constipation

Question 1

what is constipation?

Answer 1

it is broadly defined as unsatisfactory defecation characterised by infrequent stools, 3 of fewer movements per week

Question 2

what can constipation lead to?

Answer 2

hardening of stool and strain when attempting to defecate

Question 3

what are the symptoms of constipation?

Answer 3

lower abdominal pain, distension or bloating

Question 4

is constipation subjective to age?

Answer 4

no- it is commonly seen in women, the elderly or during pregnancy but can occur at any age

Question 5

what can constipation be a side effect of?

Answer 5

medications- those that slow intestinal motility
low fibre diet
disorders that disrupt the coordinated muscle contractions

Question 6

what factors contribute to constipation?

Answer 6

medical conditions
medicines
other- social class. education/ female sex/ age/ physical activity

Question 7

common causes of constipation include:

Answer 7

low fibre
no sufficient drinking water or liquids
sedentary lifestyle

Question 8

how may constipation be classified?

Answer 8

primary- the causes of intrinsic problems of colonic or anorectal function
secondary: the causes are related to organic diseases, systemic diseases or medications

Question 9

what is functional constipation?

Answer 9

must include or more of the following:
-strain at lead 25% of defecations
lumpy or hard stools in more than 25/5
sensation of incompleeye evacuation for more than 25%
manual maneuvers to faciliate more than 25%
less than 3 poos per week
loose stools are rarely present without use of laxatives

all the above must be for the oast 3 months with symptom onset more than 6 months before diagnosis

Question 10

what are the subclasifications of secondary or organic constipation?

Answer 10

medication-induced
metabolic diseases
neuropathies
myopathies
other

Question 11

what are the questions you would ask when determining constipation?

Answer 11

frequency and consistancy of stools
n and v
abdominal pain, distension or discomfort
mobility
diet

Question 12

when would patients requre further investiagtion with constipation?

Answer 12

• unexplained
• constipation without pain or vomiting
• passage of blood or mucus tenesmis
• long-standing constipation or unresponsibe to treatment

Question 13

what would the constipation further investigation involve?

Answer 13

colonic and anorectal manometry, stool analysis and a flexible sigmidoscroy or colonscopy

Question 14

how would you manage constipation?

Answer 14

education- diet and exercise
non drug treatment
diet and lifesty;e changes
no tea or coffee
laxatives- long term

Question 15

what is dyssynergic defecation?

Answer 15

it is an acquired behavioural disorder in two-thirds of adults
biodeedback therapy is the mainstay treatment
addition of sensory retraining in those with rectal hyposensitivity

Question 16

when is drug treatment in constipation recommended?

Answer 16

where there is faecal impaction, associated illness, pregnancy or poor diet

Question 17

what are laxatives classified as?

Answer 17

bulk forming
stimulant
osmotic
faecal softners

based on patient choice

Question 18

what are bulking agents

Answer 18

they are stool normalisers

help control faecal consistanct in IBS where diarrhoea is predominant for people with ileostimy of colostomy

Question 19

what is the various MOA for bulking agents?

Answer 19

a hydrophilic action- retention of water i the gut lumen- expands and softens the faeces
proliferation of colonic bacteria- increases faecal bulk- stimulation of colonic musosal receptors- promoting peristalsis
dehydration of polysacchardies in the sterculia to substances that have an osmotic laxative effect

Question 20

how should you take bulking agents

Answer 20

at least 24 hours after ingestion
need to be taken with a lot of water
est a regular bowel
they should be avoided if there is faeal impactation

Question 21

what are some examples of stimulant laxatives?

Answer 21

senna, bisacidyl, danthron and sodium picosulfate

Question 22

how does senna work?

Answer 22

it is a tea
contains sennosides and anthrone glycosides- have no purgative activity
sennoside a and b are metabolised to form rheinathrone
this inc cox 2 expression which increases prostaglandin E2
this inc is associated with a decreased in aquaporin 3
this restricts water reabsorption- inc faeceal water contentent

Question 23

how does bisacidyl work?

Answer 23

• is hydrolyzed by intestinal brush border enzymes and colonic bacteria
• form an active metabolite [bis -(p-hydroxyphenyl) pyridyl-2methane (BHPM)] that acts directly on the colonic mucosa.
• stimulates sensory nerve endings in the walls of the intestine and there ctumto produce peristalti ccontractions of the colon and cause defecation.
• It is also a contact laxative ;it increases fluid and salt secretion. Constipation

Question 24

what is the onset time of the lazatives?

Answer 24

8-12 hours