Constipation IBS

Question 1

(men/women) more affected by constipation

Answer 1

women

Question 2

rome III criteria for constipation

Answer 2

less than 3 defecations per week or 25% straining, hard & lumpy, incomplete evacuation, anorectal blockage, or manual assistance (in the ABSENCE of loose stools)

Question 3

this involuntary muscle can sample what is coming

Answer 3

internal anal sphincter

Question 4

name 4 causes of constipation

Answer 4

slow transit, Hisrchprung’s, outlet obstruction, anatomic

Question 5

metabolic causes of slow transit

Answer 5

hypothyroidism, diabetes, pregnancy

Question 6

neurogenic causes of slow transit

Answer 6

CVA, MS, Parkinson’s

Question 7

medication associated slow transit

Answer 7

narcotics, diuretics, anticholinergics

Question 8

normal transit should take ___ hours to reach the colon, and ___ hours to be defecated

Answer 8

3; 33

Question 9

outlet-type obstructions are due to paradoxical contraction of?

Answer 9

puborectalis and external sphincter

Question 10

Hischprung’s is a congenital disorder of ______, due to failure of appropriate migration of ____ cells to the distal rectum

Answer 10

motor neurons; neural crest

Question 11

an absent _____ suggests Hirschprung’s dz

Answer 11

RAIR (rectoanal inhibitory reflex)

Question 12

dx of hirschprung’s can be done by rectal biopsy and stain for ________

Answer 12

ganglion cells; no cells = hirschprung’s

Question 13

tx for slow transit

Answer 13

laxatives (polyethylene glycol, lubiprostone, linaclotide)

Question 14

tx for outlet-type obstruction of anal canal

Answer 14

physical tx for pelvic floor

Question 15

hirschprung’s dz tx

Answer 15

surgical management only

Question 16

polyethylene glycol is an _____

Answer 16

osmotic agent

Question 17

lubiprostone is a ______

Answer 17

chloride channel activator

Question 18

linaclotide is a ____

Answer 18

GC agonist (can cause dysentery)

Question 19

this drug does not affect central receptors and thus can be given with narcotic analgesics

Answer 19

methylnaltrexone (prokinetic)

Question 20

IBS responses are modulated by?

Answer 20

neurotransmitters, gut opiate receptors, myoelectric responses

Question 21

management of IBS

Answer 21

sx-based management, phychological tx

Question 22

MoA of fiber

Answer 22

resists enzymatic digestion, presented to colon unchanged, fermented by colonic bacteria to fatty acids = prokinetic

Question 23

this drug is strictly limited to severe, refractory IBS-D and has this major side effect

Answer 23

alosetron (serotonin receptor antagonist); ischemic colitis

Question 24

side effects of antispasmodics (anticholinergics)

Answer 24

constipation, dry mouth, urinary retention, confusion

Question 25

antidepressents: use _____ for IBS-D and _____ of IBS-C

Answer 25

tricyclics; SSRIs