W4L2 Consipation

Question 1

Def

Answer 1

Frequency normal bowel movements is broad range from 3/d-3/w

Question 2

Rome III criteria: 2 of the below defines constipation

Answer 2

1. Straining
2. Lumpy Hard Stool
3. Incomplete Evacuation
4. Use Digital Maneuvers=digitation rectum &/ vagina(aid evacuation)
5. Sensation of Anorectal Blockage
6. <3 Bowel Movements /w

Question 3

Causes of constipation

Answer 3

1. Poor diet & behavioral habits(MC):
   - Low-fiber diet - Dec intake fluid
   - Lack exercise - Ignoring urge
   - Change routine (travel)
2. Structural abn
   - Anal fissure -Cancer colon
   - Colonic stricture -Hirschsprung’s dis
   - Idiopathic megacolon
3. Systemic disease
   - Endocrine: hypothyroidism, DM
   - Metabolic: hypokalemia, hypercalcemia
   - Neurologic: paraplegia, parkinson’s
   - Others: amyloidosis, scleroderma
4. Medication
   - Narcotic -Diuretic -CCB
   - Fe & Ca supplement -AlOH(antacid)

Question 4

Refractory constipation

Answer 4

Pt wo identifiable coz & xrespond conservative dietary management

Question 5

2 categories refractory consti

Answer 5

1. Colonic inertia(>72H, N=35H)
   • CAUSES:
   -Idiopathic -Psychogenic
   -Chr intestinal pseudo-obs
2. Outlet disorder
   - Rectocele -Perianal descent
   - Rectal intussusception -Anismus
   - Rectal prolapse -Solitary rectal ulcer syn

Question 6

APPROACH TO A PATIENT WITH CONSTIPATION

Answer 6

1. Careful history:
2. Symptom:
   - painful bowel movements
   - bloated -uncomfortable
3. Phy exam(PR)

Question 7

Investigation

Answer 7

1. Stool test(occult bl)
2. CBC, Ca, K, TSH, gluc
3. Barium enema
4. Colonoscopy/flexible sigmoidoscopy
5. Measurement colonic transit time
6. Defecography
7. Anorectal manometry

Question 8

DIET & LIFESTYLE ADVICE

Answer 8

1. Proper dietary fluid & fiber intake
   - Apple/banana/d -7-8 glass water
   - xrefine food -whole grain & nut
   - high protein w water -xmeat
2. Become phy active
   - Daily morning & evening walk(20-30m)

Question 9

Drugs

Answer 9

1. Osmotic laxative(stool softners):
   - lactulose, sorbitol, MgOH
2. Cathartic(stimulant)laxative:
   - cascara, bisacodyl, castor oil, senna
3. Enemas:
   - bysaline(non-irritate), tapwater(irritate), oil retention(hard stool) enema