Lower GI Flashcards
1
Q
Contipation: Definition
A
- Abnormally slow movement of feces through colon (Note: What’s normal?)
- Usually hard, dry feces in descending colon
- Infrequent or difficult evacuation
- Sense of incomplete evacuation
2
Q
Constipation: LIfestyle Causes
A
- Put off urge
- Inactivity
- low fiber diet
- Low CHO diet
- inadequate fluid intake
- Cheese
- Post-op (fear of straining)
- Etc.
3
Q
Constipation: Medication Causes
A
- Opioids
- Al+ and Ca++ antacids
- Anticholinergics
- Anticholinergic actions:
- Antidepressants
- Antihistamines
- Antihypertensives
- Antipsychotics
- Bismuth salts
- Diuretics
- Iron salts
- Chronic irritant laxatives
- CCB’s (calcium channel blockers)
- Sulcralfate
Note that these are used in old people
4
Q
Constipation: Medical Conditions
A
- GI cancers
- DM (autonomic neuropathy)
- nerve damage in gut
- Age (decreased neuro. stim)
- Diverticular Dz
- pockets in gut
- Rectal stenosis, fissures, Hroids, etc.
- Stroke
- Adhesions
- Strictures
- Hernia
- Hypothyroid
- IBS (spastic colon)
- MS, PD (parkinsons)
- Pg
- E-lyte disturbances
5
Q
Constipation: Symptoms
A
- Dull headache
- Loss of appetite
- Lack of energy
- Feeling of fatigue
- Abdominal distension
- Bloating
- Lower abdominal discomfort or pain
- Lower back pain
6
Q
Constipation: The Essential Triad
A
- Bulk, Water, Exercise
7
Q
Constipation: When to Refer
A
- blood in feces
- cancer
- nausea, vomiting
- obstruction
- acute abdominal pain
- fever
- 7-10 days duration
- unresponsive to adequate laxative Rx
- quadriplegia, paraplegia
- impaction risk
- Anorexia history
8
Q
Constipation: Non-Drug
A
- Alterations in diet (fiber, bulk)
- Increased fluid
- Exercise
- Stress management
- Avoidance of constipating drugs
9
Q
Constipation: Pharmacological
A
- Bulk Laxatives (12-72 hours)
- Metamucil, Citrucel, Fibercon
- Work by hanging onto water so that water won’t be suck out by colon
- Stool stays softer
- Safe and natural
- Not acute, more of preventative agent
- Have sugar, so be careful if diabetic
- Need enough water
- •Stimulant laxatives (6-12 hours)
- Ex-Lax, phenophaline
- Irritant causes colon to contract
- Senna, bisacodol (ducalax)
- Enteric coated, can’t be ground up
- Saline laxative (30min-3 hours)
- Sodium enema
- Magnesium citrate, milk of magnesia
- Can change electrolyte balance
- Careful for renal patients, congestive heart failure
- Lubricant laxative (24-72 hr)
- Mineral oil
- Lubricates the hard stool to slide out
- Not good for chronic use: seepage, if lay down can get into lungs, can waste fat soluble vitamins
- Surfactants (6-8 hrs)
- Docusate
- Not very effective by self (usually paired with stimulant)
- Decrease water tension, supposedly let water into stool
- 250 mg at LEAST, need quite a bit to be effect
- Turn colon into secreting organ
- Used prophylactically
- Hyperosmotic (15min-1 hour)
- Glycerin (children), lactulose (chronic-lac), sorbitol, Miralax (PEG)
- 17g mix with water
10
Q
Bulk Laxatives
A
- Polycarbophil (Konsyl Fiber)
- Psyllium (Metamucil, others)
- Methylcellulose (Citrucel, Maltsupex)
- Good initial choice: “approximate normal”
- Nonabsorbable; expand and take up water; stimulate distension reflex and intestinal motility
- Also for IBS diarrhea
- Contraindicated: intestinal stenosis, adhesions
- Careful:
- Esophageal/intestinal obstruction (review mixing/dilution instructions)
- Diabetes: sugar
- ADR:
- Flatulance, borborygmi (rumbly tummy)
- Flatulance, borborygmi (rumbly tummy)
11
Q
Stimulant Laxatives
A
- Not first choice (except opiod)
- cascara sagrada
- •senna, sennasides (Senokot, Ex-Lax)
- •Castor oil (Purge, Neoloid)
- •bisacodyl (Dulcolax, Correctol)
- •Phenolphthalein – tumors, genetic damage – gone
- local irritation of intestinal tract, increase peristalsis, increase fluid secretion
- Warnings:
- Casual use discouraged
- Overuse/abuse: damages physiologic neurologic colon function – “cathartic colon”
- melanosis coli: benign (stains colon)
- Urine discoloration: senna
- Bisacodyl: enteric coated (uncoated induces gastritis - don’t break, crush, etc,)
12
Q
Saline Laxative
A
- Phillips Milk of Magnesia
- Fleet Phospho-Soda
- Magnesium Citrate
- High concentration of electrolytes - hypertonic state - osmotic gradient - draws water into colon - increased colonic pressure - stimulates movement
- Single dose or short term use
- Warnings:
- CHF, HTN (Na+)
- Renal Failure (Mg+)
13
Q
Surfactant Laxatives
A
- “emoliants”
- Docusate (Colace, Surfak)
- Mild - increase fluid secretion, “wetting” agents; lowers surface tension, allowing water into fecal mass.
- Prevention rather than treatment
- 100 mg =placebo; use 250 mg dosage
14
Q
Lubricant Laxatives
A
- Mineral oil
- Oil - lubricates colon, rectum, anal canal allowing easier passage of hard stool.
- Limited utility - one time use
- Warnings: seepage, fat-soluable vitamin malabsorption
- only time to use is impaction
15
Q
Hyperosmotic Laxatives
A
- Glycerin
- Short term, episodic use; pediatrics
- Suppositories (Fleet Babylax, Sani-Supp)
- Sorbitol, lactulose
- Polyethylene glycol (PEG) +/- E-lytes
