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Clin Med II - GI > Constipation, SBO, Toxic Megacolon Geralds > Flashcards

Constipation, SBO, Toxic Megacolon Geralds Flashcards

1
Q

Definition of constipation

A

A group of syndromes w/similar findings that include:

  • Unsatisfactory defecation (infrequent stools)
  • Difficult stool passage
  • OR both
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2
Q

What are characteristics of constipation?

A
  • Less than 3 BMs per week
  • Hard stools
  • Excessive straining
  • Prolonged time spent on commode
  • Sense of incomplete evacuation of stool
  • Abdominal discomfort or bloating
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3
Q

Epidemiology of constipation

A
  • More in children, elderly
  • Females 2:1
  • Nonwhites
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4
Q

Primary etiologies of constipation

A
  • Slow colonic transit times (normal is 35 hrs, slow is 72+ hrs)
  • Pelvic floor/anal sphincter dysfunction
  • Functional (normal transit time and sphincter function yet problems w/bloating, hard stools, pain)
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5
Q

Secondary etiologies of constipation

A
  • IBS
  • Endocrine
  • Metabolic
  • Mechanical
  • Pregnancy
  • Meds
  • Neuro disorders
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6
Q

Meds that can cause constipation

A
  • Anticholinergics (antidepressants, narcotics, antipsychotics)
  • Antacids
  • CCBs
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7
Q

Pathophys of fecal production

A
  • Food in stomach
  • Ileocecal valve relaxes
  • Chyme enters colon
  • Peristalsis moves chyme through colon
  • Na is absorbed from chyme in exchange for K and bicarb
  • Water follows
  • Chyme is converted into feces
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8
Q

Meals reach colon in:

A

4 hrs

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9
Q

Meals reach pelvic colon in:

A

8 hrs

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10
Q

What initiates the defecation reflex?

A

Rectal distension

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11
Q

Risks of constipation

A
  • Age, disability
  • Dehydration
  • Hypothyroid
  • Hypokalemia
  • Hypercalcemia
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12
Q

What are red flags of constipation that you should look out for?

A
  • New onset over 50
  • Hematochezia/melena
  • Unintentional wt loss
  • Night sweats, fever
  • Anemia
  • Neuro defects
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13
Q

How is constipation diagnosed?

A

ROME III Criteria (at least 2 for 12 wks in the past 6 months)

  • Less than 3 stools/wk
  • Straining at least 1/4 of time
  • Hard stools
  • Manual assist
  • Sense of incomplete evacuation
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14
Q

How do loose stools present in constipation?

A
  • RARELY seen w/o use of laxatives

- EXCEPT w/fecal impaction

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15
Q

How is stool classified?

A

Bristol Stool Chart

  • Types 1-2 hard/lumpy
  • Types 3-4 normal
  • Types 5-7 liquidy
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16
Q

How can colonic transit time be measured?

A
  • SITZMARK marker ingested
  • Plain films taken 5 days later
  • Retention 20+% is slow transit
  • Markers in distal colon/rectum suggest defecation disorder
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17
Q

What diagnostic procedures are useful in defecation problems?

A
  • Balloon expulsion
  • Defecography (proctogram) using barium paste
  • Anorectal manometry w/a rectal catheter
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18
Q

What is used to treat bloating, discomfort, straining?

A

Osmotic agents

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19
Q

What is used to treat hemorrhoids/fissures?

A

Stool softeners to make defecation easier

20
Q

Non-pharm treatment of constipation

A

If no known secondary cause, then:

  • Regular exercise
  • Increased fluid intake
  • Bowel habit training
21
Q

Pharmacologic treatment of constipation

A
  • Bulking agents
  • Stimulant laxatives
  • Enemas
22
Q

What is important to remember when using bulking agents?

A

Use adequate amount of liquids

23
Q

What agents are used for pre-procedural stool evacuation?

A
  • PEG 4

- Mag Citrate

24
Q

Major complication of constipation

A

Fecal impactions (can lead to large bowel obstruction, partial or complete)

25
Q

Treatment of fecal impaction

A

Manual disimpaction

26
Q

Define acute paralytic ileus

A

Neuro failure or loss of peristalsis in the intestine

*Not a true obstruction

27
Q

What bowel obstruction is common in hospitalized pts?

A

Acute paralytic ileus

28
Q

Causes of acute paralytic ileus

A
  • Intra abdominal process (surgery, peritonitis)
  • Severe illness (PNA, electrolytes abnormality)
  • Meds (opioids, anticholinergic, phenothiazines)
29
Q

What order does GI motility normalize post-op and when?

A
  • Small bowel (hours)
  • Stomach (24-48 hrs)
  • Colon (48-72 hrs)
30
Q

Post op paralytic ileus risk is reduced by:

A
  • Use of pt controlled anesthesia
  • Avoidance of IV opioids
  • Early ambulation
  • Gum chewing
  • Clear liquid diet
31
Q

Pain with a paralytic ileus may indicate:

A

Small bowel mechanical obstruction (may present as ileus first)

32
Q

Treatment of paralytic ileus

A
  • Restrict oral intake
  • NG tubes to LWS if N/V from ileus refractory
  • IV fluids/parenteral nutrition
  • Meds to reverse mu-opioid receptor antagonist
33
Q

What is Ogilvie syndrome?

A
  • Complication of paralytic ileus
  • Colonic pseudo obstruction
  • Disruption of intestinal motor function leading to massive dilation in absence of mechanical obstruction
  • NOT toxic megacolon
34
Q

What is a complication of paralytic ileus?

A

Ogilvie syndrome

35
Q

Who is affected by Ogilvie syndrome?

A
  • 60+ yo
  • Men
  • Hospitalized
  • Post op CABG/THR
  • Meds
36
Q

What must be excluded when evaluating for Ogilvie syndrome?

A

Toxic megacolon d/t C diff infection (use stool test in pts w/abdominal distension)

37
Q

Treatment of Ogilvie syndrome

A
  • Treat underlying disorder
  • Give abx if sepsis suspected
  • Conservative management for 24-48 hrs is preferred (if cecal diameter less than 12 cm)
  • Keep NPO
  • IV hydration
38
Q

What pharm treatments can be given for Ogilvie syndrome?

A
  • Neostigmine

- Antimotility agents

39
Q

Types of small bowel obstruction

A
  • Partial (low grade)

- Complete (high grade)

40
Q

Causes of small bowel obstruction

A
  • Adhesions (74% cases)
  • Malignancy
  • Hernia
  • IBD
  • Misc
41
Q

If a patient cannot pass gas, what is suspected?

A

Small bowel obstruction

42
Q

Treatment of small bowel obstruction

A
  • Surgery indicated if peritonitis, bowel ischemia

- Close monitoring

43
Q

What may be more effective for bowel decompression?

A

Transnasal ileus tube advanced endoscopically may be more effective than regular NG tube

44
Q

Define toxic megacolon

A
  • Life threatening complication of other intestinal conditions
  • Widening (dilation) of large intestine w/in 1-3 days
45
Q

Causes of toxic megacolon

A

IBD (NOT IBS)

  • Crohn’s, UC, C diff diarrhea
  • Toxic refers to inflamm/infection/acute
46
Q

Treatment of toxic megacolon

A
  • Fluids and electrolytes (not usually enough to reverse condition, used to prevent dehydration and shock)
  • Most cases need surgery

Clin Med II - GI (17 decks)

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