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Year 3 Conditions > Constipation > Flashcards

Constipation Flashcards

1
Q

What does constipation mean

A

Stools passed irregularly or with difficulty

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2
Q

Categories of constipation

A

Abnormal peristalsis
Hard faeces
Bowel obstruction
Patient not pushing

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3
Q

Main causes of abnormal peristalsis

A 
IBS
Medications such opiates, CCBs and iron supplements
Hypothyroidism
Hypercalcaemia
Hypokalaemia
MS
Diabetic neuropathy
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4
Q

Main causes of hard faeces

A

Lack of fibre

Dehydration

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5
Q

Main cause of bowel obstruction leading to constipation

A

Adenocarcinoma
Sigmoid volvulus
Pelvic masses such as uterine fibroids or ovarian cancer
Colonic stricture from Crohns, radiotherapy, diverticular disease

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6
Q

Main causes of patient not being able to push in consitpation

A

Anal fissure
Haemorrhoids
Pelvic floor dysfunction

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7
Q

What must always remember about constipation for people whove been in hopsital for a while

A

Discomfort from going so mental

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8
Q

What are red flags in constipation

A

Severe and persistent unresponsive to treatment
Absolute constipation including not passing air
Rectal bleeding
Wt loss, IDA, night sweats
PMH and Fx of UC or polyps

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9
Q

What does passing hard and lumpy stools indicate

A

Lack of fibre

Dehydration

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10
Q

Significance of onset of constipation

A

Acute could be pathological

Chronic normally benign

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11
Q

Significance of having diarrorhoea as well as constipation in relation to age

A

Young is IBS
Over 45- cancer if mucoid especially
Over 60- diverticular disease

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12
Q

What is tenesmus

A

Ever present need to empty bowels but very little if any passed

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13
Q

What does tenesmus suggest

A

Cancer or any persistent mass in rectal area

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14
Q

What does bleeding in faeces or on wiping indicate alongside constipation

A

Haemorrhoids
Anal fissure
Diverticular disease
Cancer

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15
Q

What does bloating and constipation indicate

A

IBS

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16
Q

What does weight gain, feeling cold and reduced appetite with constipation indicate

A

Hypothyroidism

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17
Q

What does bone pain and constipation indicate

A

Hypercalcaemia from bone metastases

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18
Q

What does polyuria and polydipsia with constipation indicate

A

Hypercalcaemia

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19
Q

Risk factors for constipation

A

History of endocrine, back and neurological disorders
Family history of FAP and HNPCC
Medications such as opiates, iron supplements
Low fibre diet
Dehydration

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20
Q

What does hair loss, especially in outer third of eyebrow, dry skin and malar rash indicate in constipation presentation

A

Hypothyroidism

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21
Q

What could mass on examination with constipation pt be

A

Faecal mass
Cancer of GI tract or ovarian mass
Crohns mass

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22
Q

What does lax anal tone on examination of constipation pt suggest

A

Neurological disorder

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23
Q

Neurological causes of constipation

A

MS
Parkinsons
Spinal chord compression
Diabetic neuropathy

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24
Q

Bloods investigations for constipation

A

FBC- anaemia
U and Es- hypercalcaemia and hypokalaemia
TFTs- hypothyroidism

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25
Q

Further investigations that could be carried out for constipation

A

FOBT

CA19-9

26
Q

What is CA19-9 used for more

A

To monitor relapse, recovery and recurrence

27
Q

What is a proctoscopy

A

Dilator used to visualise inside of rectum and anus

28
Q

Differences between rigid and flexi sigmoidoscopy

A

Rigid only goes as far as sigmoid colon whereas flexi reaches splenic flexure
Rigid only for visualising whereas flexi can take biopsies and remove polyps
Flexi requires sedation and bowel preparation of enema

29
Q

What is a barium enema

A

Barium enema inserted and AXR taken at various points

30
Q

Most common met sites of colorectal cancer

A

Liver
Lungs
Ovaries
Lymph nodes

31
Q

Diet advice for people with constipation

A

Cereal high in fibre
Whole meal bread
Fruit and veg
Can get fibre supplements

32
Q

Name of a fibre supplement

A

Methylcellulose

33
Q

Short term management of constipation

A

Stool softeners such as paraffin oil and arachis oil enemas
Osmotic laxatives such as lactulose, magnesium salts
Peristalsis stimulants

34
Q

Problems with stool softeners

A

Should only be used in short term as leads to steatorrhoea and anal seepage

35
Q

Problems with osmotic laxatives

A

Only used in short term as leads to dehydration and tolerance

36
Q

Who shouldnt osmotic laxatives be used in

A

Renal failure
Fluid restriction
Diurised

37
Q

Examples of peristalsis stimulants

A

Glycerol suppositories

Senna

38
Q

What laxative acts as oth softener and stimulant

A

Docusate

39
Q

What is last resort medication used for constipation

A

Enemas

40
Q

In an old person who is constipated what must consider

A

Immobility
Lack of drive to go to toilet
Medications- mainly opioids

41
Q

What can cause constipation in cancer patients

A

Bone mets

Tumour compressing spinal chord or cauda equina

42
Q

What is best laxative if taking opioids

A

Methylnaltrexone- is an opioid receptor antagonist

43
Q

Presentation of bowel obstruction

A

Colicky abdo pain
Absolute constipation
Distended abdomen
Nausea and vomiting- more common in SBO

44
Q

What diameter loops indicate small bowel obstruction

A

Over 3cm

45
Q

What diameter loops indicate large bowel obstruction

A

Over 6cm

46
Q

What diameter large bowel loops indicate imminent perforation

A

Over 9cm

47
Q

Best way to confirm bowel obstruction

A

AXR

48
Q

Most common causes of large bowel obstruction

A

Sigmoid volvulus
Cancer
Diverticulitis
Can be mechanical such as hypothyroidism

49
Q

What does coffee bean sign indicate

A

Large bowel has twsisted on itself- sigmoid volvulus

50
Q

Management of sigmoid volvulus

A

NBM
NG tube
IV fluids given to replace electrolytes building up in obstruction
Surgery using sigmoidoscope first but if unsuccessful or peritonitic then open

51
Q

Why do you get constipation after surgery

A

Opiates
General anaesthetic
Manipulation of bowels puts into state of paralysis
Also embarassment of having to go on ward

52
Q

General grading of tumours

A

TMN

53
Q

Classification of colon cancer

A

DUKES

54
Q

What are DUKES criteria

A

A- no spread into muscularis propria
B- invaded beyond muscularis propria
C- in lymph nodes
D- metastasised to other organs

55
Q

Dukes A category

A

90% survival at 5 years

Surgically removed laparascopically

56
Q

Dukes B category

A

65% survival at 5 years

Surgically removed as well as adjuvant chemotherapy

57
Q

Problem with chemo in colorectal cancers

A

Most resistant and have to give multidrug therapies

58
Q

Why are colorectal cancers most resistant to chemo

A

Reflection of their adaptations to constant dietary exposures- for example often produce efflux pumps for proteins

59
Q

Dukes C category

A

30-45% survival at 5 years

Surgically removed as well as adjuvant chemotherapy

60
Q

Dukes D category

A

5-10% survival at 5 years

Treatment palliative

61
Q

Important risk factors for colorectal cancer

A 
Smoking
Lack of exercise
Obesity
Fibre deficient potentially 
Red meats
Saturated fats
62
Q

Protective factor of colorectal cancer

A

Aspirin

Year 3 Conditions (33 decks)

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