constipation

Question 1

Pertinent Anatomy for constipation

Answer 1

(1) Large intestine
(a) Cecum
(b) Rectosigmoid colon
(2) Rectum
(3) Anus

Question 2

What is the most common digestive complaint in the United States?

Answer 2

Constipation

Question 3

Constipation may originate primarily from within the ____ and rectum or may originate externally

Answer 3

colon

Question 4

Most common cause of constipation

Answer 4

Diminishing intake of fiber associated with decreased fluid intake

Question 5

What Systemic diseases can cause constipation?

Answer 5

hypothyroidism
hyperparathyroidism
diabetes
chronic neurologic disorders

Question 6

A thorough history must be obtained. Patients may complain of:

Answer 6

(a) Infrequent stool
(b) Excessive straining
(c) Sense of incomplete evacuation
(d) Need for digital manipulation

Question 7

Differential Diagnosis for constipation

Answer 7

(1) Fecal impaction (Patients with fecal impaction must be disimpacted manually)
(2) Intestinal pseudo-obstruction (Ogilvie Syndrome)
(3) Intestinal Obstruction- refer to surgery

Question 8

Patients with fecal impaction must be

Answer 8

disimpacted manually

Question 9

Labs for constipation?

Answer 9

(1) Complete blood count for anemia.
(2) Thyroid function tests for suspected hypothyroidism.
(3) Electrolyte abnormalities (specifically hypokalemia and hypercalcemia).

Question 10

RADs for constipation

Answer 10

(1) Upright chest film and abdominal flat and erect films for the presence or absence of
intestinal obstruction.
(2) Abdominal films to assess stool burden.

Question 11

Initial Care for constipation

Answer 11

(1) Treat empirically in acute phase.
(2) Start less invasive.
(3) Lifestyle change could prove pivotal.
(4) Monitor for improvement or absence before progressing to next level of treatment

Question 12

True/False

When treating constipation Adverse psychosocial are not needed

Answer 12

FALSE

issues should be identified and addressed

Question 13

First line of treatment for constipation

Answer 13

(a) Strict dietary changes and an exercise regimen.
(b) Increased water intake
(c) Fiber supplementation (Metamucil, Benefiber, psyllium products (as prescribed on bottle).

Question 14

There is usually no immediate response to fiber therapy. Therefore, increase doses gradually over how long?

Answer 14

7-10 days

Question 15

Second line treatment for constipation is?

Answer 15

stool softening or laxative use

Question 16

Third line treatment for constipation includes

Answer 16

Supositories or enimas

Question 17

Where would you refer complicated/ chronic cases of constipation?

Answer 17

Refer to gastroenterologist