CONSTIPATION

Question 1

What is constipation

Answer 1

Infrequent bowel movements or difficulty passing stool

Question 2

Emphasis should be placed on …… in constipation diagnosis

Answer 2

Bowel habit of patient

Question 3

Emphasis should be placed on …… in constipation diagnosis

Answer 3

Bowel habit of patient

Question 4

Diarrhea alternating with constipation is likely to be due to …….in adults especially over 40 and ……. in children and the elderly

Answer 4

Large bowel malignancy

Chronic constipation with spurious diarrhea

Question 5

Habitual use of Laxatives can cause Hypokalemia T/F

Answer 5

True

Question 6

Medical causes of constipation

Answer 6

Diet deficient in roughage
Ignoring the urge to defaecate e.g. due to immobility
Hypothyroidism
Irritable bowel syndrome
Hypercalcaemia
Drugs
Lazy bowel
Lack of exercise
Dehydration and starvation

Question 7

Drugs that can cause constipation

Answer 7

atropine
codeine
morphine
tricyclic antidepressants
disopyramide

Question 8

Cause of lazy bowel syndrome

Answer 8

from chronic laxative use including ‘herbal’ preparations

Question 9

Surgical causes of constipation

Answer 9

Gastrointestinal obstruction
Anal fissure and other painful perianal lesions
Carcinoma of the rectum and sigmoid colon
Foreign body in the gut
Pelvic mass e.g. fibroid, foetus
Aganglionic and acquired megacolon
Pseudo-bowel obstruction (Ogilvie syndrome)

Question 10

Absent bowel sounds points to a suspicion of

Answer 10

Paralytic ileus

Question 10

Symptoms of constipation

Answer 10

Inability to move bowels
Passing hard stools
Infrequent passing of stools
Straining to pass stools
Feeling of incomplete evacuation of bowel
Inability to pass flatus
Colicky abdominal pain with or without
vomiting

Question 11

Signs of constipation

Answer 11

Frequent high pitched bowel sounds
Absent bowel sounds
Signs of peritonitis

Question 12

Frequent high pitched bowel sounds gives a suspicion of

Answer 12

Mechanical bowel obstruction

Question 13

Signs of peritonitis

Answer 13

Generalised tenderness
Guarding
Rebound tenderness

Question 14

Investigations in constipation

Answer 14

Digital rectal examination
Stool for occult blood
Plain abdominal X-ray (erect and supine)
Proctoscopy/proctosigmoidoscopy/colonoscopy (must not be done
if acute intestinal obstruction is suspected)

Question 15

This investigation must be carried out in all patients with
suspected diagnosis of constipation

Answer 15

Digital rectal examination

Question 16

These investigations must not be done in constipation if acute intestinal obstruction is suspected

Answer 16

Proctoscopy/proctosigmoidoscopy/colonoscopy

Question 17

Treatment objectives in constipation

Answer 17

To identify possible cause of constipation
To relieve constipation

Question 18

Non-pharmacological interventions in constipation

Answer 18

Adherence to regular exercise
High fibre diet
Adequate fluid intake

Question 19

Minimum fluid intake in constipation

Answer 19

Minimum of 3.2L of water per day if no contraindications exist

Question 20

First line Management of constipation in adults

Answer 20

Bisacodyl PO
Or
Senna PO
Or
Lactulose PO

Question 21

Bisacodyl dose in adults

Answer 21

PO 10-20 mg at night

Question 22

Dose of glycerol suppositories in adults

Answer 22

Glycerol suppositories, rectal, 4 g at night

Question 22

Dose for senna in adults

Answer 22

Senna, oral,
15-30 mg at bedtime
(maximum 70-100 mg daily)
Doses above 70 mg should be divided 12 hourly

Question 23

Second line treatment of constipation in adults

Answer 23

Bisacodyl, rectal
Or
Glycerol suppositories,
Or
Liquid paraffin, oral,
Or
Milk of Magnesia, oral

Question 23

Lactulose dose for constipation in adults

Answer 23

Lactulose, oral,
15-30 ml daily until response
then 10-20 ml daily

Question 24

Dose of rectal bisacodyl in adults

Answer 24

Bisacodyl, rectal, 10 mg in the morning

Question 25

Dose of liquid paraffin in adults

Answer 25

Liquid paraffin, oral, 10-30 ml at night

Question 26

Dose of milk of magnesia for constipation in adults

Answer 26

Milk of Magnesia, oral, 5-10 ml in a glass of water, 12-24 hourly

Question 26

Dose of rectal bisacodyl in children

Answer 26

Bisacodyl, rectal,
> 10 years; 5 mg in the morning
< 10 years; on medical advice only

Question 27

Dose of lactulose for constipation in children

Answer 27

Lactulose, oral,
10-18 years; 15 ml 12 hourly
5-10 years; 10 ml 12 hourly
1-5 years; 5 ml 12 hourly
< 1 year; 2.5 ml 12 hourly

Question 27

Dose of glycerol suppositories in children

Answer 27

Glycerol suppositories, rectal,
2-5 years; 2 g at night
< 1 year; 1 g at night

Question 27

First line treatment of constipation in children

Answer 27

Lactulose oral
or
Glycerol suppositories
or
Bisacodyl rectal
or
Senna oral

Question 28

Dose of oral senna for constipation in children

Answer 28

Senna, oral,
6-12 years; 5-40 ml at bedtime
2-6 years; 2.5-20 ml at bedtime

Question 29

Magnesium salts should not be used in children with renal impairment. T/F

Answer 29

True

Question 29

The following categories of patients with constipation should be referred to a surgeon

Answer 29

Patients with absent bowel sounds, vomiting or not passing flatus
Cases resistant to medical treatment
Any suspected surgical cause