Constipation

Question 1

Functional constipation criteria

Answer 1

at least 2 of the following for 3 months
Straining
lumpy hard stools
sensation of incomplete evacuation
Use of digital maneuvers
Sensation of anorectal obstruction or blockage with 25 percent of bowel movements
< 3 BMs/wk

Question 2

Things that may cause primary constipation?

Answer 2

Slow conolic transit time
Structural Defectory disorders
IBS
Fecal impaction

Question 3

Causes of 2ndary constipation?

Answer 3

“OLD MEN”
Organic - tumors, ishcemic change, stneosis
Lifestyle
Drugs/Diet
Myogenic - DM (Neuropathy)
Endocrine - Parkinsons

Question 4

Who is at higher risk for constipation?

Answer 4

Older adult
F
Sedentary lifestyle
Low education/income
Concurrent Med use
Depression

Question 5

refer to the ______ rule when determining if the colon is too wide and indicative of an impaction

Answer 5

3-6-9 Rule
Large bowel >6cm diameter = Impaction

Question 6

What are stool softeners (Colace)?

Answer 6

Docusate sodium
MOA: Decr surface tension to make stool more porus

Question 7

What are bulk forming laxatives?

Answer 7

Psyllium
MOA: polysacch or cellulose derivates sit in the GI tract and absorb water like a sponge -> increases fecal mass
Note: you must drink a shit ton of water with these and take them 4hrs apart from other meds, bc they will decr their absorption

Question 8

What is Bisacodyl?

Answer 8

Stimulant laxative

Question 9

How does fiber help you shit?

Answer 9

increases stool bulk -> colonic distension promotes stool propulsion

Question 10

Pt is not responding to bulk forming laxatives (Psyllium). Alternative opt?

Answer 10

Take an osmotic agent (Polythylene Glycol)
MOA: pulls water into the bowel
- incr bowel distension -> propulsion
- extra water softens stool

Question 11

When to consider an enema?

Answer 11

if older pt has constipation for many days and are at risk for impaction

Question 12

Do babies tend to shit more or less as they get older?

Answer 12

LESS

Question 13

Babies usually have their 1st BM within ___hrs

Answer 13

36

Question 14

A new breastfeeding mom is concerned bc her baby is only shitting once a day. She says the mother next her said her formula fed baby is shitting 4 times a day. What do you tell her?

Answer 14

It is normal for breastfed babies to initially shit less than formula fed ones because breastfeeding moms gradually increase the amnt of milk they produce. She should expect her baby to gradually increase in amt of shits per day

Question 15

Baby that has a delayed 1st meconium BM is concerning for what?

Answer 15

Hirschprung’s Dz

Question 16

Trmnt for constipated infants?

Answer 16

1 Sorbitol-containing juices (apple, pear, prune)

#2 PEG, Lactulose or sorbitol (if 1yo), Glycerin suppositories, Referall

Question 17

Pt has been giving their child magnesium sulfate every time its constipated. What do you say?

Answer 17

Please try PEG or Magnesium hydroxide first.
Magnesium sulfate is the atomb bomb trmnt and is reserved for refractory cases