Flashcards in 19. Constipation Deck (19)
What 4 main categories can you classify causes of constipation into ?
Patient not pushing
What can cause abnormal peristalsis?
Medications: opiates, iron, CCB's
What can cause hard faeces?
Lack of fibre
What can cause bowel obstruction?
What can cause the patient to avoid pushing when they go to the toilet?
Pelvic floor dysfunction
What are 6 red flags from constipation?
Severe persistent constipation unresponsive to treatment
Absolute constipation with no gas passing
Rectal bleeding, tenesmus, mucoid diarrhoea
PMHx UC/ Polyps
FHx polyps/ cancer
What associated symtpoms should you ask about in someone with constipation?
Diarrhoea (IBS, Colorectal cancer, diverticular disease)
Blood (haemorrhoids, fissure, diverticular disease)
What may polyuria and bone pain suggest in someone with constipation?
Hypercalcemia due to bone mets.
What are risk factors for constipation?
Hx of bowel disease, endo/ neuro disease, back problems
FHx of bowel disorders
In what neurological conditions may patients have constipation as well?
What blood tests may be relevant in someone with constipation?
FBC: colonic mass can cause anaemia
Electrolytes + calcium
What are markers for colon cancer?
Ca 125 (more ovarian cancer)
What is suggested by lax anal tone?
Neurological pathology e.g. diabetic neuropathy or MS
What is the biochemistry in a patient with bone metastases? Why?
Increased bone turnover
What is the biochemistry in a patient with myeloma? Why?
Osteoclasts activated, osteoblasts inhibited (so ALP norm)
What is the biochemistry in a patient with primary/ tertiary hyperparathyroidism? Why?
ALP: Normal/ High
PTH: Normal/ High
PTH increases bone turnover, PTH increases renal excretion of phosphate. No negative feedback on PTH
What is the biochemistry in a patient with vitamin D overdose? Why?
Increased gut absorption of calcium + phosphate.
No increase in bone turnover
What is the TNM classification?
Tumour size: 1-4
Nodes: 0 (none)- 3 (many + distant)
Mets: 0 (none) or 1 (present)