Constipation Flashcards

1
Q

_____is the difficult passage of small hard

stools

A

Constipation

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2
Q

ROME Criteria for constipation

duration:

to be positive, fulfill?

A

12 weeks

> 2

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3
Q

ROME III Criteria

• infrequent passage of stools 25% of time
• sensation of incomplete evacuation >25% of time
• use of manual manoeuvres >25% of time
• sensation of ________
>25% of time

A

3/week

straining

anorectal obstruction/blockage

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4
Q

emphasis should be on the
_______rather than on the frequency
of defecation;

A

consistency of the stool

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5
Q

Constipation from infancy may be due to

_____

A

Hirschsprung disorder

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6
Q

______is the single most important factor in

preventing constipation

A

Diet

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7
Q

Unusually shaped stools (small pellets or ribbonlike)

suggest _____

A

irritable bowel syndrome

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8
Q

The ________ is far superior to the
rigid sigmoidoscope in investigation of the lower
bowel

A

flexible sigmoidoscope

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9
Q

MC cause of constipation

A

The commonest is ‘idiopathic’ constipation where
there is no structural or systemic disease. This is also
referred to as ‘functional’ constipation

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10
Q

Alarm Sx for constipation

A
  • Recent constipation in >40 years of age
  • Rectal bleeding
  • Family history of cancer
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11
Q

In the Mx of constipation,

Ensure that the anthraquinone group of
laxatives, including_____, is never used
long term because they cause melanosis coli and
associated megacolon

A

‘Ford pills’

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12
Q

Three of the primary masquerades
are important causes of constipation, namely
______

A

drugs, depression and hypothyroidism

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13
Q

These drugs may be associated with
constipation, especially codeine and its derivatives,
___, ____ and ______

A

antidepressants, aluminium and calcium antacids

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14
Q

The metabolic causes of constipation include
1
2
3

A

hypothyroidism, hypercalcaemia and porphyria

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15
Q

Diabetes rarely can be associated with constipation
when an _______ can lead to
alternating bouts of constipation and diarrhoea.

A

autonomic neuropathy

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16
Q

Constipation may be a manifestation of an underlying
functional problem and psychiatric disorder, such
as
1
2
3
4

A

depression, anorexia nervosa, schizophrenia or

drug abuse

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17
Q

It is worth noting that 60% of polyps and
cancers will occur in the _______
and diverticular disorder should be evident with the
flexible sigmoidoscope

A

first 60 cm of the bowel

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18
Q

The presence of _____is an important
sign—it may give a pointer to the duration of the
constipation and the consequent chronic intake
(perhaps denied) of anthraquinone laxatives

A

melanosis coli

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19
Q

Labs for constipation work-up. What blood chem?

A

— thyroid function tests
— serum calcium
— serum potassium
— carcinoembryonic antigen (a tumour marker)

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20
Q
Radiological findings 
— CT colonography (virtual colonography)
—\_\_\_\_\_\_\_\_\_ (especially for
primary colonic disease, e.g. megacolon)
— \_\_\_\_\_\_\_\_, using radio-opaque
shapes taken orally and checking progress by
abdominal X-ray or stool collection
A

double contrast barium enema

bowel transit studies

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21
Q

Physiological tests:

— \_\_\_\_\_\_\_\_—test anal tone
— rectal sensation and compliance, using an
\_\_\_\_\_\_\_\_\_
— \_\_\_\_\_\_\_\_\_, to determine
disorders of defecation
— Rectal biopsy, to determine \_\_\_\_\_\_
A

anal manometry

inflatable rectal balloon

dynamic proctography

aganglionia

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22
Q

__________or faecal incontinence is the

inappropriate passage of normal stool

A

encopresis

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23
Q

constipation is difficulty or delay in passing the
stool with incomplete emptying of the rectum:
this can present as _______, due to faecal retention
with overflow of liquid faeces (paradoxical
diarrhoea)

A

soiling

24
Q

consider if stool hard and associated with pain or

bleedin

A

Anal fissure in infants

25
Q

It is best to classify idiopathic constipation into three
subgroups:

1
2
3

A

1 simple constipation
2 slow transit constipation
3 normal transit constipation (irritable bowel
syndrome)

26
Q

______or lazy bowel, is the term used to
describe a rectum that has become unresponsive
to faecal content, and this usually follows repeated
ignoring of calls to defecate

A

Dyschezia,

27
Q

Pharma Tx of constipation

An appropriate choice would be one of the
hydrophilic bulk-forming agents such as ____

A

ispaghula or

psyllium.

