Constipation Flashcards
what are the ROME III criteria for constipation?
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
what is the most concerning procedure causing constipation?
sigmoidoscopy, colonoscopy
what are the red flag symptoms of constipation?
hematochezia occult blood obstruction onset of acute constipation in elderly weight loss more than 10 lbs family history of colon cancer / IBD anemia refractoriness
what are the organic causes of constipation?
cancer, ischemia, surgical stenosis
what are the endocrine causes of constipation?
diabetes, hypothyroidism, hypercalcemia
what are the neuro causes of constipation?
spinal cord injury, PD, MS
what are the myogenic causes of constipation?
scleroderma, amyloidosis
what are the anorectal causes of constipation?
fissures, strictures, IBD
what are the dietary causes of constipation?
low fiber, dehydration, no exercise
what are the common drugs to watch for for constipation?
antihistamines antispasmodics antidepressants antipsychotics iron supplements antacids containing aluminum opiates / analgesics / sedatives calcium channel blockers / beta blockers
what are the therapies for constipation?
bulk laxatives
osmotic laxatives
stimulant laxatives
enema / stool softeners / suppositories
what are the bulk laxatives?
psyllium (metamucil)
methylcellulose (citrucel)
psyllium and methylcellulose are what type of laxative?
bulk
lactulose is what type of laxative?
osmotic
what are the stimulant laxatives?
senna
bisacodyl
senna and bisacodyl are what type of laxative?
stimulant
what is encopresis?
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
straining with the passage of soft stool in neonates and infants is normal until what age? what is the term for this?
6 months
infantile dyschezia
what are the most important elements of toilet training?
praise
hygiene
what is the most common explanation for childhood constipation?
voluntary retention turning into encopresis
what are the ddx for childhood constipation?
spinal cord damage
hypothyroidism and hypoparathyroidism
medications
hirschsprung disease should be considered if an infant has not stooled in what timeframe?
within 48 hours of life
meconeum ileus occurs in the background of what other disease?
CF
what are the red flags for childhood constipation?
delayed stooling first 24-48 hours vomiting with constipation abnormal neuromotor development abnormal growth parameters PE not consistent with functional constipation
what are the three phases of medical management for childhood constipation?
complete evacuation or disimpaction
sustained evacuation to restore colorectal tone
weaning from intervention
when are enemas indicated for childhood constipation?
if rectal exam reveals firm, wide impaction
what are the oral medications for childhood constipation?
mineral oil and milk of magnesia
how long can it take for a distended colon to return to normal tone?
3-9 months
what are the two phases of nutritional component of management?
counseling to reduce constipating foods
additional fiber once tone is restored
