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GI > Constipation > Flashcards

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
Q

When would lactulose be used for a treatment other than constipation?

A

Hepatic encephalopathy

26
Q

How does lactulose work for the treatment of hepatic encephalopathy?

A

Produces osmotic diarrhoea of low faecal pH, discourages proliferation of ammonia-producing organisms

27
Q

Onset of action of osmotic laxatives

A

2-3 days

28
Q

Side effect of laxative abuse

A

Hypokalaemia

29
Q

What type of laxative is linaclotide?

A

Guanylate cyclase-C receptor agonist

30
Q

When is linaclotide used?

A

Moderate to severe IBS associated with constipation

31
Q

How does linaclotide work?

A

Increases intestinal secretion and transit, decreases visceral pain

32
Q

What class of drug is prucalopride?

A

SSRI with prokinetic properties

33
Q

When would prucalopride be used?

A

Chronic constipation where two laxatives have been used from different classes for >6 months
In women only

34
Q

Treatment of choice for moderate to severe IBS associated with constipation

A

Linaclotide

35
Q

Treatment of choice for chronic constipation where other laxatives have failed

A

Prucalopride

36
Q

When would bowel cleansing preparations be used?

A

Prior to colonic surgery, colonoscopy, or radiological examination

37
Q

Examples of bowel cleansing preparations

A

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
Q

Treatment of acute constipation? (short duration)

A

1st: Bulk forming + good hydration
2nd: Osmotic if stools remain hard
3rd: Stimulant if inadequate emptying

BOS

39
Q

Treatment of chronic constipation

A

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
Q

How to withdraw multiple laxatives?

A

Reduce and stop one at a time
Remove stimulant first

41
Q

Treatment of faecal impaction with hard stools

A

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
Q

When should arachis oil enema be administered?

A

Overnight before sodium acid phosphate with sodium phosphate or sodium citrate enema the following day

43
Q

Treatment of faecal impaction (soft stools)

A

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
Q

Treatment of opioid-induced constipation

A

1st: Osmotic and stimulant
2nd: Naloxegol
3rd: + methylnaltrexone bromide

OS

45
Q

Which laxative to avoid in opioid-induced constipation?

A

Bulk-forming

46
Q

Treatment of constipation for pregnant women

A

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
Q

Treatment of constipation for breastfeeding women

A

1st: Bulk-forming
2nd: Lactulose if Macrogol

48
Q

Treatment of constipation in children

A

1st: Dietary advice + Macrogol (if no faecal impaction)
2nd: Stimulant
3rd: If stool is hard = lactulose or docusate

49
Q

Dietary advice for a patient with constipation

A

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
Q

Treatment of faecal impaction in children

A

Use escalating dose regimen in children > 1 years old

1st: Macrogol
If disimpaction does not occur after 2 weeks: + Stimulant

51
Q

Treatment of faecal impaction in children where there is an inadequate response from macrogol

A

Add or replace with lactulose

52
Q

Example of escalating dose regimen

A

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
Q

Maximum number of days an escalating dose regimen is used

A

7 days or until disimpaction occurs

GI (15 decks)

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