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Constipation Flashcards

1
Q

Symptoms of constipation

A

Infrequent stool passage
Difficult stool passage
Incomplete defaecation

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2
Q

Red flag symptoms associated with constipation

A

Blood in the stool
Anaemia
Abdominal pain
Weight loss (unexplained)
New onset constipation over 50 years

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3
Q

Non-drug treatment of constipation

A

Increase in dietary fibre, whole grain, fruits, veg, sorbitol

Fibre intake should be gradual to minimise flatulence and bloating

Effects of high-fibre diets may be seen in a few day to 4 weeks

Adequate fluid intake

Exercise is advised

Review medications that may be causing

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4
Q

Which medications can induce constipation?

A

Opioids, iron, aluminium, clozapine

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5
Q

Examples of bulk-forming laxatives

A

Bran
Methylcellulose
Ispaghula husk
Sterculla

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6
Q

Example of a bulk-forming laxative with faecal softening effects

A

Methylcellulose

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7
Q

How do bulk-forming laxatives work?

A

Increase faecal mass which stimulates peristalsis

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8
Q

Bulk-forming laxatives onset of action

A

2-3 days (72 hours)

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9
Q

Counselling point for a patient taking a bulk-forming laxative. Include side effects.

A

Must be taken with enough water to prevent intestinal blockage

Side effects: flatulence, bloating, cramping

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10
Q

Examples of stimulant laxatives

A

Biascodyl
Sodium picosulfate
Senna
Docusate
Glycerol
Co-danthramer
Co-danthrusate

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11
Q

Which stimulant laxative also has faecal softening effects?

A

Docusate

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12
Q

How do stimulant laxatives work?

A

Stimulate colonic nerves which induces peristalsis

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13
Q

Onset of action of stimulant laxatives

A

6-12 hours

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14
Q

When would you avoid a stimulant laxative?

A

If the patient has intestinal obstruction

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15
Q

When would co-danthramer or co-danthrusate be used?

A

In terminal illness due to carcinogenicity

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16
Q

Specific side effect of co-danthramer or co-danthrusate

A

Red urine

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17
Q

Specific side effect of senna

A

Brown urine

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18
Q

When should senna be taken?

A

At night

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19
Q

Examples of faecal softeners

A

Liquid paraffin
Docusate
Glycerol
Methylcellulose
Enemas containing arachis oil

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20
Q

How do faecal softeners work?

A

Increase water penetration into the stool

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21
Q

Quickest acting laxative

A

Docusate enema - 5-20 minutes

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22
Q

When would liquid paraffin be avoided?

A

Due to anal seepage
Granulomatous disease of the GI tract
Lipoid pneumonia on aspiration

23
Q

Examples of osmotic laxatives

A

Lactulose
Macrogols

24
Q

How do osmotic laxatives work?

A

Increases amount of fluid in the large bowel = peristalsis

25
When would lactulose be used for a treatment other than constipation?
Hepatic encephalopathy
26
How does lactulose work for the treatment of hepatic encephalopathy?
Produces osmotic diarrhoea of low faecal pH, discourages proliferation of ammonia-producing organisms
27
Onset of action of osmotic laxatives
2-3 days
28
Side effect of laxative abuse
Hypokalaemia
29
What type of laxative is linaclotide?
Guanylate cyclase-C receptor agonist
30
When is linaclotide used?
Moderate to severe IBS associated with constipation
31
How does linaclotide work?
Increases intestinal secretion and transit, decreases visceral pain
32
What class of drug is prucalopride?
SSRI with prokinetic properties
33
When would prucalopride be used?
Chronic constipation where two laxatives have been used from different classes for >6 months In women only
34
Treatment of choice for moderate to severe IBS associated with constipation
Linaclotide
35
Treatment of choice for chronic constipation where other laxatives have failed
Prucalopride
36
When would bowel cleansing preparations be used?
Prior to colonic surgery, colonoscopy, or radiological examination
37
Examples of bowel cleansing preparations
Macrogol 3350 with anhydrous sodium sulfate Potassium chloride, sodium bicarbonate and sodium chloride Citric acid with magnesium carbonate Mangensium citrate with sodium picosulfate Sodium acid phosphate with sodium phosphate
38
Treatment of acute constipation? (short duration)
1st: Bulk forming + good hydration 2nd: Osmotic if stools remain hard 3rd: Stimulant if inadequate emptying BOS
39
Treatment of chronic constipation
1st: Bulk forming + good hydration 2nd: Osmotic if stools remain hard (macrogol first then lactulose) 3rd: Stimulant if inadequate response 4th: Prucalopride if no change >6 months of two laxatives from different class BOSP
40
How to withdraw multiple laxatives?
Reduce and stop one at a time Remove stimulant first
41
Treatment of faecal impaction with hard stools
1st: Macrogol 2nd: + once softened add stimulant 3rd: Glycerol 4th: + rectal biascodyl 5th: Docusate sodium or sodium citrate enema 6th: sodium acid phosphate with sodium phosphate or arachis oil retneion enema Enemas must be repeated several times to clear hard impacted faeces
42
When should arachis oil enema be administered?
Overnight before sodium acid phosphate with sodium phosphate or sodium citrate enema the following day
43
Treatment of faecal impaction (soft stools)
1st: Stimulant 2nd: Rectal bisacodyl 3rd: + Glycerol 4th: Docusate sodium or sodium citrate enema 5th: sodium acid phosphate with sodium phosphate or arachis oil retneion enema
44
Treatment of opioid-induced constipation
1st: Osmotic and stimulant 2nd: Naloxegol 3rd: + methylnaltrexone bromide OS
45
Which laxative to avoid in opioid-induced constipation?
Bulk-forming
46
Treatment of constipation for pregnant women
1st: Dietary advice = fibre supplements such as bran or wheat 2nd: Bulk-forming 3rd: Osmotic (lactulose) 4th: Bisacodyl or senna (not near term) 5th: Docusate sodium and glycerol suppositories
47
Treatment of constipation for breastfeeding women
1st: Bulk-forming 2nd: Lactulose if Macrogol
48
Treatment of constipation in children
1st: Dietary advice + Macrogol (if no faecal impaction) 2nd: Stimulant 3rd: If stool is hard = lactulose or docusate
49
Dietary advice for a patient with constipation
Increase dietary fibre Adequate fluid intake Exercise advised Balanced diet of fruits and veg High-fibre bread Baked beans Wholegrain breakfast cereals Avoid unprocessed bran
50
Treatment of faecal impaction in children
Use escalating dose regimen in children > 1 years old 1st: Macrogol If disimpaction does not occur after 2 weeks: + Stimulant
51
Treatment of faecal impaction in children where there is an inadequate response from macrogol
Add or replace with lactulose
52
Example of escalating dose regimen
1-5 years old: Two sachets on 1st day, then 4 sachets daily for 2 days, then 6 sachets daily for 2 days, then 8 sachets daily for 2 days 5-12 years old: Four sachets on 1st day, then increased in steps of 2 sachets daily to maximum of 12 sachets daily
53
Maximum number of days an escalating dose regimen is used
7 days or until disimpaction occurs

GI (15 decks)

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