constipation

Question 1

General constipation history

Answer 1

first stool after birth (meconium)
parent’s def of constipation
toilet training
stool frequency
blood in stool
pain with defecation
withholding behaviour
PSH
Meds
Neuro sx
urinary continence
hypothyroidism

Question 2

DDX for constipation

Answer 2

CF
Hirschsprung’s disease
Hypothyroidism
Celiac disease
Medication side effect
Neurological/spinal cord disorder

Question 3

Physical exam for constipation

Answer 3

position of anus
fissures/fistula
polyps / hemorrhoids
anal sphincter tone
stool in rectum + consistency & size
presence of blood
soiling
abdominal distension
abdominal masses
neuro exam of lower limbs
check for sacral dimple

Question 4

Tests for refractory constipation

Answer 4

TSH
TTG/IgA
Lead level
sweat chloride
MRI of lumbosacral spine
anorectal manometry
rectal biopsy
barium enema
psych evaluation

Question 5

anorectal manometry finding in constipation?

Answer 5

delayed colonic transit time

Question 6

Mechanism of encopresis?

Answer 6

large stool volume –> IAS relaxation –>anal canal shortened –> EAS relaxation and soiling

Question 7

Examples of stool softeners

Answer 7

mineral oil
docusate sodium

Question 8

Examples of osmotic laxatives

Answer 8

MgOH
PEG 3350
Lactulose
Sorbitol

Question 9

Examples of stimulant laxatives

Answer 9

senna
bisacodyl

Question 10

Surgical Rx for constipation

Answer 10

Malone appendicocecostomy for anterograde colonic enema (MACE)

Question 11

predictors for poor prognosis

Answer 11

FHx
early onset
delayed referral to pediatric GI

Question 12

ROME criteria for functional constipation

Answer 12

1. 2 or less BMs/wk
2. 1 episode of incontinence/wk after toilet training
3. excessive stool retention
4. painful or hard BMs
5. large fecal mass in rectum
6. large diameter that obstruct the toilet
7. Associated Sx irritability, decrease appetite, satiety
8. Sx not explained by any other condition