Bowel Cleansing + Constipation Flashcards
What is not recommended for opioid induced constipation?
Bisacodyl
Lactulose
Docusate
Ispaghula husk
Ispaghula husk (bulk formers)
What are bowel cleansing preparations used for?
In preparation of colonic surgery, colonoscopy or radiological exam. Ensures the bowels are free of solid content. Not treament for constipation!
What is not a bulk forming laxative? Ispaghula husk Bran Macrogol Methylcellulose Sterculia
Macrogol- is an osmotic laxative, an inert polymer that draws fluid into the bowel.
MEthyl cellulose also acts as a faecal softener
Co-danthramer and co-danthrustate are stimulant laxatives, however their use is limited? In what patients are they used on and why?
Terminally ill patients because risk of carcinogenicity and genotoxicity.
The side effects and cautions for using liquid parafin are….
anal seepage, risk of granulomatous disease (inc risk of infection) of the GI tract, can cause lipid pneumonia if aspired
What is the recommended management for short duration constipation? Stimulant -> Osmotic -> Bulk forming Bulk -> Faecal softener -> Stimulant Osmotic -> Faecal softener -> Stimulant Bulk -> Osmotic -> Stimulant Osmotic -> Bulk -> Stimulant
Bulk formers first with adequate fluid, Switch or add osmotic laxative if stoold remain hard, add stimulant if stools are soft but difficult to pass or cant empty properly.
What is recommended when osmotics or stimulants dont produce an adqequate response to opioid induced constipation?
Naloxegol
What is the recommended first line treatment for a patient suffering with faecal impaction with hard stools? Macrogol Methyl cellulose Phosphate enema Glycerol suppositories Senna
High dose macrogol, if after a few days not worked, add oral stimulant. If still not working use topical preparations, first with glycerol or glyceral and bisacodyl. if still not adequate can use arachis oil enema or sodium phosphate
What is the recommended first line treatment for a patient suffering with faecal impaction with soft stools? Macrogol Methyl cellulose Phosphate enema Glycerol suppositories Senna
Start with oral stimulant, then rectal administration of bisacodyl, alternatively a docusate sodium or sodium citrate enema can be used if response insufficient. If still not adequate can use arachis oil enema or sodium phosphate
How many stools and what type of stools is the recommended aim for laxatives?
One or two soft stools per day
Prucalopride is a selective 5HT4 agonist, its high affinity stimulates colonic movement and peristalsis. When should you consider using prucalopride?
If atleast two laxatives of different classes have been tried at the highest tolerated dose for atleast 6 months
How would you go about stopping the use of laxatives once bowel movements have become normal?
Slowly withdraw, if more than one has been used stop the stimulant laxative first, it may be the case of increasing the dose of the second to compensate.
What is the first line treatment for constipation in children? Senna Macrogol Dietary modifications Behaviour intervention Glycerol sups
None. First line treatment requires the use of laxatives AND dietary mods or behaviour intervention
What is the fist line treatment for faecal impaction in children and what side effects would need to counselled as a result of treatment?
Macrogol, soiling and ab pains may get worst, but this is only during the initial treatment stage
When is the nest step after using macrogol in children with faecal impaction if macrogol is inadequate? and what are the next steps?
If disimpaction does not occur after two weeks. Stimulant can be added, for hard stools a combination of stimulant and osmotic. long term regular use is essential to prevent recurrence.
