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PR - GI > CONSTIPATION > Flashcards

CONSTIPATION Flashcards

1
Q

What is constipation?

A

Infrequent, difficult stools - most common in women, elderly, and pregnant

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2
Q

Red flags for constipation

A

Red Flags:
* Blood in the stool
* Anaemia
* Abdominal pain
* Weight loss
* New onset constipation over 50 yo

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3
Q

Non-drug treatment

A

Increase in dietary fibre
Adequate fluid intake - fruit/ fruit juice high in fibre and sorbitol
Exercise is advised
Review meds

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4
Q

Medication which can cause constipation

A

Opioids
Aluminium
Clozapine !

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5
Q

Laxatives

A

Bulk-forming laxatives (Methylcellulose, ispaghula husk and sterculia)

Stimulant laxatives (Bisacodyl, Sodium Picosulfate, Senna, Docusate, Glycerol)

Faecal softeners (liquid paraffin, docusate, glycerol)

Osmotic laxatives (macrogol, lactulose)

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6
Q

Bulk-forming laxatives - examples

A

Methylcellulose, ispaghula husk and sterculia

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7
Q

Bulk-forming laxatives

A

Small hard stools - increases faecal mass, stimulating peristalsis

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8
Q

How long do bulk-forming laxatives take to work?

A

Takes 2-3 days to work

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9
Q

Bulk-forming laxatives - counselling

A

Must be taken with enough water to prevent intestinal obstruction
Should not be taken immediately before going to bed.
Mix with at least 150ml of liquid

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10
Q

Bulk-forming laxatives - side effects

A

Symptoms of flatulence, bloating, and cramping may be exacerbated.

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11
Q

What laxatives can be used in pt who cannot tolerate bran?

A

Methylcellulose (faecal softener too), ispaghula husk and sterculia

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12
Q

Stimulant laxatives - examples

A

(Bisacodyl, Sodium Picosulfate, Senna, Docusate, Glycerol)

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13
Q

Stimulant laxatives

A
  • Stimulant laxatives increase intestinal motility
  • Stimulating colonic nerves → peristalsis
  • Takes 6-12 hours to work
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14
Q

Stimulant laxative - avoid in

A
  • Avoid in intestinal obstruction
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15
Q

How long do stimulant laxatives take to work?

A

6-12 hours

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16
Q

Bisacodyl

A
  • Not 1st line
  • Not for < 12 yrs OTC
  • Subject to misuse and overuse
17
Q

Senna

A
  • Urine discolouration
  • Take at bedtime
  • Risk of hypokalaemia with excessive use
18
Q

Docusate sodium

A

both stimulant laxative and faecal softener
PO or PR

19
Q

Co-danthramer and Co-danthrusate

A

used in terminal illness due to carcinogenicity (red urine)

20
Q

Faecal softeners - examples

A

liquid paraffin, docusate, glycerol

21
Q

Faecal softeners

A

decreasing surface tension and increasing penetration of intestinal fluid into the faecal mass.
Increases water penetration into the stool

22
Q

Which faecal softener is the quickest acting?

A

docusate enema takes 5-20 mins

23
Q

Why is liquid paraffin avoided?

A

avoided due to anal seepage, granulomatous disease of the GI tract, lipoid pneumonia on aspiration

24
Q

Osmotic laxatives - examples

A

lactulose, macrogol

25
Q

Osmotic laxatives (lactulose, macrogol)

A

Increases amount of fluid in the large bowel → peristalsis
* Take 2-3 days to work
* Also have faecal softening properties

26
Q

Short duration treatment

A
  1. bulk-forming
    ensure adequate fluid intake
  2. stools remain hard = + or switch to osmotic
  3. stools are soft, but difficult to pass = + stimulant
27
Q

Chronic constipation

A
  1. bulk-forming
    ensure adequate fluid intake
  2. stools remain hard = + or switch to osmotic e.g macrogol (lactulose 2nd)
  3. no change after 6 months = prucalopride (women only)
28
Q

When can laxatives be withdrawn in chronic constipation?

A

Laxatives can be slowly withdrawn when regular bowel movements occur without difficulty, according to the frequency and consistency of the stools

29
Q

Who can prucalopride be used in?

A

Only in women
according to BNF
Need effective contraception

30
Q

Opioid induced

A
  • osmotic + stimulant
  • no response = naloxegol
  • avoid bulk forming
31
Q

Faecal impaction

A
  • hard: macrogol + stimulant once soft
  • soft: stimulant
  • still there: PR bisacodyl +/or glycerol
32
Q

Why should you avoid bulk-forming laxative in opioid induced?

A

Peristalsis already impaired
Giving bulk forming = risk of faecal impaction or obstruction

33
Q

Pregnancy + bf

A
  1. dietary and lifestyle - fibre supplements e.g. bran or wheat
  2. bulk-forming = lactulose
  3. if no response = bisacodyl or Senna (don’t use Senna near term)
34
Q

Children

A
  1. dietary advice + macrogol (if no faecal impaction)
  2. no response or inadequate = + stimulant
  3. Stools remains hard = lactulose/ docussate
35
Q

true or false - stimulants are more effective than bulk forming laxatives but are more likely to cause SE e.g. diarrhoea, abdominal discomfort

A

T

PR - GI (13 decks)

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