Constipation/Obstruction/Fecal Impaction

Question 1

what amount of stools/wk would u consider a pt constipated

Answer 1

< 3

Question 2

what are two primary causes of constipation

Answer 2

slow transit time and defecatory d/o such as dysynergistic contaction/relaxation of sphincters.

Question 3

what are 4 secondary causes of constipation

Answer 3

meds (anticholinergics/opioids/diuretics/CCBs) , obstruction lesions(neoplasms/strictures), systemic illness (endocrine/metabolic/neurologic), and others (IBS, Hirschprung dz-congenital blockage of LI due to improper muscle) or megacolon

Question 4

when would u get labs/imaging on a pt suspected to report constipation

Answer 4

If >50 y/o >10lb wt loss, FH

Question 5

which labs & imaging would u order

Answer 5

CBC, CMP, TSH, UA

image: Abd Xray, CT, BE, colonoscopy

Question 6

what other system would u use to diagnose constipation

Answer 6

Rome III criteria (sx >3-6 months)

Question 7

what are the RF’s for fecal impaction

Answer 7

opiods, psychiatric distress, prolonged bed rest, neurogenic d/o (MS, Parkinson’s)

Question 8

sx of fecal impaction

Answer 8

abd pain/distension, N/V, anorexia, **Paradoxical diarrhea

Question 9

As opposed to internal hemorrhoids, how will ur DRE exam differ for fecal impaction

Answer 9

feces will be palpable

Question 10

u hear a high pitched tinkling bowel sound (Borborygmus) and think

Answer 10

bowel obstruction

Question 11

causes of bowel obstructions

Answer 11

75% post-op adhesions/hernias, prior radiation

Question 12

what labs would u order for bowel obstruction

Answer 12

CBC, CMP, Abd. xray shows dilated bowel loops w air-fluid levels, CT

Question 13

a pt present with sx like bowel obstruction but no imaging suggests it…

Answer 13

pseudo-obstruction (no mechanical cause-Ogilvie’s syndrome)

Question 14

a toxic megacolon would present with thse sx

Answer 14

bloody diarrhea, abd pain, & fever…