constipation

Question 1

chronic constipation is

Answer 1

>3 months of <3 bowel movements / week

>25% of bowel movements have require straining

Question 2

alarm features of constipation include:

Answer 2

anemia, hematochezia or positive FOBT or fecal occult blood test

weight loss>4.5 kg or 10 lbs

family history of colon cancer or inflammatory bowel dx

prominent or unexplained change in bowel habits

Question 3

management of chronic constipation:

Answer 3

medication change or fiber or lifestyle adjustment and further evaluation (colonoscopy, EGD) if >1 alarm feature

Question 4

what are characteristics of straining with bowel movements?

Answer 4

lumpy hard stools or sensation of incomplete evacuation or needing digital evacuation

Question 5

poor dietary or medication effects are responsible for

Answer 5

constipation

Question 6

alarm features are:

Answer 6

prominent unexplained bowel habit changes

Question 7

All pts with chronic constipation need to undergo:

Answer 7

initial evaluation with detailed history and physical examination

basic laboratory testing (CBC, serum glucose, serum creatinine, TSH, and electrolytes)

Question 8

If no alarm features then should trial for constipation

Answer 8

dietary fiber and lifestyle modification

Question 9

first line treatment for pts taking scheduled opioids is

Answer 9

a stimulant laxative like senna or bisacodyl

also do not give supplemental fiber as this can worsen constipation.

Question 10

phosphate and magnesium containing enemas preparations are

Answer 10

contraindicated in seriously ill pts and ESRD pts

can cause electrolyte shifts

Question 11

if maximal medical therapy is done for someone on scheduled opioids how do you treat their constipation?

Answer 11

give methylnaltrexone for these don’t cross the blood brain barrier and therefore don’t affect analgesia

Question 12

polyethylene glycol is an

Answer 12

osmotic laxative that increases water content of stools to improve bowel motility lactulose dose the same thing

Question 13

we avoid sodium phosphate enemas in

Answer 13

CKD and CHF pt