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Roomies Collab Deck 4: GI and ENT > Constipation > Flashcards

Constipation Flashcards

1
Q

Constipation is defaecation that is unsatisfactory because of _____________ stools, difficult ________________, or seemingly ______________ defaecation

A

Infrequent

stool passage

incomplete

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2
Q

Constipation can occur at any age and is commonly seen in _____________, the _____________, and during ______________.

A

women

elderly

pregnancy

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3
Q

It is important for those who complain of constipation to understand that bowel habit can vary considerably in frequency without ______________

A

doing harm

*Some people erroneously consider themselves constipated if they do not have a bowel movement each day.

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4
Q

What are the red flags of constipation? (6)

A
  1. New onset
  2. Age > 50 years
  3. Accompanying anaemia or…
  4. Abdominal pain
  5. Weight loss
  6. Overt or occult blood in the stool

*these should provoke urgent investigation because of the risk of malignancy or other serious bowel disorders

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5
Q

In those patients with secondary constipation caused by a drug, the drug should be ___________.

A

reviewed

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6
Q

What is the lifestyle advice given to patients with constipation? (3)

A

Increase dietary fiber (gradually to minimize flatulence and bloating)
Adequate fluid intake
Exercise

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7
Q

If fiber is increased rapidly, it may lead to what symptoms? (2)

A

Flatulence

Bloating

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8
Q

The effects of a high-fibre diet may be seen in ___________ although it can take as long as ____________

A

a few days

4 weeks

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9
Q

Fruits high in ___________ and ___________, and fruit juices high in ___________, can help prevent and treat constipation

A

fibre

sorbitol

sorbitol

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10
Q

Misconceptions about bowel habits have led to excessive laxative use. Laxative abuse may lead to ______________

A

hypokalaemia

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11
Q

Before prescribing laxatives it is important to be sure that ____________________ and that __________________.

A

the patient is constipated

the constipation is not secondary to an underlying undiagnosed complaint

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12
Q

What are the different types of laxatives? (4)

A
  1. Bulk-forming
  2. Stimulant
  3. Stool softeners
  4. Osmotic
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13
Q

Bulk forming laxatives include…? (3)

A
  1. Ispaghula husk
  2. Methylcellulose (also acts as a stool softener)
  3. Sterculia
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14
Q

What must be maintained when taking laxatives to prevent bowel obstruction?

A

Adequate fluid intake

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15
Q

Bulk-forming laxatives are ideal in which patients?

A

Adults with small hard stools if fiber cannot be increased in the diet

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16
Q

Onset of action of bulk-forming laxatives is up to _____________

A

72 hours

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17
Q

_____________, ____________, and _____________ may be exacerbated by bulk-forming laxatives

A

Flatulence

Bloating

Cramping

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18
Q

Which drugs are offered as stimulant laxatives? (5)

A
  1. Bisacodyl
  2. Sodium pico sulfate
  3. Anthraquinones (senna, co-danthramer, co-danthrusate)
  4. Docusate sodium (stimulant and stool softener)\
  5. Glycerol suppositories (also softening effects)
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19
Q

What is the mechanism of action of stimulant laxatives?

A

Increase intestinal motility

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20
Q

What is the major side effect of stimulant laxatives?

A

Abdominal cramping

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21
Q

Stimulant laxatives should be avoided in cases of _________________

A

Intestinal obstruction

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22
Q

The use of co-danthramer and co-danthrusate is limited to constipation in ______________ patients because of potential carcinogenicity (based on animal studies) and evidence of genotoxicity.

A

terminally ill

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23
Q

The use of co-danthramer and co-danthrusate is limited to constipation in terminally ill patients because of potential _______________ (based on animal studies) and evidence of _____________.

A

carcinogenicity

genotoxicity

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24
Q

Docusate sodium is believed to act as both a ____________ laxative and as a ______________

A

stimulant

faecal softener

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25
Q

Glycerol suppositories act as a ___________ and as a rectal _______________ by virtue of the mildly irritant action of glycerol.

A

lubricant

stimulant

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26
Q

______________ suppositories act as a lubricant and as a rectal stimulant by virtue of the mildly irritant action of ______________.

A

Glycerol

glycerol

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27
Q

What is the mechanism of action of stool softeners?

A

Decrease surface tension and increase penetration of intestinal fluid into the fecal mass

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28
Q

Faecal softeners are claimed to act by decreasing ________________ and increasing ______________ into the faecal mass.

A

surface tension

penetration of intestinal fluid

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29
Q

What are the different stool softeners? (4)

A
  1. Docusate sodium (also stimulant)
  2. Glycerol suppositories (also stimulant)
  3. Arachis oil enemas
  4. Liquid paraffin
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30
Q

Why is liquid paraffin used with caution as a stool softener?

A

Because of its adverse effects, which include:

  • anal seepage
  • risks of granulomatous disease of the gastro-intestinal tract
  • lipoid pneumonia on aspiration
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31
Q

What is the mechanism of action of osmotic laxatives?

