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Week 209 - Constipation/IBS Flashcards

1
Q

Week 209 - Constipation/IBS: How much water on average does the colon absorb?

A

Converts 2l into 200ml

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2
Q

Week 209 - Constipation/IBS: The colon can be divided into two main parts, the proximal and distal, what is the function of each?

A
  • Proximal - absorbs fluids/electrolytes, bacterial fermentation.
  • Distal - reservoir.
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3
Q

Week 209 - Constipation/IBS: What is the normal colonic transit time?

A

25-40hrs.

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4
Q

Week 209 - Constipation/IBS: What are the two types of motility that occur in the proximal colon?

A
  • Non-propulsive segmentation - generated by slow-wave activity which produces circular muscle contraction - mixing/absorption of contents.
  • Mass peristalsis - (1-3x/day) simultaneous smooth muscle contraction propels contents.
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5
Q

Week 209 - Constipation/IBS: What are the three controlling factors of colonic motility?

A
  • Intramural plexi - directly controls contractile behaviour.
  • Extramural - modulate function.
  • Transmitters - Stimulatory - Acetycholine and substance P. Inhibitory - VIP and Nitric Oxide.
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6
Q

Week 209 - Constipation/IBS: What is the definition of constipation?

A
  • Infrequent passage of small amount of faecaes, leading to symptoms.
  • Is not the same as obstructed defaecation.
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7
Q

Week 209 - Constipation/IBS: What are the main two mechanisms for constipation?

A
  • Luminal residue insufficiency.

* Abnormalities of neuromuscular activity.

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8
Q

Week 209 - Constipation/IBS: What are the causes of chronic constipation?

A
  • Diet
  • Purgative abuse
  • Idiopathic bowel disease (IBS, slow transit, mega-colon)
  • Metabolic (Hypothyroidism, hypercalcaemia, hypokalaemia, uraemia)
  • Drugs (opiates, iron, ganglion-blockers, anticholinergics)
  • Neuromuscular disease
  • Psychiatric
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9
Q

Week 209 - Constipation/IBS: Which nerve supplies the external anal sphincter?

A

Pudendal nerve

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10
Q

Week 209 - Constipation/IBS: What occurs to allow defaecation?

A
  • Cortical perception of rectal filling.
  • Voluntary decision
  • Straining
  • Decreased tone in pelvic floor and sphincters.
  • Anorectal angle is reduced.
  • Increase in abdominal tone.
  • Passage of stool.
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11
Q

Week 209 - Constipation/IBS: What are the five factors that help to ensure continence?

A
  • Central control.
  • Functioning reservoir.
  • Strong pelvic floor.
  • Intact sphincter mechanism.
  • Absence of peripheral neuropathy.
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12
Q

Week 209 - Constipation/IBS: What are the causes of incontinence?

A
  • Neonatal
  • Cerebral - Old age, psychiatrically disturbed.
  • Degenerative - Autonomic neuropathy, Wasting diseases.
  • Trauma - Obstetric, surgical, accidents.
  • Idiopathic
  • Diseases
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13
Q

Week 209 - Constipation/IBS: What are the four causes of obstructed defaecation?

A
  • Rectocoele
  • Rectal intussusception
  • Anismus
  • Idiopathic megarectum
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14
Q

Week 209 - Constipation/IBS: What is a rectocoele?

A

Protrusion of anterior wall of rectum, commonly follows childbirth.
Herniation may lead to obstructed defaecation.

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15
Q

Week 209 - Constipation/IBS: What is rectal intussusception?

A
  • Preliminary stage to rectal prolapse.
  • Rectal fullness or pressure.
  • Tenesmus.
  • Perineal pain.
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16
Q

Week 209 - Constipation/IBS: What are the symptoms of obstructed defaecation syndrome?

A
  • Straining
  • Laxative/enema dependancy
  • Incomplete evacuation
  • Fragmented defaecation
  • Rectal Pain
  • Perineal support
17
Q

Week 209 - Constipation/IBS: What is the initial investigation for a patient presenting with chronic constipation? What are the possible findings?

