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pre-reg exam 2021 > Constipation And Bowel Cleansing > Flashcards

Constipation And Bowel Cleansing Flashcards

1
Q

What are the symptoms of constipation?

A

Infrequent stools
Difficulty passing stools
Sensation of incomplete emptying

Excessive straining
Lower abdominal pain or discomfort
Bloating

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2
Q

What are the red flags of constipation?

A 
New onset constipation in over 50 years
Anaemia
Abdominal pain 
Unexplained weight loss
Overt or occult blood
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3
Q

What are the bulk forming laxatives?

A

Sterculia
Ispaghula husk
Methylcellulose

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4
Q

What are the osmotic laxatives?

A

Magnesium hydroxide
Lactulose
Macrogol

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5
Q

What are the softener laxatives?

A

Liquid paraffin / docusate

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6
Q

What are the stimulant laxatives?

A 
Co-danthramer
Glycerol suppositories
Bisacodyl
Sodium picosulfate
Co-danthrusate 
Senna
Docusate
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7
Q

What are the chloride channel agonists?

A

Lubiprostone

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8
Q

What are the selective 5HT4 agonists?

A

Prucalopride

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9
Q

What is the first line laxative?

A

Bulk forming

Ideal for small, hard, stools and fibre deficient diets

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10
Q

How do bulk forming laxatives work?

A

Swells in gut to increase faecal mass to stimulate peristalsis

Works within 24 hours but takes 2-3 days for full effect

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11
Q

What are the side effects of bulk forming laxatives?

A

Bloating
Cramping
Flatulence
Gut obstruction

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12
Q

What are the counselling points for bulk forming laxatives?

A

Maintain adequate fluid intake to avoid gut obstruction

Swallow with plenty of water and not immediately before bed

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13
Q

What is the risk of ispaghula husk?

A

Contains potent allergens so risk of hypersensitivity

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14
Q

Are osmotic laxatives first or second line?

A

Second line

If stools remain hard, add or switch to osmotic laxative

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15
Q

How do osmotic laxatives work?

A

Increase water in colon

Lactulose causes osmotic diarrhoea of low faecal pH

Macrogols sequester fluid in bowel

Works within 2-3 days, 48 hours for lactulose

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16
Q

What are the side effects of osmotic laxatives?

A

Discomfort, flatulence, cramps, nausea when starting lactulose

Nausea - reduced by administering with water, fruit juice or meals

17
Q

When are stimulant laxatives used?

A

Third line

Add if stools are soft but difficult to pass/incomplete emptying

Short term use

18
Q

How do stimulant laxatives work?

A

Increases intestinal motility by irritating gut lining

Glycerol suppositories work in 15-30 mins

Works within 6-12 hours

19
Q

What are the side effects of stimulant laxatives?

A

Abdominal cramps

Senna colours urine yellow-brown

Hypokalaemia, diarrhoea, lazy bowed

20
Q

What are the counselling points for stimulant laxatives?

A

Take at night to pass stool in morning

Moisten suppositories with water before use

21
Q

What are the side effects of dantron?

A

Genotoxic

Carcinogenic

Red urine

Local irritation/excoriation

22
Q

What are the side effects of faecal softeners?

A

Anal seepage
Lipoid pneumonia
Granulomatous disease of GI tract
Malabsorption of ADEK

23
Q

What are lubiprostone and prucalopride used for?

A

If at least two laxatives have been the highest tolerated recommended doses for at least 6 months

Prucalopride in women only

24
Q

What do you use for opioid induced constipation?

A

OS
Osmotic or docusate sodium + stimulant

Co-danthramer in palliative care

Methylnaltrexone/naloxegol

Avoid bulk forming laxatives

25
Q

What is used for chronic constipation?

A

BOS - bulk, osmotic, stimulant

Macrogol is choice osmotic laxative

26
Q

What is used for constipation in children?

A

Children love M&S

Macrogol + diet

+ stimulant
+ lactulose or softener if stools remain hard

27
Q

What is used for constipation in pregnancy?

A

Pregnant women are DBOS

Diet
Bulk forming
Osmotic
Stimulant - bisacodyl or senna 
Docusate or glycerol suppositories

Avoid senna if near term/history of unstable pregnancies as can stimulate uterine contractions

28
Q

What is used for constipation in breast feeding?

A

BOS

Bulk forming
Lactulose or macrogol
Stimulant

pre-reg exam 2021 (79 decks)

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