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130: Professional Practice 2 > W10. Consitpation > Flashcards

W10. Consitpation Flashcards

1
Q

What is constipation

A

*must include 2 symptoms at 25% of defecation

straining

lumpy or hard stools

sensation of incomplete evacuation

sesation of anorectal obstruction/blockage

  • <3 movements/week
  • manual maneuvers to facilitate defication
  • loose stores rate

*DISCOMFORT NOT PAIN

*IBS is not part of this, usually includes pain of defication

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2
Q

Bristol Stool chart

A

should present type 3-5

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3
Q

two maint ypes of contstipation

A
  • Primary, functional or idopathic constipation
    • idopathic = unknown
    • linked to GI motor disorders
    • normally see normal transit constipation: colonic nolility is unaltered or normal, but the stool is very hard and diff to pass
      • patient exp bloating, discomfort and difficulty passing
      • they respond best
      • 60% of cases
    • Other grup is slow retention constipation
      • leads to fecal retention, stool forms hard mass and leakage around stool plug. common in children
  • Secondary constipation
    • disease or mediaction linked
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4
Q

what are the GI motor disorders that cause constipation

A

*dont respnond well to laxatives

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5
Q

what diseases are associated with seocndary constipation

A
  • as age becomes more prevelant
  • but when suffer from dementia risk doubles
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6
Q

causes of constipation in cnacer patients

A
  • 50% of cancer patients

usual mechs: Tumor compression of the large intestine, i nterference with colonic neural innervation

  • also caused by

¨Hypercalcemia secondary to bone metastases

¨Hormonal changes

¨Chemotherapy, either directly or indirectly due to poor hydration and nutritional status resulting from nausea and vomiting

¨Direct intestinal radiation

¨Opioid use

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7
Q

constipation and fatigue

A
  • linked to prolonged fatigure states

so inc prevelance in mental health states like

depression, anxiety, chronic fatigue syndrome, fibromyalgia, IBS

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8
Q

drugs related causes for constipation

A

anticholinergics

opiod: gut paralysis
diuretics: cause dehydration

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9
Q

red falgs for constipation

A
  • unintented weight oss > 10 lbs

onset of symptoms >50

family history of colrectal cancer or IBS
N/V/adbonimal pain, fever, balck tar stools (melina)

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10
Q

Precipitating factors

quality

region

symp associated

time

to ask a patient with constipation

A
  • P
    • Any recent changes in her medications?
    • ​What are her eating and exercise patterns?
    • What has she tried for the constipation?
  • Q:
    • Consistency of BM?
    • Ability to pass?
    • Frequency of BM
  • R
    • Is there bloating, gas, or tenderness in abdominal area
  • S
    • Is there any black tarry stool or blood in the stool?
    • Any pain when defecating?
  • T
    • Time since last BM?
    • How long has this been occurring?
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11
Q

Patient analysis for constipation

A
  • Is the client suffering from primary or secondary constipation?
  • Are the signs and symptoms related to disease or drug? Or both?
  • Does she require drug treatment? (think of req, bloating, faltulance, discomfort)
  • Is current therapy effective?
  • What would happen if not treated?

*constiaption is hgihger incidence in women, diruetic is common secondary cause of cosntipation

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12
Q

cycle of chornic constipation

A
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13
Q

How do lifestylefactors are linekd to consstipation

A
  • supressing of urge to deficate

inadequate fluid and fiber intake

chronic anxiety

acute eemotional distress

infrequent physical excercise

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14
Q

non pharm methods for prevention

A

min vol 1.5L water to prev constipation *main method

  • fiber, toilet routine, bowel retaining, excercise
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15
Q

how much fiber is req for each age group

A

adult female need 25g fiber, male 30g

pregnant 28g

breastfeeding 29g

*aim for 12-15% fiber on nutritional face label

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16
Q

diff types of fiber

A

soluble fiber: gel like and soften stool: lentils, peas, oats, barely

insoluble: adds bulk helps to pass, green veg and strigny veg
- lots of fruits have sortibol which is also fiber source

want 3 insoluble:1 isoluble

17
Q

pre/probiotics and constiation

A

5 pro/pre biotics with level 1 evidence

  • activia good option

BioGaia, Visbiome also good options

18
Q

what are the 5 classes of laxatives on market

A

bulk forming agents

osmotic agents

stool softeners

saline laxatives

stimulant laxatives

19
Q

bulkf forming agents

A

insoluble fibers that inv voluem of stool in intestinal llumen

act like sponges and abs volume in intestinal tract to help soften stool

due to water retention is it V important to keep drinkign 1.5L of water, if not can act like cement and worsen constipation

  • type main ingredients: Psyllium (laxa day) and Inulin(Canada)/ Wheat dextran(US) aka (metamucil),

*metamucil is very gritty, adherence is low, not aial in capsule and wafer form (not gluten free!!!)