A

Barium enema/colonoscopy
• Excludes carcinoma.
• Normal calibre colon/rectum.
• Megacolon/rectum

18
Q

Week 209 - Constipation/IBS: Following a barium enema for the investigation of chronic constipation, you find that the colon/rectum is of normal calibre. What are the follow-up investigations?

A
  • Defaecating proctogram.
  • Colonic transit study.
  • Anorectal physiology.
  • Endoanal ultrasound.
19
Q

Week 209 - Constipation/IBS: What are the techniques used for anorectal physiology analysis?

A
  • Manometry
  • Balloon inflation.
  • Pudendal nerve terminal motor latency.
  • EMG recording.
20
Q

Week 209 - Constipation/IBS: What is functional constipation?

A

This is chronic constipation without a known cause, also known as primary and idiopathic constipation.

21
Q

Week 209 - Constipation/IBS: What is secondary constipation?

A

Constipation caused by a drug or medical condition, also known as organic constipation.

22
Q

Week 209 - Constipation/IBS: What is the difference between chronic constipation and IBS-constipation dominant?

A

IBS-C, has more pain associated with it. Patients with less pain are classified as chronic constipation.

23
Q

Week 209 - Constipation/IBS: What is the diagnostic criteria for IBS?

A

At least 12 weeks of the last 12 months with abdo. pain/discomfort and two of the following symptoms;

  • Relieved with defaecation.
  • And/or change in stool frequency.
  • And/or change in stool form.
24
Q

Week 209 - Constipation/IBS: What are the four types of laxatives?

A
  • Bulk-forming laxatives.
  • Osmotic laxatives.
  • Stimulant laxatives.
  • Surface-wetting laxatives.
25
Q

Week 209 - Constipation/IBS: How do bulk-forming laxatives work? Give examples.

A
  • Retain fluid within the stool, increasing faecal mass, stimulate peristalsis.
  • Ispaghula husk, Methylcellulose.
26
Q

Week 209 - Constipation/IBS: How do osmotic laxatives work? Give examples.

A
  • Increase fluid in large bowel, causing secretion and stimulation of peristalsis.
  • Macrogols, lactulose.
27
Q

Week 209 - Constipation/IBS: How do stimulant laxatives work? Give examples.

A
  • Peristalsis by stimulating colonic nerves (Senna)

* Or by stimulating colonic and rectal nerves (bisacodyl, sodiumpicosulfate).

28
Q

Week 209 - Constipation/IBS: How do surface-wetting laxatives work? Give examples.

A
  • Reduce the surface tension of the stools allowing water to enter.
  • Docusate, poloxamer.
29
Q

Week 209 - Constipation/IBS: How should short duration constipation be managed in adults?

A
  • Adjust any constipation-inducing medication.
  • Dietary advice (Fluids, fibre)
  • And oral laxatives if these are ineffective, beginning with a bulk-forming laxative.
30
Q

Week 209 - Constipation/IBS: Aside from laxatives, what other medications should be offered for the treatment of Constipation predominant IBS?

A
  • Pain management.
  • Antidepressants.
  • Probiotics.
31
Q

Week 209 - Constipation/IBS: What pain management medication should be offered to those suffering from constipation predominant IBS?

A 
Anti-spasmodics.
- Anti-cholinergic agents.
- Anti-muscarinics.
- Peppermint oil
Anti-depressants (They have anti-cholinergic properties)
32
Q

Week 209 - Constipation/IBS: What is the dietary management of constipation predominant IBS?

A
  • at least 1.5l water /day.

* Avoid too many carbohydrates and alcohol sugars, these can exacerbate symptoms.

33
Q

Week 209 - Constipation/IBS: What are the surgical options for dysmotility?

A
  • Colectomy and ileorectal anastomosis.
  • Sacral nerve stimulation.
  • Antegrade colonic enema.
34
Q

Week 209 - Constipation/IBS: What are the surgical indications for the treatment of obstructed defecation syndrome?

A
  • Rectocoele
  • Internal intussception
  • prolapse

Revision Cards (61 decks)

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