Constipation Flashcards
What must you elucidate when a patient say they are constipated?
Frequency
Ease of passage
Volume
What are the differential diagnoses in a patient with constipation due to abnormal bowel peristalsis?
IBS
Medications
Hypothyroidism Hypercalcaemia Hypokalaemia Spinal cord compression MS Parkinson's disease Diabetic neuropathy Idiopathic megacolon/slow transit
What are the differential diagnoses for hard faeces?
Lack of dietary fibre
Dehydration
What are the differential diagnoses of bowel obstruction?
Colorectal adenocarcinoma
Sigmoid volvulus
Other pelvic masses
Colonic strictures
What are the differential diagnoses of a patient not pushing?
Haemorrhoids
Anal fissure
Pelvic floor dysfunction (eg after hysterectomy)
What are the red flags in a patient with constipation?
Severe, persistent constipation that is unresponsive to treatment
Rectal bleeding, tenesmus, or intermittent mucoid diarrhoea
Significant weight loss, iron-deficiency anaemia, and/or night sweats
PMH of UC or polyps
Strong family history of colon caner or colonic polyps
What does intermittent diarrhoea and constipation suggest?
IBS
What does tenesmus suggest?
Persistent mass in the rectum
Why would you ask about polyuria or thirst in a patient with constipation?
These would suggest hypercalcaemia
What is the faecal occult blood test (FOBT) used for?
Screening for colon cancer
May also be due to colonic angiodysplasia, colonic polyps, haemorrhoids, aspirin or warfarin
Warrants further investigation
What are Carcinoembryonic antigen (CEA)/CA19-9/CA125?
Markers of colon cancer
But they lack specificity
What is the constellation of symptoms in hypercalcaemia?
Moans (depression), groans (aches and pain), bones, and stones (renal stones)
What can the underlying causes of the hypercalcaemia be?
What would the blood tests results be for each of these?
Bone metastases
- High ALP, low PTH and high phosphate
Myeloma
- Normal ALP, low PTH and high phosphate
Hyperparathyroidism
- Normal/high ALP, normal/high PTH and low phosphate
Vit D overdose
- Low ALP, low PTH and high phosphate