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
