S09C77 - Acute and Chronic Constipation

Question 1

Constipation: Rome criteria

Answer 1

• 2 or more of:
• straining at least 25% of time
• hard stools 25% of time
• incomplete evacuation 25% of time
• less than 3 BM/wk
• chronic constipation includes Sx for at least 12w (consecutive or not) in preceding year

Question 2

Constipation causes: acute

Answer 2

• GI: tumor, stricture, hernia, adhesions, inflammatory conditions, volvulus
• Rx: narcotics, antipsychotics, anticholinergics, antacid, antihistamine
• sedentary
• low fiber
• painful anal pathology

Question 3

Constipation causes: chronic

Answer 3

GI: tumor, colonic dysmotility, chronic anal pathology
Rx: chronic laxative abuse, narcotics, antipsychotics, anticholinergics, antacid, antihistamine
Neurologic: neuropathies, parkinson dz, cerebral palsy, paraplegia
Endocrine: hypothyroidsm, hyperparathyroidism, diabetes
Lyte abn: hypomagnesia, hypercalcemia, hypokalemia
Tox: lead, iron

Question 4

Constipation: red flags

Answer 4

• rapid onset
• n/v
• inabilitly to pass flatus
• severe abdo pain and distension
• unexplained wt loss
• rectal bleeding
• unexplained iron deficiency anemia
• FmHx CoCa

-any of these should prompt a more rigorous eval

Question 5

Constipation: investigations

Answer 5

-AXR/CT
-CBC
-lytes
-FOB
-TSH
0serum lead and iron levels for suspected heavy metal toxicity

Question 6

Constipation Tx

Answer 6

• fluid 1.5L/d

- fiber 10g/d

Question 7

Fecal Impaction

Answer 7

-always do a DRE!

Question 8

Ogilvie Syndrome (intestinal pseudo-obstruction)

Answer 8

• signs, symptoms and xr appearance of an acute large bowel obstruction with no evidence of distal colonic obstruction
• colon massively dilated >10cm
• risk of perforation, peritonitis, death

Question 9

4 things to think about in constipation before discharge

Answer 9

• possible obstructing lesion
• systemic illness
• electrolyte imabalance
• potential for intestinal perforation with self-administered enemas