Constipation

Question 1

Red flags of constipation that needs urgent investigation?

Answer 1

New onset constipation(especially over 50years)
or accompanying symptoms such as
anaemia, 
abdominal pain, 
weight loss, 
or overt or occult blood in the stool

Question 2

Non pharmacological treatment of constipation?

Answer 2

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.

Question 3

1. What are bulk forming laxatives?
2. What is their onset of action?
3. Common s/e of bulk forming laxatives?

Answer 3

1. Bran,ispaghula husk,methylcelluloseandsterculia.
2. Up to 72 hour
3. Flatulence, bloating, and cramping

Question 4

What kind of laxative is Methylcellulose?

Answer 4

Bulking forming laxatives and stool softener

Question 5

1. What are the stimulant laxatives?

2. What is their onset of action?

Answer 5

1.bisacodyl,
  sodium picosulfate,
   senna,
   co-danthramer
   co-danthrusate
2. 6 to 12 hours

Question 6

What kind of laxative Is docusate sodium?

Answer 6

Stimulant and stool softener

Question 7

1. What kind of laxative is limited to constipation in terminally ill patients and why?

Answer 7

Co-danthramerandco-danthrusate.

Because of potential carcinogenicity and evidence of genotoxicity.

Question 8

What kind of laxative is glycerol?

Answer 8

Lubricant and as a rectal stimulant.

Question 9

1. What are the osmotic laxatives?
2. Onset of action?
3. Mode of action of osmotic laxatives?
4. Common advice

Answer 9

1. Lactulose , macrogol
2. 2 or 3 days
3. Increase the amount of water in the large bowel, either by drawing fluid from the body into the bowel or by retaining the fluid
4. Increase fluid intake to avoid dehydration

Question 10

What laxative is used in hepatic encephalopathy?

Answer 10

Lactulose

Question 11

1. What laxatives are Faecal softeners?

2. Onset of action of docusate?

Answer 11

1.Docusate(also stimulant)
Glycerol(also rectal stimulant)
Enemas containingarachis oil(ground-nut oil, peanut oil)
Liquid paraffin

2. 24 to 48 hour

Question 12

What is the mode of action of faecal softeners?

Answer 12

Act by decreasing surface tension and increasing penetration of intestinal fluid into the faecal mass

Question 13

1. What is the indication of Linaclotidelaxative?

2. What is the mode of action?

Answer 13

1. moderate to severe IBS with constipation

2. It increases intestinal fluid secretion and transit, and decreases visceral pain

Question 14

1. What is the indication of Linaclotidelaxative?

2. What is the mode of action?

Answer 14

1. moderate to severe IBS with constipation

2. It increases intestinal fluid secretion and transit, and decreases visceral pain

Question 15

1. What is Prucaloprideindication?

2. How does it work?

Answer 15

1. Chronic constipation in adults, when other laxatives have failed
2. Selective serotonin 5HT4-receptor agonist with prokinetic properties

Question 16

1. What is Prucaloprideindication?

2. How does it work?

Answer 16

1. Chronic constipation in adults, when other laxatives have failed
2. Selective serotonin 5HT4-receptor agonist with prokinetic properties

Question 17

What is treatment for short duration or chronic constipation?

Answer 17

First line: bulk forming laxative with adequate fluid intake

2nd: add or switch to osmotic laxative
3rd: stimulant

Question 18

What laxative is C/I in opioid induced constipation?

Answer 18

Bulk forming laxatives.

Question 19

What laxatives is used in opioid induced constipation?

Answer 19

Osmotic laxative or docusate.

Inadequate response:

1. stimulant
2. naloxegel
3. Methylnaltrexone

Question 20

What is the criteria for using prucalopride to treat constipation?

Answer 20

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.

Question 21

What laxative is used for faecal compaction?

Answer 21

1st line:Macrogol for hard stools

2nd line: oral stimulant started or as an add on. Soft or hard stool.

Question 22

How are constipation in pregnancy and during breast feeding treated?

Answer 22

A. Non drug treatment
Dietry measures

B. Drug treatment
Ist line: bulk forming laxative

2nd: lactulose
3rd: stimulant ( avoid at term)

Question 23

How are constipation in children treated?

Answer 23

1st line: laxative + dietary measures
.

Continue laxative for several after regular pattern of bowel movement is achieved.

Question 24

Treatment of Faecal compaction in children?

Answer 24

Laxative: 1st choice: macrogol

              2nd choice: stimulant(mono or addon)

              3rd chioce: lactulose or stool can be added