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GI > CONSTIPATION > Flashcards

CONSTIPATION Flashcards

1
Q

what are the types of constipation and duration?

A
  1. acute (< or equal to 12 weeks)
  2. chronic (> 12 weeks)
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1
Q

What is constipation?

A

infrequent, irregular, or difficult evacuation of the bowels

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2
Q

do women or men get constipation more?

A

women

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3
Q

epidemiology of constipation?

A

15% adults
1/3 of elderly patients

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4
Q

etiology of primary constipation :

A

idiopathic or functional
not attributed to any structural abnormalities or systemic disease; 3 subtypes

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5
Q

etiology of secondary constipation :

A

caused by systemic disease, medications, or obstructing colonic lesions

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6
Q

what are the 4 most common causes of constipation? KNOWW THISS

A
  1. inadequate fiber or fluid intake
  2. poor bowel habits
  3. physical inactivity
  4. slow colonic transit
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7
Q

how long is normal colonic transit?

A

about 35 hours

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8
Q

what are the other common sx of constipation that aren’t the big 4?

A
  • systemic dz-> hypothyroidism, hypercalcemia, paraplegia
  • meds-> opioids, diuretics, iron
  • structural abnormalities
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9
Q

what is the PRIMARY MECHANISM that causes constipation?

A
  1. altered stool consistency
  2. altered bowel motility
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10
Q

what is the first step of defecation?

A
  1. colonic mass movements/peristalsis moves intestinal contents distally into rectum
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11
Q

what is the second step of defecation?

A
  1. rectal filling activates mechanoreceptors in the rectal wall causing awareness of the need to defacate
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12
Q

what is the third step of defecation?

A
  1. a small amount of is allowed to pass through to the anal canal by an involuntary relaxation of the internal anal sphincter (rectoanal inhibitory reflex) -> determine if the rectal contents is gaseous, solid, or liquid form
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13
Q

what is the fourth step of defecation?

A
  1. abdominal muscles contract and a Valsalva maneuver is performed while simultaneously relaxing the external anal sphincter and puborectalis muscle (pressure gradient generated between the rectum and anal canal expels the feces)
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14
Q

what are the s/sx of constipation?

A
  • infrequent bowel movements (<3/week)
  • hard stools
  • excessive straining
  • sense of incomplete evacuation
  • BLOATING
  • abdominal cramping or pain
  • tenesmus
  • overflow diarrhea
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15
Q

what can a dx of constipation be based upon?

A

based on complete hx and PE to include a digital rectal exam

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16
Q

what people need additional dx testing for constipation?

A
  • age >50
  • severe constipation
  • alarm sx
  • inadequate response to empiric therapy
17
Q

what are the 3 ALARM SX of constipation?

A
  1. hematochezia
  2. weight loss
  3. +FOBT
18
Q

what management do you do for patients with red flag features?

A

order a Colonoscopy or flexible sigmoidoscopy and biopsy to r/o colorectal cancer

19
Q

what management do you do for patients with NO red flag features?

A
  1. assess for secondary causes of constipation
    - CBC w/diff with differential, serum electrolytes, calcium, glucose and TSH
    - Review medications
20
Q

what 2 tests are done for a patient who has inadequate response to empiric therapy?

A
  1. anorectal manometry and a balloon expulsion test
  2. colonic transit studies
21
Q

what are the 3 main tx modalities for constipation?

A
  1. dietary and lifestyle measurements
  2. d/c meds linked to constipation
  3. pharmacotherapy
22
Q

what is overflow diarrhea?

A

pts w/ firm stool in sigmoid/rectum that they can not pass and softer stool above the firm stool

23
Q

what are the 4 main hx questions to ask for dx?

A
  1. stool frequency, consistency, and color
  2. length of time for a bowel movement
  3. use of laxatives or enemas
  4. review prescription medications
24
Q

what is an anorectal manometry and a balloon expulsion test?

A

measure pressures inside the rectum and anus and the ability of the pelvic muscles to expel stool from the rectum

25
Q

what do abnormal results of anorectal manometry and a balloon expulsion test indicate?

A

defecatory disorder

26
Q

what is a colonic transit study?

A

patient swallows radioopaque markers, which are then tracked through the GI tract using x-rays
differentiate between slow and normal transit constipation

27
Q

what does a normal colonic transit study indicate?

A

disorder of gut-brain axis

28
Q

what are the recommended dietary and lifestyle measurements?

A
  1. increase dietary fiber (20-35 g/day)
  2. regular exercise
  3. increase intake of water (2L/day if not on water restriction)
  4. decrease constipating agents, such as dairy products, coffee, tea and alcohol
29
Q

what are the pharmacotherapy options?

A
  1. laxatives: fiber, osmotic, or stimulant laxative
  2. suppositories-> glycerin
  3. stool surfactants: colace, mineral oil
  4. enemas: warm water, Na phosphate, milk of molasses
  5. acute purgative/clean bowel prep: polyethelene glycol (PEG), magnesium citrate
  6. opioid-receptor antagonists
30
Q

what are the 5 complications of constipation?

A
  1. anal fissures
  2. hemorrhoids
  3. fecal incontinence
  4. urinary retention
  5. syncope w/ straining
  6. fecal impaction
  7. bowel obstruction
31
Q

what is anal fissures?

A

passage of hard, lumpy stools causes a tear in anoderm
leads to painful defecation and rectal bleeding

32
Q

what are hemorrhoids?

A

d/t excessive straining w/ hard, lumpy stools
leads to rectal pain, itching, and/or bleeding

33
Q

what is fecal incontinence?

A
  • chronic constipation-> formation of a hard stool mass-> progressive distention of the anal sphincter complex-> patient no longer feels urge to defecate
  • soft or liquid stool begins to seep around the obstructing stool mass, causing overflow incontinence
34
Q

what age population is fecal impaction seen in?

A

elderly

35
Q

what happens (pathophys) in fecal impaction?

A

increased rectal capacity, decreased colonic motility

36
Q

what is fecal impaction?

A

firm often puttylike mass in rectal vault on DRE; sometimes rock-like

37
Q

what are the sx of fecal impaction

A

rectal pain
tenesmus
overflow (paradoxic) diarrhea: watery fecal material leaking around impacted stool

38
Q

what is the tx of fecal impaction?

A

enema and manual disimpaction

39
Q

what are the categories of bowel obstruction?

A

partial or complete

40
Q

what are the sx of bowel obstruction?

A

decreased appetite
N/V
abdominal pain and/or distention

41
Q

what is the dx test of bowel obstruction?

A

flat and upright abdomen x-ray or CT scan

GI (22 decks)

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