Constipation

Question 1

what are the ROME III criteria for constipation?

Answer 1

straining for 1/4 of stools 
lumpy or hard 1/4 of stools 
sensation of incomplete evacuation 
sensation of anorectal blockage 
manual maneuvers with 1/4 of stools 
fewer than 3 stools / week 
no criteria for diagnosis for IBS

Question 2

what is the most concerning procedure causing constipation?

Answer 2

sigmoidoscopy, colonoscopy

Question 3

what are the red flag symptoms of constipation?

Answer 3

hematochezia 
occult blood 
obstruction 
onset of acute constipation in elderly 
weight loss more than 10 lbs 
family history of colon cancer / IBD 
anemia 
refractoriness

Question 4

what are the organic causes of constipation?

Answer 4

cancer, ischemia, surgical stenosis

Question 5

what are the endocrine causes of constipation?

Answer 5

diabetes, hypothyroidism, hypercalcemia

Question 6

what are the neuro causes of constipation?

Answer 6

spinal cord injury, PD, MS

Question 7

what are the myogenic causes of constipation?

Answer 7

scleroderma, amyloidosis

Question 8

what are the anorectal causes of constipation?

Answer 8

fissures, strictures, IBD

Question 9

what are the dietary causes of constipation?

Answer 9

low fiber, dehydration, no exercise

Question 10

what are the common drugs to watch for for constipation?

Answer 10

antihistamines 
antispasmodics 
antidepressants 
antipsychotics 
iron supplements 
antacids containing aluminum 
opiates / analgesics / sedatives 
calcium channel blockers / beta blockers

Question 11

what are the therapies for constipation?

Answer 11

bulk laxatives
osmotic laxatives
stimulant laxatives
enema / stool softeners / suppositories

Question 12

what are the bulk laxatives?

Answer 12

psyllium (metamucil)

methylcellulose (citrucel)

Question 13

psyllium and methylcellulose are what type of laxative?

Answer 13

bulk

Question 14

lactulose is what type of laxative?

Answer 14

osmotic

Question 15

what are the stimulant laxatives?

Answer 15

senna

bisacodyl

Question 16

senna and bisacodyl are what type of laxative?

Answer 16

stimulant

Question 17

what is encopresis?

Answer 17

prolonged and repetitive stool witholding and avoidance of defecation leading to large amounts of retained stool in the rectum

impaction leads to difficulty with evacuation

Question 18

straining with the passage of soft stool in neonates and infants is normal until what age? what is the term for this?

Answer 18

6 months

infantile dyschezia

Question 19

what are the most important elements of toilet training?

Answer 19

praise

hygiene

Question 20

what is the most common explanation for childhood constipation?

Answer 20

voluntary retention turning into encopresis

Question 21

what are the ddx for childhood constipation?

Answer 21

spinal cord damage
hypothyroidism and hypoparathyroidism
medications

Question 22

hirschsprung disease should be considered if an infant has not stooled in what timeframe?

Answer 22

within 48 hours of life

Question 23

meconeum ileus occurs in the background of what other disease?

Answer 23

CF

Question 24

what are the red flags for childhood constipation?

Answer 24

delayed stooling first 24-48 hours 
vomiting with constipation 
abnormal neuromotor development 
abnormal growth parameters 
PE not consistent with functional constipation

Question 25

what are the three phases of medical management for childhood constipation?

Answer 25

complete evacuation or disimpaction
sustained evacuation to restore colorectal tone
weaning from intervention

Question 26

when are enemas indicated for childhood constipation?

Answer 26

if rectal exam reveals firm, wide impaction

Question 27

what are the oral medications for childhood constipation?

Answer 27

mineral oil and milk of magnesia

Question 28

how long can it take for a distended colon to return to normal tone?

Answer 28

3-9 months

Question 29

what are the two phases of nutritional component of management?

Answer 29

counseling to reduce constipating foods

additional fiber once tone is restored