GI: Constipation Flashcards
Causes of constipation
OPENED IT
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Obstruction
- Mechanical- adhesions, hernia, cancer, inflammatory strictures, pelvic mass
- Pseudo-obstruction- post-op ileus
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Pain
- Anal fissure
- Proctalgia fugax
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Endocrine/Electrolytes
- Endocrine- hypothyroid, DM
- Electrolytes- hypercalcaemia, hypokalaemia, uraemia
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Neurological
- MS
- Myelopathy
- Cauda equine syndrome
- Stroke
- Parkinson’s
- Elderly
- Diet/Dehydration
- IBS
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Toxins
- Opioid
- Anti-muscarinic,
- CCBs
Other general causes:
- Pregnancy
- Reduced fibre diet
- Immobility
- Depression
What is the general definition of constipation?
Passage of =2 bowel movements/week, with a sense of straining, pain or incomplete evacuation
What might constipation + rectal bleeding indicate?
Cancer
What might constipation + distention + active bowel sounds indicate?
Stricture/obstruction
What might constipation + menorrhagia indicate?
Hypothyroidism
What would you consider asking someone who was presenting with constipation?
- Frequency/nature/constistency?
- Recent change?
- Blood/mucus?
- Diarrhoea as well as constipation?
- Digitating rectum/vagina to pass stool?
- Diet
- Drugs
What is essential to do when examining someone with constipation?
PR exam
What anorectal disease can cause constipation?
- Anal/colorectal cancer
- Fissures
- Rectal prolapse
- Proctalgia fugax
- Mucosal ulceration
- Pelvic muscle/levator ani dysfunction
What are causes of intestinal obstruction which can cause constipation?
- Colorectal cancer
- Strictures
- Pelvic mass
- Diverticulosis
- Pseudo-obstruction
What are metabolic/endocrine causes of constipation?
- Hypercalcaemia
- Hypothyroidism
- Hypokalaemia
- Porphyria
- Lead poisoning
What drugs can cause constipation?
- Opiates
- Anticholinergics
- Iron
- Antacids
- Diuretics
- CCBs
What neuromuscular problems can cause constipation?
- Spinal/nerve injury
- Systemic sclerosis
- Diabetic neuropathy
- Hirschsprung’s disease
- Chagas disease
What are general causes of constipation?
- Poor diet +/- lack of exercise
- Dehydration
- IBS
- Old age
- Post-operative pain
What investigations might you perform in someone with constipation?
None in those who are young - consider investigating if red flag symptoms:
- Bloods - FBC, ESR, U+E’s, Ca2+, TFTs
- Other - Colonoscopy + biopsy
What lifestyle advice would you give someone with constipation?
Reassurance
- Drink more
- Exercise more
- High-fibre diet