EXAM #2: CONSTIPATION Flashcards
What are the Rome III Criteria for constipation?
2+ of the following for 3 months:
1) Straining for 0.25% of defecations
2) Lumpy or hard stool in 0.25% of defecations
3) Sensation of incomplete evacuation
4) Sensation of anorectal blockage
5) Manual maneuver to help with 0.25% of defecations
6) Fewer than 3 defecations per week
7) Rare loose stools without laxatives
List the red flags relating to constipation.
- Hematochezia
- Positive occult blood
- Obstructive sx.
- Acute constipation
- Weight loss (more than 10 lbs.)
- FMHx of colon cancer
- Anemia
- Lack of response to treatment
What are important historical questions to ask adults with constipation?
1) Alternating diarrhea and constipation
2) Any neuro, GI, or endocrine diagnosis
3) Past GI surgery
4) Medications
List the key parts of the physical exam in a patient with constipation.
1) Compare weight
2) Signs of dehydration?
3) Full abdomen and rectal exam
4) Guaiac?
What labs should you consider ordering for a patient with constipation?
1) CBC
2) CMP
3) TSH (hypothyroid?)
4) Hgb A1C (DM?)
What imaging studies should you consider for a patient with constipation?
Abdominal x-ray at a minimum
What are the classes of drugs that are used to treat constipation?
1) Bulk laxatives
2) Osmotic laxatives
3) Stimulant laxatives
4) Enema/ stool softeners/ suppositories
In addition to pharmacologic therapy, what other treatment options are there for patients with constipation?
- Biofeedback
- Fecal disimpaction
What are the common drug classes that can cause constipation?
Antihistamines Antispasmodics Antidepressants Antipsychotics Iron supplements Aluminum antacids Opiates Ca++ blockers Beta blockers
What is encoporesis?
- Chronic stool withholding
- Stool finds somewhere to go i.e. there is “overflow”
Describe the bowel habits of infants less than 6 months old.
- Straining/crying is common
- This is NOT constipation
This is referred to as “infantile dyschezia”
When are most children potty trained?
4 years old
What is the most important thing to remember about potty training?
Need to praise the child and be a positive role model
What is the most common cause of constipation in children?
Function i.e. voluntary withholding
- Pain with pooping= hold it
What is the result of functional constipation?
Encopresis
What are the pathologic causes of constipation?
1) Spinal cord damage
- Spinal dysraphism i.e. malformation e.g. spina bifida
- Tumor
- Trauma
2) Endocrine
- Hypothyroid
- Hypoparathyroid
3) Hirschsprung
4) Meconium Ileus/ Cystic Fibrosis
When should a child have their first poop?
Within 24 to 48 hours of life
What are you worried about if a neonate does not have a BM within 48 hours of life?
Hirchsprung’s Disease
Meconium Ileus
What is Meconium Ileus?
Delayed passage of meconium in children with CF
- One of the first manifestations of CF
What is a common cause of constipation in older children?
Sexual or rectal abuse
What are the red flags of constipation in children?
1) No BM within 24-48 hours of birth
2) Vomiting + constipation
3) Abnormal neuromotor development
4) Abnormal growth
5) PE not consistent with functional constipation
What are the three phases of medical management in functional constipation?
1) Disimpaction/ evacuation
2) Sustained evacuation
3) Weaning from intervention
How is disimpaction accomplished in children?
- Enemas
- Oral meds e.g. mineral oil or milk of magnesia
What children cannot take mineral oil?
Kids less than 1 year–risk of aspiration
How is sustained evacuation of stool maintained?
Stool softeners for 3-9 months
What is weaning in the treatment of functional constipation?
Gradually taking a child off oral laxatives
**Child should be off meds by roughly 1 year
What are the two phases of nutritional management in functional constipation?
1) Initially avoid dairy and starch
2) Once tone has been restored, then start additional fiber
Don’t start additional fiber initially*
How is milk of magnesia dosed?
- 1 ounce per year of age
- Take for 3-5 days
Max 240mL/day
