Constipation and chronic diarrhea - management and treatment

Question 1

what is the definition of of diarrhea ?

Answer 1

increase in the volume of stool and the frequency of bowel movements is also increased

it is present if one of the following criteria is fulfilled
frequent defecation of more than 3 times in 24hrs
altered stool consistency where the water content is more than 75 percent
increase in stool quantity moe than 200-250g per day

Question 2

what is important when taking he medical history in diarrhoea patients ?

Answer 2

the frequency and size of each bowel movement

Question 3

small and frequent bowel movements indicate what ?

Answer 3

left colon or rectal disease

Question 4

voluminous stool usually indicate what ?

Answer 4

small bowel and right colon disease

Question 5

if diarrhoea does not interrupts sleeping pattern what does this suggest ?

Answer 5

absence of nocturnal diarrhea indicates functional bowel disease

Question 6

what is the definition of acute diarrhoea ?

Answer 6

ongoing for less than 14 days

Question 7

what is the etiology of diarrhoea ?

Answer 7

travelling

food consumption of tainted and spoilt food , improper heating

secretory diarrhoea - staphylococcus, 
eccoli , 
cholera (acute) 
rotavirus  (acute)
colchicine medication  (secretory diarrhoea) 

medications:
antacids ,
laxatives (osmotic diarrhea - lactulose , citrate of magnesia , maldigestion of milk) ,

pancreatic insufficiency , 
billary disease  
chrons disease , 
celiac disease 
surgical resection 
scleroderma 
(diarrhoea secondary to malabsorption )

inflammatory bowel disease - chrons disease,
ulcerative colitis
enteric infections - shigella , salmonella , campylobacter , yersina
(exudative diarrhoea)

hyperthyroidism

hypokalaemia

irritable bowel syndrome -

Question 8

what is the classification of pathophysiological mechanism for diarrhoea

Answer 8

diarrhoea secondary to mucosal transport or secretory dysfunction (occurs independent of dietary intake and does not subside with fasting)

osmotic diarrhoea - ceases with fasting

diarrhoea secondary to malabsorption

exudative diarrhoea - diseases associated with large quantities of inflammatory exudate such as pus , blood and proteinaceous materials

diarrhoea secondary to altered bowel movement - when bowel movement decreases it encourages bacterial overgrowth and bile salt beconjugation diarrhoea is then th direct result of fat malabortioon and increased colonic secretion
significant increase in bowel movement can deliver excessive large volumes of stool to colon and the maximum absorptive capacity of the colon which is 4l is exceeded , and the bowel is emptied before the adequate absorption

Question 9

what is the definition of persistent diarrhoea ?

Answer 9

diarrhoea has persisted for more than 14 days which rules out any of the toxin and infectious diarrhoea

Question 10

which infections result as chronic diarrhoea ?

Answer 10

giardiasis

amebiasis

Question 11

what is the definition of chronic diarrhoea ?

Answer 11

lasting more than 30 days

Question 12

what are some anti diarrhoea drugs ?

Answer 12

loperamide

Question 13

loperamide is contraindicated in ?

Answer 13

fever or blood in stool

Question 14

what are the diagnosis for diarrhoea ?

Answer 14

stool microscopy

dark field microscopy fro cholera

stool cultures

ELISA fro rotavirus

immunoassays ad bioassays for ecoli strains

Question 15

what is the treatment for diarrhoea ?

Answer 15

ringer lactate solution iv infusion or fluids given under nasogastric gastric tube

Question 16

what is the definition of constipition

Answer 16

infrequent difficult passage of stool with sensation of incomplete bowel emptying

Question 17

constipation can be classified according to what ?

Answer 17

acute - sudden onset resolving within 3 months

chronic - persists longer than 3 months

Question 18

constipitaion is classified into what?

Answer 18

primary - functional
unidentifiable disorder or side effect of medication.
Mostly due to poor diet and insufficient exercise and not good hydration and low in fibre

secondary - constipitaion due to medical disorder such as structural abnormality or medication

Question 19

what is the normal bowl movements frequency ?

Answer 19

1-3 bowl movements per day

Question 20

what is fecal impaction ?

Answer 20

accumulation of hard stool usually in the rectum that cannot be passed because of its size and consistency

Question 21

what is a megacolon ?

Answer 21

constipation carried out to the extreme , hugely dilated atonic colon containing a lot of stool

Question 22

what is the pathophysiology of constipation

Answer 22

motility disorder

hyper motility

hypotonia

Question 23

where is stool normally stored ?

Answer 23

in the sigmoid and not the rectum

Question 24

what gives us the sensation to emptying ?

Answer 24

when the stool is passed from the sigmoid to the rectum it passes these afferent stimulus which indicates us to defecate

Question 25

what is the etiology of constipation

Answer 25

not enough hydration

not enough fibre

sigmoid spasms, so content is held proximally to the sigmoid

decrease propulsive activity - intrinsic muscle =scleroderma ,
neurological disorder,
anticholinergic antidepressants ,
laxatives- eventually giving atonic colon,
calcium channel blockers
opiates

suppression of normal defecation through external anal sphincter

depression

decreased physical activity

hypothyroidism

anatomical changes in colon - colorectal carcinoma , stricture

Question 26

acute change of bowl movements especially after 40 indicate what ?

Answer 26

neoplasm

Question 27

what is the subclassifications of chronic constipation ?

Answer 27

elder: well established laxative habit

young :often female constipated because of lifestyle - does not spontaneously defectae in the morning and skipping breakfast
junk food or salad low in fibre such as lettuce

Question 28

why is the constipation in megacolon ?

Answer 28

the colon musculature is hypotonic , allowing he fecal accumilations

Question 29

how can we differentiate a megacolon from hirschpung disease (congenitally acquired megacolon)

Answer 29

rectal examination: the rectum is empty despite huge accumulation of stool in the sigmoid

in acquired megacolon the rectum is foll of stool

ganglion cell biopsy

rectosphincteric manometry

fluoroscopy

Question 30

what are better treatments other than laxatives due to their dependency and therefore desensitisation

Answer 30

enema

suppositories

Question 31

why is enema and suppository better than laxatives ?

Answer 31

they only stimulate the rectosigmoid or rectum rather than the entire colon

fibre therapy - increase stool bulk , increasing colonic contractions
psyllium products / methycellulose artificial forms of bran

lactulose not digested and enters the colon and broken down by the bacteria creating an osmotic load stimulate colonic emptying

Question 32

what is the criteria that needs to be met for definitive diagnosis of constipation

Answer 32

rome 3 diagnostc criteria , atleast two of the symptoms has occurred in the past 6 months over 12 week period

Question 33

what are the factors in the rome 3 diagnostic criteria for constipation ?

Answer 33

less than 3 times a week stool passage

hard lumpy stool

incomplete defectaion sensation

manual anuveing to empty bowl

straining during attempt to defecate

sensation of anorectal obstruction