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209 Constipation and IBS > Medical Management of Constipation > Flashcards

Medical Management of Constipation Flashcards

1
Q

What is functional (primary) constipation?

A

Chronic constipation without a known cause

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2
Q

What is organic (secondary) constipation?

A

Constipation caused by drugs or disease

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3
Q

What is faecal loading/impaction?

A

Retention to the extent that spontaneous evacuation is unlikely

Retention faeces are palpable on abdominal examination, PR or around anus

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4
Q

How many bowel movements/week is part of the constipation criteria?

A

< 3x /week

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5
Q

How would you differentiate between IBS constipation and chronic constipation?

A

Chronic constipation - not much pain

IBS - associated with pain

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6
Q

What is the IBS criteria?

A

12 weeks in the past 12 months of abdo pain/discomfort + 2 of:

relief by defaecation

change in stool frequency

change in stool form

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7
Q

Give 3 examples of bulk forming laxatives

How do they work?

A

Ispaghula Husk

Methylcellulose

Sterculia

Retain fluid in stool, stimulate perstalsis

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8
Q

Name two osmotic laxatives.

And how do they work?

A

Lactulose, Macrogol

Increase fluid in large bowel → distention → peristalsis

Stool soften. Lactulose → farting.

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9
Q

Name stimulant laxatives that work on colonic nerves and rectal nerves.

A

Senna → Colonic nerves

Bisacodyl, Sodium picosulphate → Rectal nerves

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10
Q

Name two surface wetting agents.

A

Docusate, Poloxamer.

Reduce surface tension of stool - allow water to penetrate and soften it.

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11
Q

What is the order of oral laxative choices?

A

Bulk → Osmotic → Stimulant

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12
Q

Why are anticholinergic drugs given with caution for pain management in constipation?

A

Smooth muscle relaxant → aggrevate constipation

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13
Q

What are the role of antidepressants in pain management of constipation and diarrhoea?

A

Constipation dominant → use SSRI - less anticholinergics

Diarrhoea dominant → use TCAs - more anticholinergics

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14
Q

How can dietary management help with constipation?

A

Fluid intake >1.5L/day

Diuretics (tea, coffee, alcohol) - counter productive

Carbs (FODMAP) and sugar alcohols malabsorbed → ferment in colon → bloating and discomfort

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15
Q

How does the probiotic bifidobacterium help with IBS?

A

Change in cytokine profile → less pain and bloating

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209 Constipation and IBS (4 decks)

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