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GPEP Gastro > Constipation > Flashcards

Constipation Flashcards

1
Q

Red flags

A

Unintentional weight loss
Abdominal mass
Iron deficient anaemia
Blood in or with stool
Palpable or visible rectal mass

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2
Q

Defining constipation

A

Infrequent passage of stools – < 3x/week
Difficulty in passing a stool
Passage of hard stools
Sensation of incomplete evacuation

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3
Q

Medications that can cause constipation

A

Opioids
TCA/SSRI
Antipsychotics, especially clozapine
Antacids that contain calcium
Iron and calcium supplements
Ondansetron
CCB
PPI
Antiparkinsonian medications

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4
Q

Common causes of constipation

A

Reduced mobility
Medications
Dietary (low fibre, low fluid intake)
Stress

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5
Q

Complications of constipation

A

Haemorrhoids
Faecal impaction
Faecal and urinary incontinence
Rectal bleeding
Anal fissures
UTI

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6
Q

Constipation may result from underlying conditions such as…

A

IBS
Dehydration
Diabetes
Neurological conditions e.g. Parkinson’s and MS
Electrolyte disorders such as hypercalcaemia or hypokalemia
Depression and other psychiatric disorders
Coeliac disease
Hypothyroidism
GI obstruction (e.g. due to tumours)
Damage to pelvic floor muscles e.g. after childbirth

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7
Q

Dietary and lifestyle advice for constipation

A

Increase fibre (may see benefit in 3-5 days but ideally trial for 1 month)
Fluids - 2L recommended if high fibre diet
Regular exercise encourages peristalsis in the colon

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8
Q

Types of laxatives

A

Bulking Agents
Stimulant Laxatives
Faecal softeners
Osmotic Laxatives

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9
Q

Bulking Agents examples

A

Psyllium (Konsyl D, metamucil)

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10
Q

Bulking Agents time to effect

A

2-3 days

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11
Q

Stimulant Laxatives examples

A

Laxsol
Bisacodyl (oral or suppository)

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12
Q

Stimulant Laxatives time to effect

A

Laxsol: 8-12 hours
Bisacodyl (oral): 10-12 hours
Bisacodyl (suppository): 20-60 min

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13
Q

Faecal softeners examples

A

Coloxyl tablets, drops or enema

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14
Q

Faecal softeners time to effect

A

Coloxyl tablets: 12-72 hours
Coloxyl drops: 12-24 hours
Coloxyl enema: 15-20 mins

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15
Q

Osmotic laxative examples

A

Lactulose
Movicol
Glycerol Suppositories (also stimulant effect)
Fleet enema

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16
Q

Osmotic laxative time to effect

A

Lactulose: Up to 2 days
Movicol: 1-3 days
Glycerol Suppositories: 15-60 min
Fleet enema: 15 min

17
Q

Constipation caused by an opioid analgesic is caused by ________ and will usually require what type of laxative?

A

Reduced gut motility –> need stimulant

18
Q

Use of laxatives in intestinal obstruction

A

Generally, all oral laxative preparations should be avoided in people with intestinal obstruction

But there is evidence of safe and effective use of macrogols in malignant obstruction

19
Q

What sort of patients are bulk forming laxatives useful for?

A

Normal gut motility and uncomplicated constipation, who require long-term control

20
Q

Bulk forming laxatives should be avoided in people with…

A

Intestinal obstruction
Colonic atony
Faecal impaction
Dehydration

21
Q

Main side effects of bulk forming laxatives

A

Abdominal bloating and flatulence
Need to also make sure adequate fluid intake

22
Q

Macrogols (Movicol) should be avoided in people with…

A

Severe inflammatory conditions of the gut (e.g. Crohn’s disease, ulcerative colitis, toxic megacolon)

23
Q

Duration of use/when to take stimulant laxatives

A

Short term use to restore normal bowel function
Usually taken at night to produce an effect the next morning

24
Q

Choice of suppository/enema is governed by…

A

The site of the impaction and stool type

25
Q

Phosphate enemas (e.g. Fleet) are suitable for _________ stools

A

Hard impacted

26
Q

Bisacodyl suppositories can be used for ______ stools

A

Soft stools in the lower rectum

27
Q

Glycerol suppositories are often effective for ______ stools

A

For both soft and hard stools in the lower rectum

28
Q

Docusate enemas (e.g. Coloxyl) can be used for _______ stools

A

Both hard and soft stools occurring higher in the rectum

29
Q

Constipation is common in children and can present at three important stages of childhood…

A

Infants at weaning
Toddlers acquiring toilet skills
School age

30
Q

Most common cause for constipation in children is ________ (90-95%)

A

Functional

31
Q

What can be mistaken for constipation in infants <6 months old?

A

Infants <6 months often strain or become distressed when stooling (dyschezia), which in a healthy infant can be considered normal, and should not be mistaken for constipation.

32
Q

First-line laxative in elderly patients if not taking opioids

A

Osmotic laxatives

33
Q

Phosphate enema should usually be avoided in who?

A

Elderly or CKD as there have been cases of phosphate nephropathy and AKI some of which have been fatal

34
Q

Acupuncture as a treatment for constipation - is it effective?

A

Acupuncture has been shown to be as effective as medical treatment in increasing bowel movements

GPEP Gastro (9 decks)

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