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Gastro 2 > Constipation > Flashcards

Constipation Flashcards

1
Q

Def

Typical # of bowel movements per week

Other signs of constipation

A

Persistent, dufficult, infrequent or incomplete defecation

3

Excessive straining, hard stools, incomplete evacuation

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2
Q

Primary cz

Secondary c

A

related to diet/lifestyle/colorectal dysfunction

Functional/anatomic/neuro abnormalities that prevent passage of stool

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3
Q

Most frequent predisposing factor

Addtl

A

low fiber/fluids- delays passgae

Physical inactivity/immobility- delays transit

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4
Q

Children causes

Complications

A

Behavior- avoid bc of pressure, wanting to play or social

Hard bowel mvment, anal fissure, continues to hold stool

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5
Q

Colorectal dysfunction

Due to

Leads to

A

Delayed emptying of ascending/trasnverse colon

Reduced freq of high amplitude propagated contractions (HAPCs)

inc time for water reasborption, hard stool

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6
Q

Muscle dyssenergy

At rest

Mass movement

w strain

Any process that causes

A

puborectalis/IS muscle are tonically contracted (90 angle btw rectum & anal canal)

Feces enters rectum, distenstion causes invol relaxation of IAS/contraction of EAS

relax puborectalis and EAS t widen angle to allow stool flow

failure w cause incomplete evac

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7
Q

Secondary disorders

impair luminal passage leads to

Distl lesions

Anorectal pathology obstruction

Neuro disorders

A

retention of bulky stool

Direct prevention of stool passage

Dec luminal diamter or contrbuting to muscle dysfunction

impair ANS, delay HAPCs, leading to intestinal peristalsis

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8
Q

Secondary causes of constipation

Gastro

Neuro

Metabolic

Drug/toxin

A

G- Obstruction (tumor/stricture), anorectal patho, paralytic ileus

N- Cerebral palsy, neuropaty, paraplegia, PD

M- hypo thyroid/K/Mg, hyperCa

D- lead/narcotics/anticholinergics/antipsychotics, diuretics. CCB, cholestyramine

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9
Q

MCC constipation in infants/kids

usually due to

Anatomic cz

Neurologic cz

A

Functional- no clear etiology

behavior/diet

congenital imperforate anus, anal stenosis, acquired via surgery

Hirschsprungs, spinal cord damage

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10
Q

Adulthood MCC constipation

A

Inadequate fiber/fluids

Red freq of HAPCs

IBS (one subset has cons)

Pelvic floor dyssenergia

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11
Q

Bristol Stool Chart

Type 1
2
3
4
5
6
7
A

1- separate, hard lumps like nuts (hard to pass)

2- sausage shaped, lumpy

3- like sausage, cracks on surface

4- smooth and soft

5- soft blobs, clean edges (easy to pass)

6- fluffy, ragged edges, mushy

7- entirely liquid

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12
Q

Children

Functional const considered if 2 of following are present for 1 mnth

A 
<2 defecations/wk
Incontinence
Hx of excessive stool retetion
Hx of pain/hard stools
Large fecal mass in rectum
Hx of large diameter stools
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13
Q

Encopresis

W chronic constipation

A

passing of semisolid/liquid stool

rectume distends, shortens anal canal and dilates anal sphincter

Liquid stool leaks and released with relaxed EAS

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14
Q

Hirschprungs

Suggestive sx

A

Distal colon not relaxed, functional obstruction

Sx t birth or 1st few months

Meconeum delayed

Ab distension/vomitting

May not present until later

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15
Q

Adults

Functional cons if 2+ present for 3 nths

IBS

Cons subset

Mixed subset

A 
Straining
Lumpy/hard
Incomplete evac
Anorectal obstruction/blockage
Requires manual maneuvers
Less than 3 defecations/wk

All >25% of time

Bowel discomfort for 6+ mnths
3 days every month

hard/lumpy stools, pain relieved w defecation

hard or loose stools, pain relieved w defecation

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16
Q

Dx

Xray

Sudden change in bowel habits

Test of choice

A

hx and physical exam

sig stool retention, not sensitive

look for secondary causes- anemia(Hb), Ca, creatinie, TSH

Colonoscopy

17
Q

Mx first step

Large stool burden/hard stool

Impacted pt

A

look for fecal impaction

need stool evac

fiber/bulk dont help

Need osmotic laxatives in high doses

18
Q

Less severe manifestations

2-5 yrs

6-10yrs

12-15yrs

Adults

Maintenance

A

dietary change initiated, inc fliber/fluids

5+

10+

15+

20-35

bulk forming lax, low dose osmotic lax

19
Q

Docusate (surfactant)

Stimulat lax

daily use leads to

A

well tolerated w medications that produce const

adjunct, intermittent use

HypoK, salt overload

20
Q

Soft stool (1-3d)

Bulk forming lax

Surfactant lax

A

B- Ca polycarb
Guargum
Methylcellulose
Psyllium

S- docusate
Lactulose
Mineral oil

21
Q

Semifluid stool (6-8hrs)

Stimulant lax

A

Bisacodyl
Cascara
Senna

22
Q

Dose dependent

Osmotic

Low (soft stool 1-3d)
High (watery stool 1-3hrs)

A

MgOH
Mg Citrate
Polyethylene glycol
NaPhos

Gastro 2 (28 decks)

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