow diarrhoea

Ileus vs bowel obstruction on exam

• Minimal abdominal pain
• Absent bowel sounds (↑in obstruction)

Management

Non-pharmacological

• Diet - hydration, fibre
• Exercise
• Laxatives Order of ↑potency; start with less potent and escalate if required
• Stool softeners - Docusate (Coloxyl) allows more water to enter stool
• Bulk forming - psyllium (Metamucil); good for chronic constipation with hard stools; very low risk of adverse effects
• Osmotic - lactulose, sorbitol, polyethylene glycol (Movicol); use if not responding to bulk forming
• Stimulants - Senna (stimulates intestinal smooth muscle motility); good for post-operative ileus
• Suppositories - saline or phosphate enema, glycerin suppository

Coloxyl & Senna

• Dual action - coloxyl stool softener, senna stimulates motility

Question 3

Dysphagia

Question 4

Nausea and vommiting

Question 5

Diarrhoea

Question 6

Constipation

Question 7

Jaundice

Question 8

Haematemesis

Question 9

Melena/hematochezia

Question 10

Dyspesia /reflux

Question 11

Abdominal distension/ascites

Question 12

Delirium/Dementia/Depression

Question 13

Osteoporosis:

Question 14

Falls and Frailty

Question 15

Weakness