Chapter 10, Module 7; Constipation

Question 1

Low dietary fiber and bulk; inadequate fluid intake; physical inactivity; pain before and with bowel movements; anorexia

Answer 1

Simple constipation

Question 2

Normal abdominal and rectal examination; can feel fecal masses in colon and rectum

Answer 2

Simple constipation

Question 3

DIAGNOSTIC STUDIES FOR Simple constipation?

Answer 3

None if resolved; consider colonoscopy/sigmoidoscopy, anorectal manometry, colon transit studies if not resolved

Question 4

Adults: bowel habits; chronic use of laxatives. Straining during defecation, hard or lumpy stools, a sensation of incomplete evacuation and/or anorectal obstruction Preschool and school-age children: history of abdominal pain and stool soiling

Answer 4

Functional constipation

Question 5

Abdomen may or may not be distended. The external sphincter is intact.

Answer 5

Functional constipation

Question 6

DIAGNOSTIC STUDIES FOR Functional constipation?

Answer 6

Abdominal radiography, unprepped barium radiography

Question 7

Onset in young adulthood; alternating diarrhea and constipation; mucus in stools

Answer 7

Irritable bowel syndrome (IBS)

Question 8

Can have tender, palpable colon

Answer 8

Irritable bowel syndrome (IBS)

Question 9

DIAGNOSTIC STUDIES FOR Irritable bowel syndrome (IBS)?

Answer 9

Colonoscopy/sigmoidoscopy if indicated

Question 10

Passage of hard stool at 3- to 5-day in¬ tervals; diarrhea, small caliber stools; common in those confined to bed

Answer 10

Obstipation/ impaction

Question 11

Hard feces in rectal ampulla; may have palpable feces-filled bowel

Answer 11

Obstipation/ impaction

Question 12

DIAGNOSTIC STUDIES FOR Obstipation/ impaction?

Answer 12

Colonoscopy/sigmoidoscopy if indicated

Question 13

Common in older adults; physical inactivity; decreased stool frequency; stool dry and hard

Answer 13

Slow transit

Question 14

Normal abdominal and rectal examination

Answer 14

Slow transit

Question 15

DIAGNOSTIC STUDIES FOR Slow transit?

Answer 15

Colonoscopy/FOBT or FIT to rule out tumors; consider anorectal manometry, colon transit studies

Question 16

Delayed passage of meconium at birth; no urge to defecate

Answer 16

Hirschsprung disease

Question 17

Empty rectal ampulla on examination

Answer 17

Hirschsprung disease

Question 18

DIAGNOSTIC STUDIES FOR Hirschsprung disease?

Answer 18

Colonoscopy

Question 19

Rectal pain on defecation; history of hemorrhoids; blood on stool, on toilet tissue, or in toilet

Answer 19

Anorectal lesions

Question 20

On rectal examination: hemorrhoids, fissures, tears, abrasions; increased sphincter tone

Answer 20

Anorectal lesions

Question 21

DIAGNOSTIC STUDIES FOR Anorectal lesions?

Answer 21

Anoscopy

Question 22

History of chronic laxative use; history of taking medications that produce constipation

Answer 22

Drug induced

Question 23

Normal rectal and abdominal examinations

Answer 23

Drug induced

Question 24

DIAGNOSTIC STUDIES FOR Drug induced?

Answer 24

None if resolved; consider colonoscopy/ sigmoidoscopy, barium enema if not resolved

Question 25

Recent onset: pain and abdominal distention, stool leakage, urgency; late onset: weight loss, anorexia; rectal bleeding; increased incidence over age 40; uncommon in children

Answer 25

Colorectal cancer

Question 26

Can have palpable abdominal mass or organomegaly

Answer 26

Colorectal cancer

Question 27

DIAGNOSTIC STUDIES FOR Colorectal cancer?

Answer 27

CBC, FOBT, FIT, fecal/stool DNA; colonoscopy