Constipation (oxford clin cases) Flashcards

1
Q

What are some pathophysiological reasons someone might be constipated?

A

Lack of peristalsis
Hard stools
Patient unable to push stool
Bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some differentials that you may have in mind when a patient presents with constipation?

A
IBS
Carcinoma 
Low fibre diet 
Dehydration
Secondary to drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What types of drugs are commonly known to cause constipation?

A
CCBs
Opiates
Iron supplements
Trycyclic antidepressants 
Anticholinergics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common cause of constipation in a hospital setting?

A

Patients being embarrassed to defecate eg because they are in earshot of others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common cause of constipation in a GP setting?

A

Lack of dietary fibre or dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some red flags when someone has constipation?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is absolute constipation?

A

When the patient is not passing any faeces or flatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does absolute constipation suggest is the diagnosis?

A

Small bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does hard/lumpy stool suggest is the cause of constipation?

A

Lack of dietary fibre or dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does chronic constipation suggest?

A

A benign cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does diarrhoea alongside constipation suggest is the diagnosis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What diagnosis does mucoid diarrhoea alert you to?

A

Possible colorectal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does tenesmus alongside constipation suggest?

A

Mass in the rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What diagnoses does blood in the faeces or on wiping suggest?

A

Anal fissure
Haemorrhoids
Diverticular disease
Colorectal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What diagnosis does feeling cold, tired and weight gain alongside constipation suggest?

A

Hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does polyuria and thirst alongside constipation suggest is the diagnosis?

A

Hypercalcaemia

17
Q

What are some signs of hypothyroidism you should look for when examining someone with constipation?

A
Loss of hair- especially outer 1/3rd of eyebrows 
Brittle hair
Dry skin
Puffy eyes
Malar flush
18
Q

What might you look for on examination if someone has constipation and why?

A

Abdominal masses- could be carcinoma or impacted faeces
Virchows node- suggest GI malignancy
Anal tone- if lax could be neurological pathology
Abdominal distention- bloating due to IBS
Anal fissure or haemorrhoids
Mass on DRE- colon/rectal cancer

19
Q

What electrolyte imbalances will cause constipation?

A

Hypercalcaemia

Hypokalemia

20
Q

What investigations might you do if someone presents with constipation?

A

FBC- masses may bleed and cause anaemia
U+Es- look for hypercalcaemia or hypokalemia
Thyroid function tests- to rule out hypothyroidism
Colon cancer markers
Faecal occult blood test

21
Q

What imaging should always be done if someone has iron deficiency anaemia and why?

A

OGD- to rule out an upper GI bleed as the cause

22
Q

Up to where is visualised via OGD?

A

The duodenum

23
Q

What imagine is done for someone after they have been diagnosed with colorectal cancer and why?

A

PET-CT to see how far it has spread

Also could do an chest, abdomen and pelvis CT

24
Q

What lifestyle changes would you suggest to a patient with constipation caused by low fibre, dehydration and an immobile lifestyle?

A

Increase dietary fibre by eating more fruits and veg, high fibre cereal, wholemeal bread etc

Try to exercise more eg a brisk 30 min walk everyday

Increase fluid intake

25
Q

What medications can be given for constipation and how do they work?

A

Osmotic laxatives
Stool softners
Peristalsis stimulants

26
Q

What is the mechanism of action of osmotic laxatives?

A

They help retain water in the gut

27
Q

What are some commonly used osmotic laxatives?

A

Macrogol
Lactulose
Magnesium salts

28
Q

What is the most common cause of hypothyroidism in young women?

A

Hashimoto’s thyroiditis

29
Q

What are some features of hypothyroidism?

A
Tiredness
Carpal tunnel syndrome
Constipation
Cold intolerance
Weight gain 
Heavy periods
30
Q

What are the symptoms of hypercalcaemia and how do you remember them?

A

Stones, moans, bones and abdominal groans= kidney stones, depression/low mood, aches and pains abdominal pain

31
Q

What are some causes of hypercalcaemia?

A

Vitamin D overdose
Bone metastases
Hyperparathyroidism

32
Q

What might you advise a patient if they tell you they have a family hx of colorectal cancer and want to know how they can reduce their risk of developing it?

A

Have a good diet- high in fibre
Stop smoking if they do
Exercise adequately and maintain a healthy weight
High dose aspirin has also been found to reduce the risk of colorectal cancer however moderate dose will not make a difference

33
Q

What scoring system can be used to stage colorectal cancer?

A

Duke’s criteria