Week 5 GI Up to Dates

Question 1

Constipation most often side effect of

Answer 1

drugs

Question 2

Drugs associated with constipation

Answer 2

Anticholinergics – antihistamines, antispasmodics, antidepressents, antipsychotics. Cation containing agents – iron, antacids, carafate, barium. Neurally active agents – opiates, antihypertensives, galgionic blockers, vinca alkaloids (wtf?) calcium channel blockers, 5HT3 receptors

Question 3

metabolic causes of constipation

Answer 3

DM, Hypothyroid, hypercalcium, heavy metal intoxication

Question 4

Rome criteria

Answer 4

Defines constipation. Based upon the presence of 3 months of two of the following: 1) straining during more than 25 percent of defecations. 2) lumpy or hard stools in more than 25 percent. 3) sensation of incomplete evacuation more than 25 percent. 4) sensation of blockage in more than 25 percent of defecations. 5) manual maneuvers to defecate more than 25 percent ……. < 3 spontaneous stools a week. loose stools rarely present. insufficent criteria for IBS.

Question 5

Why do diseases of the central and peripheral nervous systems cause constipation

Answer 5

Colonic and anorectal motor functions are coordinated by enteric, sympathetic and parasympathetic nerves

Question 6

severe idiopathic chronic constipation

Answer 6

predominently in women. abdominal pain is uncommon. infrequent defecation, excessive straining or both. Does not improve with fiber or laxatives. Subtypes depend on studies of bowel function

Question 7

Normal colonic transit

Answer 7

Misperceive bowel frequency often exhibit psychological distress. May have abnormalities in anorectal sensory and motor function indistinguishable from slow transit times

Question 8

Colonic inertia

Answer 8

This is the majority of those with severe constipation. – delayed passage of radiopaque markers through the proximal colon in the absence of defecation abnormality. No increase in motor function after meals or with bisacodyl and a blunted response to cholinergic agents. Dysfunction of enteric nerve plexus.

Question 9

Outlet delay

Answer 9

Form of idiopathic constipation which markers move normally through the colon but stagnate in the rectum. Seen w megarectum, recal impaction, hirchsprung disease.

Question 10

Dysynergic defecation

Answer 10

Failure to relax, or innappropriate contraction of the puborectalis and external anal sphincter muscles which increases pressure of anal canal making it less effective. Aquired, learned dysfunction. Inappropriate contraction of the pelvic floor < 20percent relaxation of basal resting pelvic pressure will also have abnormal balloon expulsion test

Question 11

Megacolon

Answer 11

primary a/w neurogenic dysfunction. secondary a/w chronic fecal retention — have increased rectal compliance and elasticity, blunted rectal sensation and smaller degree of relaxation of the internal anal sphincter

Question 12

Megarectum

Answer 12

fecal impaction and soiling, occurs in the physically and mentally impaired elderly. sensory and motor abnormalities a/w megarectum may be reversed.