Constipation Flashcards
Causes of constipation
Drugs - opiates, ondansetron, anti cholinergics, diuretics
Diet - low fibre diet, poor fluid intake
Reduced activity - sedentary
Electrolytes imbalance - hypercalcaemia, hypokalaemia
Underlying conditions - cancer, hypothyroidism
Neurological conditions spinal cord compression.
What is constipation on the Bristol stool chart
Type 1 - separates hard lumps, like nuts which are hard to pass
Type 2 - sausage shaped but lumpy
Hx constipation
Last BO How often is normal Flatus What are they like Reasons
Managing constipation
Avoid if poss try not to start causative drugs etc
If stool hard - need softener
If soft - need stimulant
If impacted (not obstructed) consider movicol PO
Patients on reg opioids need reg stimulant
Types of laxatives
Stimulant
Softener
Osmotic
What does a stimulant do
Works on the large bowel Good when cause opiates CI obstruction Causes abdo pain E.g. senna, bisacodyl Danthron - terminal care
What do stool softener do
Doscosate sodium
Well tolerated
Osmotic laxatives
Act in small bowel
Need inc fluid intake
Lactulose/movicol
Types of bowel intervention for constipation
Suppositories - bisacodyl - anorectal stimulation, glycerol - draws fluid in and softens and lubricates
Enema- phosphate, microlax
Inc fluid in small intestine
Causes of bowel obstruction in palliative care
GI, gynae malignancies
Irreversible is a poor prognosis
Causes of MBO
Extrinsic compression - tumour, omental mets, malignant adhesions, radiation, fibrosis
intraluminal occlusion - annular tumour.
Motility disorders - infiltration of mesentery
If patient has abdo colic + bowel sounds
MECHANICAL - something in the way extrinsically or intrinsically
If patient has No colic and absent bowel sounds
Paralytic ileus
What MBO does management depends on
Whether the patient is a surgical candidate or not
MBO surgery management
NG/IVI
