Constipation Flashcards
Revision
Red flags of constipation that needs urgent investigation?
New onset constipation(especially over 50years) or accompanying symptoms such as anaemia, abdominal pain, weight loss, or overt or occult blood in the stool
Non pharmacological treatment of constipation?
Increase in dietary fibre(gradually to minimise flatulence and bloating) 4 weeks to see the effect.
Adequate fluid intake.
Exercise.
Balanced diet.
Fruits high in fibre and sorbitol, and fruit juices high in sorbitol, can help prevent and treat constipation.
- What are bulk forming laxatives?
- What is their onset of action?
- Common s/e of bulk forming laxatives?
- Bran,ispaghula husk,methylcelluloseandsterculia.
- Up to 72 hour
- Flatulence, bloating, and cramping
What kind of laxative is Methylcellulose?
Bulking forming laxatives and stool softener
- What are the stimulant laxatives?
2. What is their onset of action?
1.bisacodyl, sodium picosulfate, senna, co-danthramer co-danthrusate 2. 6 to 12 hours
What kind of laxative Is docusate sodium?
Stimulant and stool softener
- What kind of laxative is limited to constipation in terminally ill patients and why?
Co-danthramerandco-danthrusate.
Because of potential carcinogenicity and evidence of genotoxicity.
What kind of laxative is glycerol?
Lubricant and as a rectal stimulant.
- What are the osmotic laxatives?
- Onset of action?
- Mode of action of osmotic laxatives?
- Common advice
- Lactulose , macrogol
- 2 or 3 days
- Increase the amount of water in the large bowel, either by drawing fluid from the body into the bowel or by retaining the fluid
- Increase fluid intake to avoid dehydration
What laxative is used in hepatic encephalopathy?
Lactulose
- What laxatives are Faecal softeners?
2. Onset of action of docusate?
1.Docusate(also stimulant)
Glycerol(also rectal stimulant)
Enemas containingarachis oil(ground-nut oil, peanut oil)
Liquid paraffin
- 24 to 48 hour
What is the mode of action of faecal softeners?
Act by decreasing surface tension and increasing penetration of intestinal fluid into the faecal mass
- What is the indication of Linaclotidelaxative?
2. What is the mode of action?
- moderate to severe IBS with constipation
2. It increases intestinal fluid secretion and transit, and decreases visceral pain
- What is the indication of Linaclotidelaxative?
2. What is the mode of action?
- moderate to severe IBS with constipation
2. It increases intestinal fluid secretion and transit, and decreases visceral pain
- What is Prucaloprideindication?
2. How does it work?
- Chronic constipation in adults, when other laxatives have failed
- Selective serotonin 5HT4-receptor agonist with prokinetic properties
- What is Prucaloprideindication?
2. How does it work?
- Chronic constipation in adults, when other laxatives have failed
- Selective serotonin 5HT4-receptor agonist with prokinetic properties
What is treatment for short duration or chronic constipation?
First line: bulk forming laxative with adequate fluid intake
2nd: add or switch to osmotic laxative
3rd: stimulant
What laxative is C/I in opioid induced constipation?
Bulk forming laxatives.
What laxatives is used in opioid induced constipation?
Osmotic laxative or docusate.
Inadequate response:
- stimulant
- naloxegel
- Methylnaltrexone
What is the criteria for using prucalopride to treat constipation?
If at least two laxatives (from different classes) have been tried at the highest tolerated recommended doses for at least 6 months.
If treatment withprucaloprideis not effective after 4 weeks. Refer.
What laxative is used for faecal compaction?
1st line:Macrogol for hard stools
2nd line: oral stimulant started or as an add on. Soft or hard stool.
How are constipation in pregnancy and during breast feeding treated?
A. Non drug treatment
Dietry measures
B. Drug treatment
Ist line: bulk forming laxative
2nd: lactulose
3rd: stimulant ( avoid at term)
How are constipation in children treated?
1st line: laxative + dietary measures
.
Continue laxative for several after regular pattern of bowel movement is achieved.
Treatment of Faecal compaction in children?
Laxative: 1st choice: macrogol
2nd choice: stimulant(mono or addon)
3rd chioce: lactulose or stool can be added
