Constipation Flashcards
26/M complains of passage of hard, lumpy stools more than 25% of the time, incomplete evacuation 50% of the time, and passes stools 2x/week. This patient has
A. Constipation
B. Outlet obstruction
C. Colonic inertia
D. Normal findings
A
65/F complains of difficulty in passing bowel movement. Colonoscopy showed normal findings. Colonic transit study was done which showed passage of 80% of the markers by day 5. This is indicative of
A. Constipation
B. Outlet obstruction
C. Colonic inertia
D. Normal findings
D
48/M complains of decreased caliber of stools, hematochezia, no weight loss. Colonoscopy
done showed a fungating mass occupying 50% of the circumference of the bowel wall at the
sigmoid colon. This is most likely
A. Intraluminal
B. Extraluminal
C. Mural
D. Constipation
C
60/M complains of passage of stools 2x/week and passage of hard bulky stools. Digital rectal
exam showed hard, stools in the rectal vault. Plain abdominal x-ray showed fecaloid material from
the transverse colon to the sigmoid. Colonoscopy was normal. To normalize his bowel function,
you would prescribe
A. Enema and/or suppository
B. Mineral oil
C. Colonic irritants like senokot
D. Bulk laxatives like metamucil
C
The correct sequence of the defecatory process is
A. 1, 3, 4, 5, 2
B. 1, 5, 4, 3, 2
C. 1, 3, 5, 4, 2
D. 1, 4, 3, 5, 2
1 – Distention of the rectum 2 – External anal sphincter relaxes and anal canal contents evacuated 3 – Internal anal sphincter relaxation 4 – Puborectalis muscle relaxatioin 5 – Valsalva maneuver
C
The process of defecation is effected when the following takes place
A. The anorectal angle is around 95 degrees
B. The internal anal sphincter contracts and the external anal sphincter relaxes
C. The external sphincter and the puborectalis muscle relax
D. There is a mass movement of stools from the colon to the rectum
C
A physician should consider diagnostic investigations when presented with the following patient
A. A 5 day old breastfed neonate with passage of meconium on 48th hour of life with bowel
movements occurring 1-2 times a day
B. 3 month old bottlefed passes soft stool motions twice a day with straining
C. 4 year old boy with a strict nanny who spanks him when he soils his underpants
D. 12 year old girl who moves her bowels thrice a week
A
Basic in the management of constipation in children is A. Education and demystification B. Disimpaction C. Laxatives D. Pavlovian reflex
A
6/F previously toilet-trained presents to the clinic for constipation. Her mother noted that the
problem began when she started attending school. She takes in a fair amount of fluids but is not
keen with eating vegetables. She has a piece of fruit for lunch and dinner. On PE, the abdomen
was soft with palpable masses over the left lower quadrant and dry firm stools within the rectal
vault. As the health personnel manning the clinic, your initial management for this child would
consist of
A. Insert glycerin suppository
B. Start oral laxatives
C. Advise 7 portions of fruits and vegetables
D. Have the child sit in the toilet commode after each meal
A
Which of the following patients is likely to be suffering from functional constipation
A. A 6 month old baby, mixed fed with breastmilk and milk formula with bowel movements
occurring every other day associated with abdominal distention
B. A 3 year old boy with on and off history of blood-streaked stools associated with irregular
bowel movements and straining on defection who recently had a strict caregiver
C. A 7 year old girl with cerebral palsy with passage of hard stools every other day, sometimes
requiring manual extraction
D. A 9 year old stunted boy with mental age of 5 years who has a distended abdomen and
palpable stools on LLQ
B
A 3 year old boy is brought for outpatient consultation because the mother claims that the
child has bowel movement every 3-4 days. She claims that the problem started when toilet
training began 6 months ago. The patient would pass stool every 3-4 days associated with the
child hiding behind the sofa while straining into his diaper. The stools are noted to be big and
bulky and associated with some pain. There has been loss of appetite this week but no vomiting
and no weight loss. Based on the history, the most likely diagnosis is
A. Functional constipation
B. Hirschsprung’s disease
C. Lymphoma
D. Colonic polyposis
A
A 12 year old boy is consulting for constipation associated with abdominal pain since three
months ago. He claims that he is having on and off episodes of alternating constipation and
diarrhea associated with anorexia and easy fatigability. His mother consulted several
pediatricians where he was prescribed antibiotics for amebiasis and once underwent deworming.
On PE, he was found to be slightly pale with BP 120/70 HR 106/min RR 24/min T 36.8 C. The
abdomen was slightly distended with a palpable nontender mass at the left hemiabdomen. Rectal exam revealed an intraluminal mass at the tip of the examining finger. The most appropriate
examination he needs is which of the following?
A. Plain abdominal xray
B. Barium enema
C. Proctosigmoidoscopy
D. CT scan
C
A 2 year old boy is brought to the outpatient clinic because of chronic constipation since he
was born. The mother claims that the boy would only pass stools every 3-4 days only if she
inserted a glycerine suppository per rectum. The boy was born at home as the 6th child and was
noted by the mother that he only passed meconium on the 3rd day of life after rectal stimulation as
suggested by the midwife the mother consulted. Since then, as the patient grew up, there were
episodes of constipation associated with abdominal enlargement and occasional vomiting
relieved by insertion of suppository per rectum. On PE, the boy had an enlarged abdomen with
palpable distensible masses on the abdomen. Rectal exam resulted in a large gush of air and
passage of voluminous loose stool and this decreased the boy’s abdominal girth. Based on
history and PE, the most likely diagnosis is
A. Functional constipation
B. Abdominal lymphoma
C. Hirschsprung’s disease
D. Wilms’ tumor
C
The following minimizes constipation
A. Dietary intake of 20-30 grams non-starch polysaccharide
B. Intake of at least 8 glasses of fluids per day
C.Exercise
D. AOTA
D
To meet the Rome criteria for functional constipation, the patient must have fewer than 3
bowel movements per week, institute manual maneuvers to evacuate stool, straining, passage of
lumpy/hard stools, incomplete evacuation, and have a sensation of anorectal
obstruction/blockage more than _____% of the time
A. 25
B. 30
C. 35
D. 40
A