28
Q

What to avoid in the tx of constipation

A

Avoid stimulant laxatives except for short

sharp treatments.

29
Q

Stimulant (irritant) laxatives examples

A

Sodium picosulfate
Anthraquinones: senna (Senokot/Sennetabs), senna with
dried fruits (Nu-Lax), sennosides A and B; cascara
Frangula bark (in Normacol Plus)
Castor oil
Triphenylmethanes: bisacodyl (e.g. Dulcolax); picsulfate

30
Q

CX of fecal impaction

A

Complications include spurious
diarrhoea, faecal incontinence, bowel obstruction,
urinary incontinence or retention

31
Q

Tx of fecal impaction

A

Treat with oral or osmotic
laxatives (e.g. 8 sachets of macrogol 3350 for 3 days
with or without rectal suppositories) or enema e.g.
Fleet Enema, Microlax.

32
Q

• Commonest GIT malignancy
• Second most common cause of death from cancer
in Western society
• Generally men over 50 years (90% of all cases)

A

Colorectal cancer

33
Q

Prognosis of colon CA

A

Good prognosis if diagnosed early

34
Q

location of Colon CA

A

Two-thirds in descending colon and rectum

35
Q

RF for colon CA

A

• Ulcerative colitis (long-standing)
• Familial: familial adenomatous polyposis (FAP),
hereditary non-polyposis colorectal cancer
• Colonic adenomata
• Decreased dietary fibre

36
Q

Why is DRE impt in rectal CA

A

this is appropriate because
many cancers are found in the lowest 12 cm and
most can be reached by the examining finger

37
Q

Cx of rectal CA in the rectum

A

If obstructing, there is a risk of rupture of the caecum.

38
Q

Spread of colon CA

  • Lymphatics → _______
  • Direct → _________
  • Blood → ______
A

epigastric and para-aortic nodes

peritoneum

portal circulation

39
Q

Dx of choice for colon CA

A

CT colonography (investigation of choice)

40
Q

Serum_____is not useful for diagnosis but is

useful for monitoring response to treatment

A

CEA level

41
Q

_____ (if available) is useful for follow-up

A

PET scanning

42
Q

If FOBT is positive—investigate by ____ or ____

A

colonoscopy

or by flexible sigmoidoscopy

43
Q

An FOBT every_____ years is now recommended for all

people from 50 years

A

2

44
Q

Colonoscopy recommendation for moderate risk COlon CA

A

• Moderate risk: every five years from 50 years or
10 years younger than when a family member
presented

45
Q

Colonoscopy reco for high risk

A

• High risk: guided by clinical genetics team but as
a rule yearly or 2 yearly commencing at 25 years,
and every 12 months from 12–15 years of age if a
strong family history of FAP.

46
Q

Criteria used for colorectal CA

A

Modified Dukes’ classification of colorectal

cancer

47
Q

What is Modified Dukes’ classification of colorectal
cancer

A
B
C
D

A

A: Cancer limited to mucosa and submucosa

B. Cancer extends into muscularis or serosa

C. Cancer involves regional lymph nodes

D. Distant metastases (e.g. liver

48
Q

5 year SR of diff stages of colon CA

A
B
C
D

A

88

70

43

7

49
Q

ff up pts with colon CA

A
  • CEA antigen
  • colonoscopy
  • abdominal imaging: ultrasound or CT scan of liver
50
Q

DRE of Hirschprung

A

Rectal examination—narrow or normal rectum

51
Q

Dx of Hirschprung

Abdominal X-ray/barium enema—_____

A

distended

colon full of faeces to narrow rectum

52
Q

Dx of Hirschprung

Absent rectoanal reflex on ______

A

anal manometry

53
Q

Tx of Hirschprung

A

Resect narrow segment after preliminary colostomy

54
Q
• In older children and adults
• Mainly due to bad habit
• Can be caused by:
— chronic laxative abuse
— milder form of Hirschsprung disorder
— Chagas disease (Latin America) 2
— hypothyroidism (cretinism)
— systemic sclerosis
A

Acquired megacolon

55
Q

DRE of acquired megacolon

A

Rectal examination—dilate loaded rectum, lax

sphincter

56
Q

First-line treatment of functional constipation
(unresponsive to simple measures) is _______. An _______ is good second-line
therapy.

A

a bulking agent

osmotic laxative

57
Q

Beware of ______ causing constipation in

the elderly patient on diuretic treatment

A

hypokalaemia