Constipation Flashcards
infrequent bowel movements or difficult passage of stools
constipation
how many BM constitutes constipation?
less than 3 BM per week
what can constipation lead to in the extremes of life (infants and elderly)? (2)
encopresis
aneurysm
soiling of clothing when impacted stool collects in the colon/rectum creating an overflow of liquid stool that leaks out
encopresis
what most often causes encopresis?
voluntary retention of stool
what is the treatment for encopresis? (2)
patience
positive reinforcement
what are 2 common primary etiologies of constipation?
slow colon transit (reduced motility of the large intestine)
defecatory disorders (impaired coordination of musculature during defecation)
what are 3 common secondary etiologies of constipation?
opiates
neuro, myopathies, electrolyte abnormalities
colon lesion/cancers (cause obstruction)
what are the 2 most common general etiologies of constipation?
inadequate fiber/fluid intake
poor bowel habits
what are 5 symptoms of constipation?
nausea +/- vomiting
bloated feeling
wave-like spasms
worse post-prandial
+/- bowel incontinence from overflow
what are 4 red flags of constipation?
new onset over 50 yo
bloody rectum/stools
weight loss
FHx of colon cancer or IBD
what physical finding will suggest that constipation has progressed to ileus?
hyperactive bowel sounds to hypoactive or absent bowel sounds
where will there be a palpable mass if a patient is constipated?
left side of abdomen
what physical exam is required for constipation?
DRE
what are 3 red flags during a physical exam?
systemic disease signs
severe abdominal tenderness, guarding, rebound
grossly bloody DRE, + FOBT, +FIT
when are diagnostics for constipation needed? (2)
secondary constipation
+ RED FLAGS
what is the diagnostic of choice for red flags?
colonoscopy
what diagnostic can be used to test internal pressures and coordination of musculature?
anal manometry w/ balloon expulsion test
what diagnostic can be used to see shape and position of rectum during defecation?
defecography with barium paste
what diagnostic is used to determine transit time by xray?
radiopaque markers
what is the first line treatment for constipation?
fiber supplement trial
what are 5 OTC fiber supplements that can be used as first line treatment of constipation?
bran powder
psyllium
methylcellulose
calcium polycarbophil
guargum
what are 2 stool softeners for constipation?
docusate sodium
mineral oil
what is the 2nd line treatment for constipation that does not respond to fiber and stool softeners? name them? (3)
osmotic laxatives
magnesium hydroxide
lactulose
polyethelene glycol (PEG)
what is the 3rd line treatment for constipation that does not respond to osmotic laxatives? name them? (4)
stimulant laxatives
bisacodyl
bisacodyl suppository
cascara
senna
what 2 medications are effective for chronic constipation?
PEG
lubiprostone
what are the last resort treatments for constipation?
Cl secretory laxatives
lubiprostone
linaclotide
what treatment is fast acting and often used in conjunction with digital disimpaction? name them? (3)
enemas
tap water
sodium phosphate
mineral oil
what meds increases fluid absorption and slows/inhibits colon peristalsis?
opioid receptor antagonists
what must be done for a fecal impaction?
disimpact with digit +/- enema BEFORE oral med
what is the most common complication of constipation?
hemorrhoids
