Chapter 20 Chrinic constipation

Question 1

What are the differential diagnosis for chronic constipation?

Answer 1

Inadequate fiber/fluid intake, medication side-effect, colonic obstruction by tumor, diabetic autonomic neuropathy, hypothyroidism, electrolyte disturbances (hypokalemia, hypercalemia, hypophosphatemia hypermagnesiumia)

Question 2

What should be ran for an outpatient in chronic constipation?

Answer 2

CBC, FOBT, BMP, Mg, Phos, TSH, HbA1c, microalbumin, colonoscopy

Question 3

What is the initial treatment for chronic constipated patients?

Answer 3

Bulk forming laxatives (psyllium methylcellulose and or milk of magnesia)
Patient education (increase fluid and fiber intake)
Avoid medications (CCB narcotics anti-cholinergics)

Question 4

What should be done for refractory constipation?

Answer 4

Give other classes of laxatives such as softeners (docusate), osmolar agents (lactulose, sorbitol, magnesium citrate) and stimulants (bisacodyl, senna)

Disimpact in cases of fecal impaction
Diagnostic studies (Anorectal manometey, pelvis floor studies, colonic transit studies)

Question 5

What are some additional tests that can be ran for chronic constipated patients?

Answer 5

LFTs as he is on Simvastatin, lipid profile, abdominal x-ray, ECG

Question 6

What is the appropriate therapy for this patient?

Answer 6

High-fiber diet, Metamucil, Oral hydration, low salt diet, low fat diet, exercise program, patient counseling