Constipation (oxford clin cases) Flashcards
What are some pathophysiological reasons someone might be constipated?
Lack of peristalsis
Hard stools
Patient unable to push stool
Bowel obstruction
What are some differentials that you may have in mind when a patient presents with constipation?
IBS Carcinoma Low fibre diet Dehydration Secondary to drugs
What types of drugs are commonly known to cause constipation?
CCBs Opiates Iron supplements Trycyclic antidepressants Anticholinergics
What is the most common cause of constipation in a hospital setting?
Patients being embarrassed to defecate eg because they are in earshot of others
What is the most common cause of constipation in a GP setting?
Lack of dietary fibre or dehydration
What are some red flags when someone has constipation?
Blood in the stool
Intermittent mucoid diarrhoea
Persistent constipation
Absolute constipation
Previous hx of colonic polyps or colon cancer
Family hx of colonic polyps or colon cancer (especially if they were under 60)
Significant weight loss, anaemia (fatigue) or night sweats
What is absolute constipation?
When the patient is not passing any faeces or flatus
What does absolute constipation suggest is the diagnosis?
Small bowel obstruction
What does hard/lumpy stool suggest is the cause of constipation?
Lack of dietary fibre or dehydration
What does chronic constipation suggest?
A benign cause
What does diarrhoea alongside constipation suggest is the diagnosis?
IBS- especially if the patient is young
Diverticular disease- especially if the patient is old and has left iliac fossa pain
Colorectal cancer- especially if the diarrhoea is mucoid
What diagnosis does mucoid diarrhoea alert you to?
Possible colorectal cancer
What does tenesmus alongside constipation suggest?
Mass in the rectum
What diagnoses does blood in the faeces or on wiping suggest?
Anal fissure
Haemorrhoids
Diverticular disease
Colorectal cancer
What diagnosis does feeling cold, tired and weight gain alongside constipation suggest?
Hypothyroidism