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GI Exam 2 > Constipation disorders > Flashcards

Constipation disorders Flashcards

1
Q

Most common digestive
complaint in the United
States

A

Constipation

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2
Q

Review ROME IV CRITERIA for constipation

A

Slide 9

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3
Q

ETIOLOGY of primary (idiopathic, functional) constipation

A

Primary = its the organ itself being affected
Normal-transit constipation (NTC) - most common
Slow-transit constipation (STC)
Pelvic floor or anal sphincter dysfunction

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4
Q

Etiology for secondary constipation

A

Dietary issues
Structural causes
Systemic disorders
Medications

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5
Q

Medications that can cause constipation

A
  • Antidepressants
  • Anticholinergics
  • Opioids
  • Antacids
  • NSAIDs
  • Pseudoephedrine
  • Calcium channel blockers
  • Long-term use of stimulant laxatives
  • Inadequate thyroid hormone supplementation
  • Metals
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6
Q

Constipation leads to ____

A
  • Issues of stool consistency
  • Hard, painful stools
  • Issues of defecatory behavior
  • Infrequency
  • Difficulty with evacuation
  • Straining during defecation
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7
Q

T/F Constipation may originate from
within the colon and rectum, or it
may originate externally

A

T

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8
Q

Factors within the colon/rectum that affect constipation

A
  • Colon obstruction (neoplasm, volvulus,
    stricture)
  • Slow colonic motility (Chronic laxative abuse?)
  • Hirschsprung disease in children
  • Chagas disease
  • Outlet obstruction (anatomic vs. functional)
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9
Q

Anatomic and functional causes of outlet obstruction:

A

Anatomic
- Rectal prolapse
- Rectocele
- Intussusception of rectum on straining
Functional
- Pudendal nerve damage
- Short segment Hirschsprung disease
- Puborectalis or external anal sphincter
spasm with bearing down

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10
Q

Factors ouside the colon/rectum affecting constipation

A
  • Poor dietary habits
  • Medications
  • Systemic disease
  • Psychological issues
  • Lead poisoning
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11
Q

SYMPTOMS associated with constipation

A
  • Rectal bleeding
  • Anemia
  • Inability to pass flatus
  • Vomiting
  • Unexplained weight loss
  • Abdominal bloating
  • Pain on defecation
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12
Q

PHYSICAL EXAM for constipation

A
  • Abdominal distention or masses
    may indicate the presence of
    colonic stools or tumors
  • Large abdominal wall hernias
  • Pelvic examination in women should
    specifically address the posterior vaginal
    wall, with particular attention to any
    evidence of internal prolapse or rectocele
  • General physical examination is
    often of no benefit in determining the etiology or in deciding the treatment
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13
Q

RECTAL EXAM

A
  • Inspect for skin excoriations, skin tags, anal fissures, scars, external hemorrhoids, prolapsed hemorrhoids, rectal prolapse, and condyloma.
  • Assess anocutaneous reflex, observe for prolapse with straining
  • Digital rectal examination
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14
Q

Work up & Labs for constipation

A
  • Colonoscopy immediately if
    any red flag symptoms
  • Labs
  • Fecal occult blood
  • CBC
  • TSH
  • CMP
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15
Q

Imaging for constipation

A
  • Colonoscopy
  • Abdominal x ray
  • Abdomen/pelvis CT
    – Especially if acute abdominal pain, fever, or
    leukocytosis present
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16
Q

SPECIAL TESTS for constipation

A
  • High resolution anal manometry (HRAM)
  • Defecography
  • Lower GI endoscopy
  • Colonic transit study
  • Barium or gastrografin study
17
Q

High resolution anal manometry (HRAM)

A
  • Assesses anorectal tone, strength, and
    sensitivity.
  • Can also be used to assess for
    dysynergistic defecation and ability to
    expel stool
18
Q

Defecography

A
  • Barium past inserted in rectum and pt
    expels in seated position
  • Can use fluoroscopy or MRI
  • MRI can evaluate pelvic floor function
    and can detect rectal intussusception
19
Q

Colonic transit study

A
  • Pt ingests radio-opaque markers or
    wireless recording capsule
  • Transit time through colon measured
20
Q

TREATMENT for constipation

A

Start with dietary measures
* Increase fluid intake
* Increase fiber intake
* Fiber supplements
* Early failure usually reflects inadequate water intake
* Reoccurrence months to years later usually reflects a patient’s decision that fiber supplementation is no longer necessary

21
Q

PHARMACOLOGIC THERAPY for constipation

A
  • Stool softeners: colace
  • Osmotic laxatives: milk of magnesia, polyethylene glycol
  • Stimulant laxatives
  • Rapidly acting lubrication (mineral oral)
  • Suppositories (glycerin)
  • Enemas: Sodium phosphate (Fleet enema)
22
Q

In what scenarios is surgical correction an option for constipation?

A
  • Large bowel obstruction
  • Volvulus
  • Intra-abdominal infection or ischemia
  • Hemorrhoidal thrombosis
  • Rectocele
  • Rectal prolapse
  • Rectal intussusception
  • Hypomotile colon refractory to treatment
23
Q

Management for constipation in pregnancy

A
  • Fiber supplementation
  • Increased water intake
  • Gentle exercise
  • Occasional laxative use
  • Hemorrhoid suppositories
  • Sitz baths
24
Q

management for constipation in the elderly

A
  • Diet changes
  • Exercise
  • Medication adjustments
25
Q

Management for constipation in children

A
  • Diet changes
  • Miralax
  • Behavioral therapy
  • Regular toilet sitting after meals
  • Reward system (reward for effort,
    not success)
  • Stool for foot support, child-sized
    toilet seat
26
Q

FECAL IMPACTION

A
  • Mass of hard, dry stool that will not
    pass out of the colon or rectum
  • Can lead to bowel obstruction
  • Caused by inability to sense and
    respond to the presence of stool in
    the rectum
  • Decreased mobility, lowered
    sensory perception
27
Q

Risk factors for fecal impaction

A
  • Chronic constipation
  • Low fiber diet
  • Limited fluid intake
  • Lack of physical activity
  • Medication side effects
  • Previous fecal impaction
28
Q

FECAL IMPACTION symptoms

A
  • Abdominal cramping
  • Bloating
  • Loss of appetite
  • Nausea and vomiting
  • Sudden episodes of diarrhea after
    constipation
  • Rectal bleeding
  • Small, semi-formed stools
  • Straining
  • Bladder pressure
  • Lower back pain
  • Rapid heartbeat/lightheadedness
29
Q

Colonoscopy imperative if ______

A

recent change in bowel habits

30
Q

_____ will not be felt on DRE (needs x-ray)

A

Impaction of proximal rectum or
sigmoid colon

31
Q

______ can cause severe pain
and cramping because attempts to
evacuate the rectum are blocked by the
fecal mass.

A

Osmotic laxatives

32
Q

TREATMENT for constipation

A
  • Warm mineral oil enema (softens
    and lubricates)
  • Manual disimpaction
  • Pharmocologic treatment
33
Q

Digital Disimpaction process

A
  • Lubricate the anus and use ONE gloved finger in a
    slow, scooping motion to break up the fecal mass.
  • Process must be done in small steps to avoid injury
    to the rectum.
  • Usually performed without anesthesia or sedation
    since that increases risk of damage to the anal
    sphincter.
  • Surgery indicated if procedure fails

GI Exam 2 (6 decks)

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