Chapter 10, Module 7; Constipation Flashcards
Low dietary fiber and bulk; inadequate fluid intake; physical inactivity; pain before and with bowel movements; anorexia
Simple constipation
Normal abdominal and rectal examination; can feel fecal masses in colon and rectum
Simple constipation
DIAGNOSTIC STUDIES FOR Simple constipation?
None if resolved; consider colonoscopy/sigmoidoscopy, anorectal manometry, colon transit studies if not resolved
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
Functional constipation
Abdomen may or may not be distended. The external sphincter is intact.
Functional constipation
DIAGNOSTIC STUDIES FOR Functional constipation?
Abdominal radiography, unprepped barium radiography
Onset in young adulthood; alternating diarrhea and constipation; mucus in stools
Irritable bowel syndrome (IBS)
Can have tender, palpable colon
Irritable bowel syndrome (IBS)
DIAGNOSTIC STUDIES FOR Irritable bowel syndrome (IBS)?
Colonoscopy/sigmoidoscopy if indicated
Passage of hard stool at 3- to 5-day in¬ tervals; diarrhea, small caliber stools; common in those confined to bed
Obstipation/ impaction
Hard feces in rectal ampulla; may have palpable feces-filled bowel
Obstipation/ impaction
DIAGNOSTIC STUDIES FOR Obstipation/ impaction?
Colonoscopy/sigmoidoscopy if indicated
Common in older adults; physical inactivity; decreased stool frequency; stool dry and hard
Slow transit
Normal abdominal and rectal examination
Slow transit
DIAGNOSTIC STUDIES FOR Slow transit?
Colonoscopy/FOBT or FIT to rule out tumors; consider anorectal manometry, colon transit studies
Delayed passage of meconium at birth; no urge to defecate
Hirschsprung disease
Empty rectal ampulla on examination
Hirschsprung disease
DIAGNOSTIC STUDIES FOR Hirschsprung disease?
Colonoscopy
Rectal pain on defecation; history of hemorrhoids; blood on stool, on toilet tissue, or in toilet
Anorectal lesions
On rectal examination: hemorrhoids, fissures, tears, abrasions; increased sphincter tone
Anorectal lesions
DIAGNOSTIC STUDIES FOR Anorectal lesions?
Anoscopy
History of chronic laxative use; history of taking medications that produce constipation
Drug induced
Normal rectal and abdominal examinations
Drug induced
DIAGNOSTIC STUDIES FOR Drug induced?
None if resolved; consider colonoscopy/ sigmoidoscopy, barium enema if not resolved
Recent onset: pain and abdominal distention, stool leakage, urgency; late onset: weight loss, anorexia; rectal bleeding; increased incidence over age 40; uncommon in children
Colorectal cancer
Can have palpable abdominal mass or organomegaly
Colorectal cancer
DIAGNOSTIC STUDIES FOR Colorectal cancer?
CBC, FOBT, FIT, fecal/stool DNA; colonoscopy
