Constipation

Question 1

What are some causes of constipation

Answer 1

1. Abnormal bowel peristalsis: IBS, medications
2. Hard faeces: lack of fibre, dehydration
3. Bowel obstruction: colorectal adenocarcinoma, sigmoid volvulus
4. Haemorrhoids, anal fissure

Question 2

Passing hard, lumpy stools indicates what?

Answer 2

Lack of fibre or dehydration (not obstruction)

Not passing anything indicates complete bowel obstruction

Question 3

Intermittent diarrhoea and constipation can indicate what?

Answer 3

IBS - young
Colorectal cancer - >45
Diverticular disease - >60 (especially if LIF pain)

Question 4

Blood on faeces, per rectum, or when wiping indicates?

Answer 4

Haemorrhoids, anal fissure, diverticular disease or colorectal cancer

Question 5

Bloating is a classical feature of?

Answer 5

IBS

Question 6

Feeling cold, reduced appetite and weight gain may indicate what cause of constipation?

Answer 6

Hypothyroidism

Question 7

How can bone pains be linked to constipation

Answer 7

Bone metastases lead to hypercalcaemia which causes constipation

Question 8

Polyuria and thirst are indicators of what cause of constipation

Answer 8

Hypercalcaemia

Question 9

What signs upon examination in a patient with constipation should you look for?

Answer 9

1. Signs of hypothyroidism - outer third of eyebrows hair loss, brittle hair, dry skin, malar flush
2. Virchows node
3. Abdominal mass
4. Anal fissures/haemorrhoids
5. DRE mass
6. Lax anal tone

Question 10

Which blood/biochemical should be done in someone with constipation

Answer 10

1. FBC
2. Electrolytes and calcium - hypercalcaemia and hypokalaemia can cause constipation
3. TFTs
4. Glucose and HbA1c

Second line:

1. Faecal occult blood test (FOBT) - faecal blood can be used for colon cancer screening.
2. Carcinoembryonic antigen (CEA).CA19-9/CA125 - markers of colon cancer - not diagnostic

Question 11

What imaging should be used for constipation investigation

Answer 11

1. Proctoscopy
2. Rigid or flexible sigmoidoscopy
3. Colonoscopy
4. CT colonography
5. Double contrast barium enema (DCBE)
6. OGD - use if there is iron deficiency anaemia

Question 12

Constipation with polydipsia, polyuria, aches, pains, lethargy and low mood are pointers to what diagnosis?

Answer 12

Hypercalcaemia

Moans, groans, bones and stones

Question 13

In primary and tertiary hyperparathyroidism, what are the biochemistry levels

Answer 13

PTH high/normal
Ca high
ALP high/normal
Phosphate low

Question 14

Vitamin D overdose. Explain biochemistry

Answer 14

High Ca
High phosphate
Low PTH (as it is suppressed)
Low ALP

Question 15

What are common causes of large bowel obstruction

Answer 15

Mechanical obstruction by colorectal tumour, sigmoid volvulus (twisting of sigmoid colon) or diverticulitis.

May also be due to hypothyroidism

Question 16

What is “coffee bean” sign characteristic of?

Answer 16

Sigmoid volvulus

Question 17

How is sigmoid volvulus managed

Answer 17

Drip and suck

Remove obstruction