A

Increase water content of large bowel either by drawing fluid from the body into the bowel OR by retaining the water they were administered with

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32
Q

What are the different osmotic laxatives? (2)

A
  1. Lactulose

2. Macrogols (inert polymers of ethylene glycol)

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33
Q

Lactulose is a semi-synthetic disaccharide which is not absorbed from the gastro-intestinal tract. It produces an ______________ diarrhoea of ________ faecal pH, and discourages the proliferation of _______________. It is therefore useful in the treatment of hepatic encephalopathy

A

osmotic

low

ammonia-producing organisms

34
Q

Lactulose is a semi-synthetic disaccharide which is not absorbed from the gastro-intestinal tract. It produces an osmotic diarrhoea of low faecal pH, and discourages the proliferation of ammonia-producing organisms. It is therefore useful in the treatment of _______________

A

hepatic encephalopathy

35
Q

_________________ are inert polymers of ethylene glycol which sequester fluid in the bowel; giving fluid with them may reduce the dehydrating effect sometimes seen with osmotic laxatives.

A

Macrogols

36
Q

Giving ______________ with macrogols may reduce the dehydrating effect sometimes seen with osmotic laxatives.

A

fluid

37
Q

Giving fluid with macrogols may reduce the ______________ effect sometimes seen with osmotic laxatives.

A

dehydrating

38
Q

______________ is a guanylate cyclase-C receptor agonist that is licensed for the treatment of moderate to severe irritable bowel syndrome associated with constipation. It increases intestinal fluid secretion and transit, and decreases visceral pain

A

Linaclotide

39
Q

________________ is a selective serotonin 5HT4-receptor agonist with prokinetic properties. It is licensed for the treatment of chronic constipation in adults, when other laxatives have failed to provide an adequate response

A

Prucalopride

40
Q

Linaclotide is a guanylate cyclase-C receptor agonist that is licensed for the treatment of moderate to severe ________________ associated with constipation. It increases intestinal fluid secretion and transit, and decreases visceral pain

A

irritable bowel syndrome

41
Q

Prucalopride is a selective serotonin 5HT4-receptor agonist with prokinetic properties. It is licensed for the treatment of _____________ in adults, when other laxatives have failed to provide an adequate response

A

chronic constipation

42
Q

Bowel cleansing preparations are used before ______________, _______________, or ______________ to ensure the bowel is free of solid contents

A

colonic surgery

colonoscopy

radiological examination

43
Q

What are the main bowel cleansing preparations? (4)

A
  1. Macrogol (also used as an osmotic laxative)
  2. Citric acid with magnesium carbonate
  3. Magnesium citrate with sodium picosulfate
  4. Sodium acid phosphate with sodium phosphate
44
Q

Can bowel cleansing treatments be used as treatments for constipation?

A

No, these are not treatments for constipation

45
Q

What is the treatment of choice for short-duration constipation not responding to dietary measures?

A

First line:
- Bulk-forming laxatives, ensuring adequate fluid intake

Second-line:

  • add or switch to an osmotic laxative IF stools remain hard
  • if stools are soft but difficult to pass or the person complains of inadequate emptying, a stimulant laxative should be added
46
Q

A patient is complaining of short-duration constipation that is has not responded to lifestyle modification or bulk-forming laxatives. Their stools remain hard and difficult to pass. What medication should be recommended?

A

Add or switch to an osmotic laxative

47
Q

A patient is complaining of short-duration constipation that is has not responded to lifestyle modification or bulk-forming laxatives. Their stools are soft but difficult to pass and they have the feeling of inadequate emtying. What medication should be recommended?

A

Add a stimulant laxative

48
Q

What is the laxative of choice in patients with opioid-induced constipation?

A

Osmotic laxative and a stimulant laxative

Eg docusate sodium

49
Q

Which laxatives should be avoided in opioid-induced constipation?

A

Bulk-forming laxatives

50
Q

_______________ is recommended for the treatment of opioid-induced constipation when response to other laxatives is inadequate

A

Naloxegol

51
Q

_______________ is also licensed for the treatment of opioid-induced constipation when response to other laxatives is inadequate but should only be used as an adjunct to existing therapy in patients receiving palliative care

A

Methylnaltrexone bromide

52
Q

The treatment of faecal impaction depends on the __________________.
In patients with hard stools, a high dose of an oral _________________ may be considered. In those with soft stools, or with hard stools after a few days treatment with a macrogol, an _________________ should be started or added to the previous treatment.

A

stool consistency

macrogol

oral stimulant laxative

53
Q

In cases of fecal impaction, if oral laxatives are inadequate, for soft stools consider __________________ and for hard stools ___________________. Alternatively, a __________________ may be tried

A

Rectal bisacodyl

Rectal glycerol OR glycerol plus bisacodyl

Docusate sodium or sodium citrate enema

54
Q

If oral and rectal laxatives are insufficient in treating fecal impaction, a _________________ may be necessary

A

Retention enema (sodium acid phosphate or arachis oil)

55
Q

In the management of chronic constipation, treatment should be started with a(n) ____________ laxative, whilst ensuring good hydration. If stools remain hard, add or change to a(n) _____________ laxative such as a(n) _____________.