20
Q

Psyllium concern

A

18% of aptients exposed in HC setting notted to have an allergic anaphylactic rxn: asthma attack or other allergic reaction

  • do not inhale the powder form
21
Q

what line are bulk forming

what are contraindiactions

A

1st line

constaindicatin: gastic obstruction, fecel impaction, swallowing difficulties

*woudl make fecal impaction must worse

*if patient not passing gas and no bowel movement in 4-5 days dont use this as the first agent, can maybe add on for maintenance later on

22
Q

osmotic agents for constipation

A

unqiue mechanism

  • non abs ions or mol that are broken down by gut flora
  • acidifies the intestinal lumen and then creates and osmotic gradient where water is drawn from body into intestinal lumen, this softens stools
  • only laxative family with grade A evidence to inc stool freq and consistenct
  • PEG is the first line agents for pediatricts
    ex: glycerin suppository (fast acting), lactulose, sorbitol 70%, PEG (restoralax, miralax, Lax a day)

*glycerin is good for fast res (acute cases), the others better for maintenance *only targets last bit of digestive tract

23
Q

best for fast acting product

A

glycerin suppository

24
Q

Lactulose and diabetes

A
  • sweet but not abs systemically so will not alter their sugar

can recommmend safely

25
Q

AE of osmotic agents

A

can cause diarrhea, so start low and go slow

26
Q

smotic agent of choice for constipation

A

PEG

onset of action for 3 days

best for kids too

avoid high doses in children

27
Q

Purgative agents for constiaption

A

PEG with electrolytes

  • shoudl eb supervised by HC provider or caregiver
  • much higher dse, use for impacted bowl
28
Q

stool softeners for constipation

A

act is surfactats and softed stool acting as surfactants

*no RCT

  • not actually efficacious, not better than placebo
  • ex: docusate sodium and calcium,
  • Ex: lubricants: mineral oil (oral and enema form) -> AVOID IN CHILDREN AND ELDERLY bc large risk of aspiration
  • patients feel like they work because they have been on forever
  • dont recommend ever!
  • some very small evidence for use postpartum to prevent hemrhoids
29
Q

saline laxative

A

create osmotic gradient through electrolyte imablance

  • faster acting
    oral: Mg hydroxide, Mg citrate, sodial phosphate oral, milk of magnesium
    enemas: tap water, soap suds, mg enema, phosphate soda, saline enema, mineral oil (used for release of impaction lower in intestinal tract, or before a scope)

*dont use tap water or soap suds anymore bc of irritation

  • mechanism is also downfall,

*only consider for young health patients that need fast relief for short term (enema works in 5-10 min, be near a toilet, and go at first sense of urgency)

30
Q

who should not take saline laxatives

A

elderly, CHF, renal failure and young

31
Q

when shoudl enemas be used

A

only pre scope

or is prescribed by a health care provide due to impaction

32
Q

Stimulant laxatives

A
  • produce rhythmic contractions in the intestines
  • senna, bisacodyl, cascara castor
  • use in case of slow transit bowel to enhance paristallisis and with opiod usage to prevent constipation
  • can cause lazy bowel and dependency with overusage

Myth: melanosis Coli has not been shown to be statistically significant

Ex-lax Anthraquinone has been removed from products so not longer a risk

33
Q

homeopathic/herbal ageents

A
  • no randomized control trails and little evidence to suport
  • aloes, bitter orange, buckthorn, dandelion, elderberry, flaxseed, lavender, licorish, rhibarb, soy
  • flexseed is a soluble fiber that is an effective laxative
  • yellow dock is an effective laxative but its safety has not been detinitvely established
34
Q

what are the goals of therapy

A

requirements:

  • Eliminate impaction
  • Improve stool consistency
  • Return frequency to normal or minimum >3/ week.
  • Reduce bloating or discomfort
  • Improve quality of life, behavioral modification
  • Avoid complications of constipation
  • Use laxatives appropriately for prevention

*minimize use of ineffective treatment, minimzie cost, maximize quality of life, increase patient satisfaction of patient, empowerment, self confidence

130: Professional Practice 2 (30 decks)

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