Constipation Flashcards
What is the ROME III criteria for constipation?
Two or more of the following for at least three months:
- Fewer than 3 defecations per week
- straining
- lumpy/hard stools
- sensation of blockage/incomplete evacuation
What do you have to r/o with constipation?
IBS
If constipation alternates with normal stools/diarrhea is suggestive of what?
Blockage that occasionally dumps out diarrhea
What endocrine disorder can cause constipation?
DM
Why do past GI surgeries cause constipation?
strictures
Do fluids really help with constipation?
Not really
Onset of acute constipation in the elderly?
BO
Weight loss over what amount of weight is concerning with constipation?
10 lbs
What are the three major endocrine causes of constipation?
DM
Hypothyroidism
Hypercalcemia
What are the three major neurological diagnoses that can lead to constipation?
Parkinson’s
MS
What are the two myogenic problems that can lead to constipation?
Scleroderma
Amyloidosis
What are the three psychiatric disorders that should be considered with elderly constipation?
Depression
Eating disorders
OCD
What are the PE things you should pay attention to with constipation?
Mucus membranes (dehydration) DRE
What type of antacids are concerning for constipation?
Al containing
What supplement may cause constipation?
Fe
What two antiarrhythmics may cause constipation?
CCB
Beta blockers
What are the psychiatric drugs that can cause constipation? (3)
Antispasmodics
Antidepressants
Antipsychotics
What labs should be considered with constipation?
Thyroid
Hgb A1C
What are the bulk laxative that are used to treat constipation?
Psyllium
Methylcellulose
What are the osmotic laxatives that are used to treat constipation?
Lactulose
What are the stimulant laxatives that are used to treat constipation?
Senna
Bisacodyl
What type of enemas should be used for constipation in the elderly?
Warm water
What muscle is working for stooling?
Puborectalis
The internal and external sphincter are composed of what type of muscle?
Smooth
What signals the sensation to defecate?
Distention of the rectum
What is encopresis?
Prolonged and repetitive stool withholding and avoidance of defecation leads to large amount of retained stool in the rectum.
What is the sign of encopresis?
Overflow from the rectum
True or false: straining with the passage of soft stool in infants is normal
True
Why do infants have to strain with their stool?
Incoordination of their rectal muscles
Up until what age is infantile dyschezia resolve?
6 months
Most children have achieved bowel and bladder control by what age?
4 years
What is the best way to toilet train children?
Praise
What is the most common cause of constipation in children?
functional fecal retention–voluntary tightening of the external anal sphincter and contraction of the gluteal muscles preventing the passage of stools
What should be in the ddx for childhood constipation?
Hypothyroidism
TCAs
Spinal cord damage/hirschsprung’s disease
When should you have your first stool?
first 24 hours
What is the early presentation of Hirschsprung’s disease?
If stools do not occur within 24-48 hours
Meconium of the ileus causes what?
delayed passage of meconium in CF
What parts of the PE should be done with constipation?
DRE for sphincter tone
What are the labs that can be done to screen for laxative abuse?
BMP + Mg
What are the three phases of medical management?
- complete evacuation or disimpaction
- Sustained evacuation to restore normal colorectal tone
- Weaning from intervention
Why should you not use mineral oil under 1 yo?
Risk for aspiration
What are the components of sustained evacuation? How long does this last?
Habitual toilet use, stool softeners
3-9 months
What is involved in the weaning stage?
use of laxative gradually reduced, increase fiber
This usually occurs when children can better understand
