Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3 Oxford Cases > Constipation > Flashcards

Constipation Flashcards

1
Q

What are the 4 broad causes of constipation

A

Abnormal bowel peristalsis
Hard stools
Bowel obstruction
Patient not pushing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the differentials for constipation caused by abnormal bowel peristalsis

A 
IBS 
Medications e.g. opiates, iron supplements, CCBs
Hypothyroidism
Hypercalcemia
Hypokalaemia
MS, Parkinson's, diabetic neuropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the differentials for constipation with hard stools

A

Lack of dietary fibre

Dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the differentials for constipation due to bowel obstruction

A

Colorectal adenocarcinoma
Sigmoid volvulus
Pelvic masses - uterine fibroids, ovarian tumour
Colonic stricture - radiotherapy, Crohn’s, diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the differentials for constipation due to the patient not pushing

A

Haemorrhoids
Anal fissure
Pelvic floor dysfunction e.g. after hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What red flags warrant further investigation of a patient presenting to the GP with constipation

A

Severe, persistent constipation unresponsive to treatment
Absolute constipation
Rectal bleeding, tenesmus or intermittent mucoid diarrhoea
Significant weight loss, IDA, night sweats
PMHx UC or colonic polyps
Strong FHx of colon cancer of colonic polyps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What should be asked about the constipation itself

A

Specify what the patient means by constipation

When did it start

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What associated symptoms should be asked about in a patient with constipation

A 
Weight loss, night sweats, fevers
Diarrhoea
Tenesmus
Blood on faeces, PR or when wiping
Bloating
Feeling cold, reduced appetite, gaining weight 
Bone pain 
Polyuria, thirst
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q 
What do the following symptoms (with constipation) suggest:
Weight loss, night sweats, fevers
Diarrhoea
Tenesmus
Blood on faeces, PR or when wiping
Bloating
Feeling cold, reduced appetite, gaining weight 
Bone pain 
Polyuria, thirst
A

Weight loss, night sweats, fevers: malignancy
Diarrhoea: IBS (younger), colorectal cancer (>45), diverticular disease (>60)
Tenesmus: mass e.g. tumour
Blood on faeces, PR or when wiping: haemorrhoids, anal fissure, diverticular disease, colorectal cancer
Bloating: IBS
Feeling cold, reduced appetite, gaining weight: hypothyroidism
Bone pain: bone mets -> hypercalcaemia -> constipation
Polyuria, thirst: hypercalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What risk factors should be asked about for constipation

A

History of bowel disease, neuro disorders, back problems, endocrine disease

FHx of bowel disorders e.g. FAP, HNPCC, Peutz-Jegher’s

Opiate, anticholinergic, TCA, CCB and iron supplement use

Low-fibre diet and dehydration (ask for colour of urine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should be looked for on general inspection in an exam for a patient with constipation

A

Cachexia (malignancy)

Hypothyroidism signs: loss of hair, brittle hair, dry skin, puffy eyes, malar flush

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should be looked for on abdominal exam for a patient with constipation

A

Virchow’s node (GI malignancy)
Abdominal mass (faeces, tumour, Crohn’s, ovarian)
Anal fissure or haemorrhoids
Mass on digital rectal examination
Lax anal tone (neuro path e.g. diabetic neuropathy or MS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What blood tests should be ordered to investigated consipation

A

FBC: anaemia suggests malignancy

U+Es: electrolytes (hypoK and hyperCa) can cause constipation

TFTs: exclude hypothyroidism

Glucose and HbA1c: assess diabetic control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What additional markers may be ordered for suspected colorectal cancer

A

Faecal occult blood test (FOBT)

CEA (Carcinoembyonic antigen), Ca19-9, Ca-125

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What imaging should be ordered for constipation

A 
Proctoscopy 
Rigid sigmoidoscopy / Flexible sigmoidoscopy
Colonoscopy 
CT colonography 
Double contrast barium enema 
OGD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are bulk producers, fibre supplements and stool softeners

A

Bulk producers - helps constipation by providing bulk which activates stretch receptors in the bowel

Fibre supplements: methylcellulose tablets, isphaghula husk

Stool softeners: liquid paraffin and arachis oil enemas (short term use)

17
Q

What are osmotic laxatives

A

Lactulose, macrogols/polyethylene glucols e.g. movicol, magnesium salts

Retains fluid in the bowel -> osmotic diarrhoea

Patient MUST increase fluid intake to avoid dehydration

18
Q

Give examples of peristaltic stimulants

A

Glycerol suppositories
Bisacodyl
Senna
Docusate

19
Q

How will a patient who is constipated due to dehydration, low fibre diet and immobility present

A

Long-standing constipation
Hard stools and dark urine
DRE - rectum loaded with hard faeces with normal anal tone

NO pain, rectal bleeding, no other symptoms
Social history - little fluid intake, low fibre diet, immobility

20
Q

How will a patient who is constipated due to hypothyroidism present

A 
Progressive constipation over months 
No pain, blood or straining 
Cold intolerance
Weight gain despite reduced intake 
Fatigue 
Heavy menstruation 
Bradycardia , carpal tunnel syndrome
21
Q

What are common causes of constipation in elderly women

A 
Medications e.g. opiates
Hypercalcaemia 
Immobility 
Weakness
Poor diet and dehydration 
Megarectum
22
Q

What is the treatment for sigmoid volvulus

A

Drip and suck (IV in, NG tube out)
Removal of obstruction by
1. sigmoidoscopy and flatus tube insertion
2. Surgery

23
Q

why is constipation very common after surgery

A

Anaesthesia + opiate analgesia + bowel manipulation -> paralysis/ileus
Electrolyte disturbances e.g. hypokalaemia, magnesaemia
Embarrassment of using commode in hospital

24
Q

Describe Dukes classification

A

Dukes A - no spread into muscularis propria

Dukes B - invasion beyond the muscularis propria

Dukes C - Spread to lymph nodes

Dukes D - metastases to other organs

25
Q

What is the management and prognosis of Dukes stage A

A

90% survival at 5 years

Offer surgical removal of the affected bowel potion, consider pre-op radiotherapy

26
Q

What is the management and prognosis of Dukes stage B and C

A

65% and 30-45% survival at 5 years

Surgical removal of the tumour + chemotherapy + radiotherapy (recta tumour)

27
Q

What is the management and prognosis of Dukes stage D

A

5-10% past 5 years

Largely palliative care

28
Q

What are the modifiable risks of colorectal cancer

A

Smoking
Exercise and obesity
Fibre
Aspirin

Y3 Oxford Cases (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions