Constipation Flashcards
What is the clinical criteria for diagnosing constipation from history?
at least 3 months of at least two of the following…
1) infrequent passage of stools
2) straining
3) passage of hard stools
4) incomplete evacuation and sensation of the anorectal passage
Give 3 clinical presentations associated with constipation:
1) abdominal bloating
2) abdominal discomfort
3) perianal pain
Give 5 drugs that can cause constipation?
- Opiates
- Antidepressants
- Iron supplements
- Calcium channel blockers
- Antimuscarinics
Give 2 general causes of constipation?
- immobility
- Inadequate fibre intake
Give 2 psychological causes of constipation:
1) depression
2) anorexia nervosa
Give 6 GI diseases that can cause constipation:
1) carcinomas
2) diverticulitis
3) Hirschsprung’s disease
4) Chagas disease
5) anal fissures
6) intestinal obstruction
Give 2 neurological causes of constipation:
1) Parkinson’s disease
2) spinal cord lesions
Give 2 functional causes of constipation:
1) idiopathic slow transit
2) IBS
Give 3 metabolic causes of constipation:
1) diabetes
2) hypothyroidism
3) hypercalcaemia
What is Hirschsprung’s disease?
congenital lack of ganglion cells in the distal colon, leading to uncoordinated peristalsis and decreased motility
What is Chagas disease?
tropical parasitic disease that causes an enlarged colon and impedes on bowel emptying (trypanosoma cruzi)
What investigations can be used to assess the cause of constipation? (2)
- Colonoscopy
- CT of the colon
What are the three categories of constipation?
1) normal transit constipation
2) slow transit constipation
3) defectory disorder (pelvic floor) constipation
What is the most common type of constipation?
normal transit (functional constipation)
What is normal transit constipation?
where stool travels through the colon at a normal rate and stool frequency is normal yet patients believe they are constipated due to perceived difficulties on evacuation or the passage of hard stools
What test can be used to distinguish normal transit and slow transit constipation?
marker studies
Describe how marker studies can be used to distinguish between normal and slow transit constipation:
1) capsules containing 20 radio-opaque shapes are swallowed
2) an abdominal X-ray is obtained after 120 hours from ingestion
3) if capsules remain, there is likely slow transit
In what types of patient
is slow transit consitpation common: (2)
- Young women
- Elderly
What is defectory disorder constipation?
dysfunction of the anal sphincter and pelvic floor can result in contraction rather than normal relaxation of the external anal sphincter which prevents defaecation
Give an example of defectory disorder constipation:
anterior rectocele - where the rectum bulges into the vagina, creating an area to trap stool
Give 2 lifestyle changes to manage constipation:
1) increase fibre content of the diet
2) increase fluid intake
Give 4 types of foot that are rich in fibre:
1) oats
2) fruit
3) legumes
4) vegetables
How do osmotic laxatives work?
They cause water retention in the stool material by the process of osmosis, increasing inflow of fluid and electrolytes to soften the stool
Give 3 examples of osmotic laxatives:
1) magnesium sulphate
2) lactulose
3) macrogols
How do stimulant laxatives work?
they stimulate motility and intestinal secretion
Give 4 examples of stimulant laxatives:
1) phenophthalein
2) prucalopride
3) bisacodyl
4) senna
What class of drug is senna?
anthraquinones
Give two forms of enema treatments for constipation:
1) hypertonic phosphate
2) sodium citrate
Give two forms of suppository treatments for constipation:
1) glycerol
2) bisacodyl
