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E CAN ext. > Constipation > Flashcards

Constipation Flashcards

1
Q

Why is constipation difficult to define?

A

As it is a subjective experience

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2
Q

What generally suggests constipation?

A

Defecation less than 3x per week

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3
Q

What are the possible features of constipation?

A
  • Straining
  • Lumpy or hard stools
  • Sensation of complete evacuation
  • Sensation of anorectal obstruction/blockage
  • Less than 3 defecations per week
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4
Q

Are loose stools a common feature of constipation?

A

Not without laxatives

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5
Q

Why is constipation an important symptom to consider?

A

Without treatment, can cause unnecessary suffering

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6
Q

What can cause constipation in cancer?

A
  • Cancer treatments
  • The cancer itself
  • Side effects from other medications
  • Insufficient fibre
  • Insufficient fluids
  • Lack of exercise
  • Long term use of laxatives
  • Ignoring the call to stool
  • Depression and anxiety
  • Other medical conditions
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7
Q

What aspects of cancer treatment can cause constipation?

A
  • Chemotherapy or targeted drugs

- Abdominal surgery

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8
Q

Why can chemotherapy/targeted drugs cause constipation?

A

They affect the nerve supply to the bowel

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9
Q

What factors can cause constipation after abdominal surgery?

A
  • Muscles may be too weak to expel stool
  • Pain may make patient unable to expel stool
  • Drugs for anaesthetic or for pain
  • NBM
  • Major pelvic operations can damage nerves that help bowel work properly
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10
Q

How can the cancer itself cause constipation?

A
  • Press on nerves of spinal cord, slowing down or stopping movement of bowel
  • Abdominal tumours can distort the bowel
  • Tumour in lining of bowel can affect nerve supply to muscles
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11
Q

What are the most common medications that have constipation as a side effect in cancer?

A
  • Painkillers, especially opioids

- Anti-emetics

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12
Q

What other medications can cause constipation?

A
  • Some BP medications
  • Antidepressants
  • Vitamin supplements, such as iron and calcium
  • Anti-convulsants
  • Drugs for Parkinsons disease
  • Diuretics
  • Antacids
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13
Q

What medical conditions can cause constipation?

A
  • Bowel obstruction
  • Parkinson’s disease
  • Spinal cord injiry
  • Diabetes
  • Hyper calcaemia
  • Multiple sclerosis
  • Thyroid problems
  • Stroke
  • Hypokalaemia
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14
Q

What should the history for constipation in cancer include?

A
  • Full assessment of pre-disease and current bowel pattern
  • Experience of defecation - difficulty, effort, outcome
  • Stool itself
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15
Q

What information about the stool should be obtained in constipation?

A
  • Type
  • Consistency
  • Colour
  • Odour
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16
Q

What may be useful in the assessment of constipation?

A

An assessment scale or the Bristol Stool Chart

17
Q

What examination should be done in constipation?

A

Abdominal examination with DRE

18
Q

Why do opiates cause constipation?

A

Their impact on interstitial smooth muscle tone and fluid absorption prevents the forward peristalsis of faecal matter in the colon, and results in a dry hard stool

19
Q

How should constipation caused by opiates be prevented?

A

A laxative should be titrated against the dose of opiates, and increased accordingly

20
Q

What are the principles for management of constipation?

A
  • Re-establishment of comfortable bowel pattern
  • Promotion of independence and personal preference
  • Management distressing side effects of treatment
21
Q

What are the distressing side effects of treatment of constipation?

A
  • Discomfort
  • Flatulence
  • Pain
22
Q

Describe the role of natural methods of constipation management in cancer patients?

A

Natural methods alone are unlikely to be successful in a debilitated patient

23
Q

What route of administration is preferred for laxatives in constipation?

A

Oral

24
Q

What is the first line management for constipation?

A

Combine laxative stimulant and softner

25
Q

What is the second line management for constipation?

A

Use rectal suppository and/or enema

26
Q

What can be used for opioid-dependant patients with constipation who do not respond to suppositories and/or enema?

A

Peripherally specific opioid antagonist such as methylnaltrexone administered SC

27
Q

What happens towards the end of life, regarding the management of constipation?

A

The overall priority of constipation in terms of symptom burden may be less important

28
Q

What might indicate the need for assessment and intervention for constipation at the end fo life?

A

Restlessness

E CAN ext. (47 decks)

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