Wk 10 Flashcards
what are common non-GI diseases that include constipation as a symptom?
metabolic disorders (Hypothyroid, DM2, etc) neurological disorders mechanical obstruction (masses, tumors) anorectal disorders (prolapse, etc)
definition of constipation
Two or more of the following for the past 3 months with symptom onset at least 6 months prior to diagnosis:
- Straining during >25% of BMs
- Lumpy or hard stool for >25% of BMs
- Feeling of incomplete evacuation for >25% of BMs
- Feeling of anorectal blockage for >25% of BMs
- Use of manual maneuvers to facilitate >25% of BMs (digital evacuation or support of pelvic floor)
- Less than 3 BMs per week
- Insufficient criteria for IBS-C
Limitations of cathartic herbs in the treatment of constipation
shouldn’t be used for more than 10 days
consequence of overuse: dependence/aggravation of constipation, electrolyte imbalance, C/I in PG and with lactation,
useful for severe atonic constipation
Why would we be concerned with sudden onset constipation?
colon cancer
Why does the Western (S.A.D.) diet often result in constipation
eating food allergens/sensitivities
high carb/fat, high inflammatory foods
low veggies, fruit, fiber
lack of exercise
What role does ignoring stool urge have on constipation?
loss of BM reflex
Know the homeopathic remedies for constipation
-says he won’t ask about remedies
Aesculu Aloe Alumen Alumina Bryonia Calc carb Causticum Graphites Lachesis Lycopodium Magnesia muriaticum Nat mur Nux vom Opoium Phosphorus Platina Plumbum metallicum Silicea Sulphur Veratrum album
How are BUN levels affected by colon bleeding?
blood urea nitrogen levels may be elevated (30-50 mg/dL)
BUN: Creatinine ratio greater than 36:1 likely represents blood loss from GI
DDX for colorectal bleeding
Angiodysplasia (AV malformation) Carcinoma Colonic diverticula Ischemic colitis Trauma Anal fissure Colitis- UC, Crohn's, Infective Hemorrhoids Meckel's diverticulum Radiation proctitis Polyps
Know which imaging is the best in diverticulitis
Abdominal CT (may demonstrated bowel wall thickening, abscess formation, diverticula) Endoscopy is C/I in diverticulitis
Understand key dietary principles in diverticulosis prevention
- diet rich in fruits, vegetables, legumes, nuts. Avoid seeds
- whole grain moderation
- overall fiber goal: 50 g daily non-grain based fiber
- decr. grain fed meats and processed foods
- incr. exercise and water (64 oz daily)
- incr omega 3 EFA intake
- elimination diet/food sensitivity testing
Know acute diverticulitis therapies
signs of internal bleeding or acute abdomen require immediate hospitalization
otherwise:
-abdominal castor oil pack (w heat) for 60 minutes TID
-probiotics 50-100 billion live organism QID
-water fasting
-acute diverticulitis formula (Yarnell)
-monitor every 12 hrs, if no improvement with 48 hrs, hospitalize
Treatment protocols for diverticulosis/diverticulitis
dietary:
increase fluids, short fruit or vegetable juice fast progressing to solid food (for acute), elimination/rotation diet, high fiber, high complex carbs, unrefined diet (chronic)
increase cellulose and hemicellulose fiber to protect against diverticulosis
consume food rich in Vit A, Vit B-complex food, acidophilus
avoid food intolerances and inflammatory foods
supplement:
ground flaxseed, vit B-complex, folic acid, vit C, probiotics, vit E, Yarnell’s formula
hydrotherapy:
constitutional hydro, vinegar pack, warm castor oil packs
homeopathy:
belladonna, bryonia, iris tenax, lachesis, mercurius, phosphorus, silicea
Know herbal therapies for colorectal cancers
green tea extract avena sativa baptisia tinctoria berberis aquifolium conium maculatum echinacea spp gentiana lutea Larrea divaricata Phytolacca decandra Rumex crispus Taraxacum officinale Trifolium pratense Viola odorata with Galium aparine Viscum album Hoxsey-like formula
Recommendations for colorectal screening schedule
CRC screening tests are grouped into two categories:
Tests that detect cancer and precancerous polyps*
Flexible sigmoidoscopy (FSIG) every 5 years, or
Colonoscopy every 10 years, or
Double contrast barium enema (DCBE) every 5 years, or
CT colonography (CTC) every 5 years*
Tests that primarily detect cancer
Annual guaiac-based fecal occult blood test (gFOBT)* with high test sensitivity for cancer, or
Annual fecal immunochemical test (FIT)* with high test sensitivity for cancer, or
Stool DNA test (sDNA)*, with high sensitivity for cancer, interval uncertain
*Note: All positive screening tests should be followed up with colonoscopy
Exams that are designed to detect both early cancer and precancerous polyps should be encouraged if resources are available and patients are willing to undergo an invasive test
If the full range of screening tests are not available, physicians should make every effort to offer at least one test from each category