History + Exam Flashcards
Constipation?
Passing stool infrequently or with difficulty, be clear on frequency, ease of passage, volume.
Normal defecation requires?
bowel peristalsis, soft faeces, no obstruction and ability to push.
Constipation common diagnoses?
Constipation red flags (9)?
Severe persistent and unresponsive constipation,
absolute (no stool or flatus), rectal bleeding, tenesmus, or intermittent mucoid diarrhoea, significant weight loss, iron deficiency anaemia and night sweats, PMH or UC or colonic polyps, fam hist of colon cancer.
Constipation + weight loss, night sweats, fever?
malignancy
Constipation + diarrhoea?
intermittent diarrhoea/constipation in young is IBS, colorectal cancer in >45 and diverticular disease in >65.
Constipation + tenesmus?
suggests a persistent mass in rectum.
Constipation + blood (4)?
haemorrhoids, anal fissure, diverticular disease, colorectal cancer
Constipation + bloating?
feature of IBS.
Constipation + feeling cold, reduced appetite, gainign weight?
hypothyroidism
Constipation + bone pains?
bone metastases, can lead to hypercalcaemia which can cause constipation.
Constipation + polyuria, thirst?
hypercalcaemia
Constipation risk factors family hist of?
colorectal cancer, FAP, HNPCC
Constipation risk factors medications?
opiates, anticholinergics, tricyclic antidepressants, calcium channel blockers, iron supplements.
Constipation risk factors diet?
fibre rich and hydrated? Ask about colour of urine.
Abdo exam what are the signs of hypothyroidism?
loss of hair (outer third of eyebrows), brittle skin, dry hair, puffy eyes, malar flush.