A

bulk-forming

osmotic

macrogol

*lactulose is an alternative if macrogols are not effective or not tolerated); if the response is inadequate, a stimulant laxative can be added

56
Q

In the treatment of chronic constipation, the dose of laxative should be adjusted gradually to produce ____________ stools per ________________

A

one or two soft, formed

day

57
Q

If at least ___________ laxatives (from different classes) have been tried at the highest tolerated recommended doses for at least ____________, the use of prucalopride (in women only) should be considered.

A

two

6 months

58
Q

If at least two laxatives (from different classes) have been tried at the highest tolerated recommended doses for at least 6 months, the use of _______________ (in women only) should be considered.

A

prucalopride

59
Q

If treatment with prucalopride is not effective after ______________, the patient should be re-examined and the benefit of continuing treatment reconsidered

A

4 weeks

60
Q

What is the mechanism of action of prucalopride?

A

Promotion of ACh release via activation of 5-HT receptors leading to contraction of colonic longitudinal smooth muscles

61
Q

When and how should laxatives be withdrawn?

A

Slowly, when regular bowel movements occur without difficulty

62
Q

If a combination of laxatives has been used, ___________________; if possible, the _____________ laxative should be reduced first.

A

reduce and stop one laxative at a time

stimulant

63
Q

If dietary and lifestyle changes fail to control constipation in pregnancy, _______________ are likely to help women experiencing constipation in pregnancy, and raise no serious concerns about side-effects to the mother or fetus

A

fibre supplements in the form of bran or wheat

64
Q

A(n) _______________ laxative is the first choice during pregnancy if fibre supplements fail.

A

bulk-forming

*An osmotic laxative, such as lactulose, can also be used. Bisacodyl or senna may be suitable if a stimulant effect is necessary but use of senna should be avoided near term or if there is a history of unstable pregnancy

65
Q

Bisacodyl or senna may be suitable if a stimulant effect is necessary but use of ______________ should be avoided near term or if there is a history of unstable pregnancy

A

senna

66
Q

______________ laxatives are more effective than ______________ laxatives but are more likely to cause side-effects (diarrhoea and abdominal discomfort), reducing their acceptability to patients

A

Stimulant

bulk-forming

67
Q

A(n) _____________ laxative is the first choice during breast-feeding, if dietary measures fail

A

bulk-forming

Lactulose or a macrogol may be used if stools remain hard. As an alternative, a short course of a stimulant laxative such as bisacodyl or senna can be considered

68
Q

Without early diagnosis and treatment of constipation in children, an acute episode of constipation can lead to ______________ and become ___________

A

anal fissure

chronic

69
Q

What is the first-line treatment for constipation in children?

A

Laxatives in combination with dietary modification or behavioral intervention

*dietary modifications alone should NOT be recommended as first-line in children

70
Q

______________ alone is not recommended as first-line treatment for constipation in children

A

Diet modification

71
Q

______________ (which may cause bloating and flatulence and reduces the absorption of micronutrients) is not recommended for treatment of constipation in children

A

Unprocessed bran

72
Q

What is the first-line laxative for managing constipation in children without fecal impaction?

A

Macrogol

Second line:
- add or change to a stimulant

Third line:
- lactulose or another softening agent

73
Q

In children with chronic constipation, laxatives should be continued _______________ a regular pattern of bowel movements or toilet training is established.

A

for several weeks after

74
Q

In children who have been treated for chronic constipation, the dose of laxatives should be tapered gradually, over a period of ___________, according to response. Some children may require laxative therapy for ____________

A

months

several years

75
Q

What time of day should laxatives be administered in children?

A

A time that produces an effect that is likely to fit in with the child’s toilet routine

76
Q

Treatment of faecal impaction in children may initially increase symptoms of ____________ and ___________

A

soiling

abdominal pain

77
Q

In children over 1 year of age with faecal impaction, an oral preparation containing a ___________________ is used to clear faecal mass and to establish and maintain soft well-formed stools, using an escalating dose regimen depending on symptoms and response.

A

macrogol (such as macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride)

78
Q

In children with fecal impaction, if disimpaction does not occur after 2 weeks of oral macrogols, a ______________ laxative can be added or if stools are hard, used in combination with an osmotic laxative such as ______________

A

stimulant

lactulose

79
Q

Regarding fecal impaction in children, _______________ use of laxatives is essential to maintain well-formed stools and prevent recurrence of faecal impaction; ______________ use may provoke relapses

A

Long-term regular

intermittent

80
Q

Macrogol (osmotic laxative) is not licensed for treatment of chronic constipation or prevention of fecal impaction in children under ___________; it is not licensed for treatment of fetal impaction in children under __________

A

2 yo

5 yo

Roomies Collab Deck 4: GI and ENT (23 decks)

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