Constipation Flashcards
Physiological elements needed for an effective, soft stool
Neurological input for defecation and the urge to push intact (no pain)
Effective peristalsis
Soft stool
Think of a tube with a head on the end
Red flags of constipation
Acute change in bowel habit Blood No flatus FLAWS Severe, persistent constipation
Is constipation more likely to be serious if acute or chronic?
Acute
Chronic is usually dehydration or lifestyle
What is tenesmus and what may it indicate?
It’s the feeling of incomplete emptying. May indicate a persistent mass in the rectum, e.g. a tumour
If the patient reports bleeding PR, what important questions need asking?
Colour
When you noticed
How much
On the tissue?
FH of bowel cancer conditions
FAP
HNPCC
Which drugs can cause constipation?
Opiates, anticholinergics, TCA antidepressants, CCB, iron supplements
In all abdominal pathology, which lymph node should you check?
Virchows
If constipated, what examination should you consider?
DRE, checking for impacted faeces
If you find lax anal tone on DRE, what may it indicate?
Neuropathy, e.g. diabetic neuropathy or MS
Which cancer marker is indicated in bowel cancer?
CEA
Which cancer marker is indicated in ?ovarian cancer?
CA125
Which electrolyte disturbances can cause constipation
Hypercalcaemia
Hypokalaemia
What may you find on FBC in cancer?
Micro cystic anaemia (Fe deficiency from blood loss)
What investigations are available to look at the colon?
Protoscopy Rigid sigmoidoscopy Flexible sigmoidoscopy Colonoscopy CT colonography OGD for the top bit
How can we treat chronic constipation?
Lifestyle changes, e.g. more fluid, exercise, fibre.
Can give bulk producers such as fibre supplements
Stool softeners
Laxatives
Patient with long standing constipation, heavy periods, fatigued, positive talen test. Likely diagnosis?
Hypothyroidism
Likely cause of hypothyroidism in a young woman
Autoimmune = Hashimoto’s thyroiditis
Which antibodies are present in Hashimoto’s?
Anti TPO
Patient with constipation, aches and pains all over his body, polyuria, polydipsia, normal capillary glucose, lethargy and low mood.
Likely diagnosis
Hypercalcaemia
Moans, bones, groans and stones
A patient is found to have hypercalcaemia, how do we find a cause?
Blood tests
ALP, PTH, phosphate
Calcium profile
Bone cancer increases turnover of bones -> raised ALP and phosphate
Hyper parathyroidism, high ALP. High calcium should inhibit ALL PTH! So normal is still high.
In metastatic breast cancer, what drug can you take to protect your bones?
Alendronate or pamidronate
What drug can you give for nausea from morphine?
Cyclizine
Neurological cause of constipation?
Cauda equina or other cord compression
What drug can you give for morphine induced constipation?
Methylnaltrexone
Coffee bean sign =
Sigmoid volvulus
Management of sigmoid volvulus
Drip and suck = IV fluids and an NG tube
Referral to surgeons for removal of obstruction
TNM classification
T = 1-4 local invasion and size N = nodes 1-3 (3 being distant nodes) M = 0/1 if metastasised
Dukes classification
A= muscularis propria B = beyond C = lymph nodes D = other organs
The sigmoid colon derives its arterial supply from which branch of the abdominal aorta?
Inferior mesenteric artery
