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GIR Test 1 > B5-036 CBCL: Constipation > Flashcards

B5-036 CBCL: Constipation Flashcards

1
Q

Rome IV criteria for functional constipation

8

A
  1. straining in 25% of defecations
  2. lumpy or hard stools 25% of the time
  3. sensation of incomplete evacuation 25% of the time
  4. sensation of anorectal obstruction/blockage 25% of time
  5. manual maneuvers to facilitate more than 25% of defecations
  6. fewer than 3 SBM/week
  7. loose stools rarely present without use of laxatives
  8. insufficient criteria for IBS

must have two or more

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2
Q

Rome IV for opiod induced constipation

A
  1. straining in >25% of defecations
  2. lumpy, hard stools >25% of defecations
  3. sensation of incomplete evacuation >25% of defecations
  4. sensation of anorectal obstruction/blockage in >25% of defecations
  5. manual maneuvers to facilitate more than 25% of defecations
  6. fewer than 3 SBM/week

two or more of the above, new or worsening with opiod therapy

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3
Q

Rome IV for IBS

A
  1. Abdominal pain at least 1 day per month over at least 3 months associated with one or more of the following:
  2. Related to defecation
  3. A change in frequency of stool
  4. A change in form (appearance) of stool

Symptom onset should occur 6 months before diagnosis and symptoms should be present within past three months.

must have all

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4
Q

for IBS diagnosis, criteria need to occur for at lease

length of time

A

3 months

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5
Q

stimulant laxatives act by

A

stimulating enteric nerves to induce peristalsis

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6
Q

activating enteric mu receptors is a mechanism of what drug class?

A

antidiarrheal

loperamid, difenoxin, diphenooylate, etc

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7
Q

mu agonists are selective for […] opiod receptors

A

intestinal

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8
Q

decrease parasympathetic drive and inhibit ACh release resulting in decreased motility

what drug class

A

anti-diarrheals
(mu agonists)

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9
Q

dietary supplements that add bulk and hold water to expand intestinal contents

what drug class

A

bulk forming laxatives

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10
Q

constipation is [more or less] common in the elderly

A

more

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11
Q

what receptor is responsible for mediating opiod induced constipation?

A

mu opioid receptor

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12
Q

what neurotransmitter is used to induce smooth muscle cell contraction during peristalsis?

A

ACh

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13
Q

what is the consequence of chloride secretion into the lumen?

A

water is drawn into intestinal lumen

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14
Q

what neurotransmitters relax the receiving segment of the intestine distal to the bolus?

A

NO, VIP

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15
Q

what transporter maintains cellular Cl- concentrations?

A

basolateral Na/K/Cl transporter

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16
Q

Na and water are drawn into the lumen through the paracellular pathway by

A

lumen negative transepithelial voltage

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17
Q

psychosocial disturbances are associated with

A

IBS

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18
Q

associated with psychiatric stress, sleep disturbance, affective culnerability, and over adjustment to environment

A

IBS

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19
Q

gastrocolin and duodenocolic reflexes intiate […], moving fecal matter to rectum

A

power propulsions

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20
Q

rectoanal reflex relaxes the

A

internal anal spinchter

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21
Q

the voluntary decision to defecate results in the relaxation of

2

A

puborectalis muscle
external anal sphinchter

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22
Q

the colon is sacculated in small pouches called

A

haustra

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23
Q

motor patterns with the haustra are involved in

A

mixing and stool formation

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24
Q

decreased effectiveness of medicine over time

A

tolerance

25
Q

abberant behavioral response that is characterized by craving a substance, obsessive thinking and poor inhibitory control relating to a substance

A

addiction

26
Q

clinical phenomenon associated with chronic low mood, vegetative symptoms, and mild cognitive dysfunction

A

depression

27
Q

intentional or accidental misuse of a substance

A

substance abuse

28
Q

clinical phenomena associated with negative and intrusive thinking and physiological arousal

A

anxiety

29
Q

predicatable responses associated with opioids that affect most patients

2

A

tolerance and dependence

30
Q

risk factors associate with an increased risk of addication

2

A

hx of depression
hx of substance abuse

31
Q

common adverse effect of aluminum antacids

A

constipation

32
Q

common adverse effects of magnesium antacids

A

diarrhea

33
Q

dry mouth can be a side effect of [….] as they can limit acid secretion

A

anti cholinergic

34
Q

when given orally, has extensive first pass metabolism and can reduced OIC

A

naloxone

35
Q

mu selective antagonist incapable of crossing the blood brain barrier

A

methylnatrexone

36
Q

side effects of iron supplement

2

A

constipation
darken stool

37
Q

magnesium salts cause

A

diarrhea

38
Q

pain with defecating is more consistent with what diagnosis?

A

IBS

39
Q

fewer than […] bowel movements per week is criteria for functional constipation

A

3

40
Q

pain during defecation
change in stool

A

IBS

41
Q

for constipation to be attributed to opioid use, what criteria must be met

A

new or worsening constipation after initiating, changing or increasing opiod use

42
Q

what is the mechanism of OIC?

A

hypolarization by activating K+ channels
causes decreased release of neurotransmitters involved in peristalsis

43
Q

opioids cause hyperpolarization via activation of […] channels

A

potassium

44
Q

adenylate cyclase is […] with opioid use

increased or decreased

A

decreased

45
Q

opioid use […] Ca channels

inhibits or upregulates

A

inhibits

46
Q

opioid inhibition of VIP and ACh results in

A

less intestinal secretions

47
Q

slow intestinal transit time allowing for greater absorption of water

A

opioids

48
Q

activation of CFTR results in […] secretions

increased or decreased

A

increased

49
Q

opioids can diminish the perception of sensation for urgency for defecation by

A

increasing the threshold for pain

50
Q

opioids increase the threshold for pain sensation resulting in the decreased sensation for the

A

urgency to defecate

51
Q

why do bulk forming laxatives + opioids cause abdominal distension?

A

opioids decrease perstalsis what cause a much lower transit time giving the bulk forming laxative more time to accumulate and distend the intestine

52
Q

does not develop tolerance to opioids

A

GI tract

53
Q

potential contributors to the development of IBS

4

A
  • altered intestinal mobility
  • altered microbiota
  • disturbance of brain/gut function
  • immune dysfunction
54
Q

pathophysiologic changes causing constipation in the aging bowel

3

A
  • depletion of interstitial cells of Cajal
  • increased deposit of collagen in ascending colon
  • slow transit constipation
55
Q

PEG requires adequate

A

hydration

56
Q

if a patient is not experiencing an adequate response to PEG, what is the initial advise?

A

drink more water

57
Q

what do lubiprostone and linacoltide do?

A

increase water content of stool

58
Q

stimulate secretion of chloride into the lumen resulting in the passive diffusion of Na+ and water

A

lubiprostone

59
Q

stimulate secretion of chloride into the lumen resulting in the passive diffusion bicarb and water

A

lubiprostone

GIR Test 1 (16 decks)

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