Diarrhea and Constipation Flashcards
What is the definition of constipation?
2
- Passage of stool infrequently or with difficulty.
2. Stool frequency of less than three per week.
Characteristics passing the stool in constipation?
3
- Straining
- Hard Stool
- Incomplete evacuation
- What is the most common etiology of constipation?
2. What leads to this? 3
- Lifestyle
- Inadequate fiber in diet
- Inadequate hydration
- Inactivity
Fiber promotes what?
3
- normal transit time,
- frequent stools,
- lower use of laxatives.
Medications that cause constipation?
9
- Opiates/narcotics
- Antidepressants
- Calcium channel blockers
- Antipsychotic
- Antiparkinsonian agents
- Anticholinergics
- Calcium, iron supplements
- Antispasmodics
- Antacids (calcium and aluminum)
Structural Abnormalities that could lead to constipation
5
- Carcinoma
- Ischemia
- Volvulus
- Megacolon
- Anorectal disorders
Anorectal disorders that lead to consitpation? 3
- Prolapse
- Rectocele
- Pelvic floor dysfunction
Metabolic causes of constipation?
7
- Hypokalemia
- Hypomagnesemia
- Hypothyroidism**
- Hyperparathyroidism
- Porphyria genetic hemoglobin disorder
- Addison’s disease
- Hypercalcemia
Neurologic causes of constipation?
7
- Parkinson’s
- Multiple Sclerosis
- Automonic neuropathy
- Hirschprung disease
- Chagas disease
- Spinal cord lesions
- Cerebrovascular disease
Systemic causes of constipation? 4
- Amyloidosis
- Scleroderma
- Polymyositis
- Pregnancy
Surgical causes of constipation? 4
Psychiatric causes of constipation? 2
Surgical
- Abdominal
- Pelvic
- Colonic
- Anorectal
Psychiatric:
- Depression
- Eating disorders
Examination of constipation?
3
- Full history
- Full physical exam
- DRE - Stool for occult blood
In patients less than 50y/o with no alarm symptoms, may start what?
empiric therapy
Further treatment should be performed on patients with any of the following:
6
- Over age 50
- Severe constipation
- Signs of an organic disorder
- Hematochezia
- Weight loss
- Positive FOBT
Consitipation evaluation?
4
- KUB (abdominal xray),
- Barium enema or
- colonoscopy
- Blood Tests
- Colonic Transit Study
What blood tests would you do to work up constipation?
6
- Glucose
- CBC –anemia detect colorectal neoplasm
- Thyroid***
- Calcium
- Magnesium
- Phosphorous
Colonic transit study is used for what?
To observe transit time in patients with refractory constipation not responding to conservative measures.
Management first and foremost for constipation is what?
prevention
Patient education for constipation
3
- Exercise:
key stimulus to colon peristalsis and defecation encourage and enable patient to be mobile, or be in upright position. - Fluid intake:
constipated stools are low in water content. - Fiber intake:
acute constipation low on fiber diet, chronic constipation responds poorly to fiber.
Treatment types of constipation?
4
- Stool softeners (surfactants)
- Laxatives
- Opiod-receptor antagonists
- Digitial disimpaction
What are the types of laxatives? 3
- Bulk
- Osmotic
- Stimulant laxatives
What are the stool softener medications?2
- Colace (docusate sodium)
2. Docusate calcium
What are the drugs in the following categories:
- Bulk 4
- Osmotic 5
- Stimulant laxatives 2
- Opioid-receptor antagonist 1
- Bulk laxatives
- Psyllium
- Methylcellulose
- Fibercon (polycarbophil)
- Benefiber (wheat dextran) - Osmotics
- Lactulose
- Sorbitol
- Polyethylene glycol
- Magnesium Citrate
- Magnesium Sulfate (caution in renal impairment) - Stimulant laxatives
- Bisacodyl
- Senna - Methylnaltrexone
Opioid-receptor antagonist
(Methylnaltrexone) is approved for who?
2
What does it not affect?
Approved for
- palliative care pts,
- pts on chronic opiod tx,
doesn’t effect central analgesia