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Flashcards in 5 - GI: Constipation Deck (30)
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1

What is Constipation?

Abnormally slow movement of feces through colon w/ accumalation

Straining to have stool

Dry / Hard / Small stools

Feelings of Incomplete bowel evacuation

BLOATING

2

Epidemiology of Constipation

WOMEN > men

no difference in age groups

Higher in > 65 y/o

Common in Pregnancy

3

Etiology of Constipation

  • Disease Induced
    • ​Ulcers / Fissures / hemorroids
    • gallbladder disease  apppendicitis / ileitis
    • hypothyroidism / diabetic neuropathy / CVA / MS / IBS / DVT
  • Drug Induced
    • OPIATES + more
  • Psychogenic
    • Depression / eating disorders
  • Lifestyle
    • low calorie / carbs / fiber / inadequite fluid intake

4

Special Populations in Constipation

 

  • Older Adults >65 y/o
    • Physiologic changes / meds / disease
  • Children
    • ​emotions / febrile / dietary changes / POOR EATING habits
  • Women
    • PREGNANCY / HORMONES
    • IBS / slower gut transit times
    • surgery after childbirth

5

Common Symptoms of Constipation

  • ​Decreased Frequency of bowel movements
  • Difficult Passage of HARD stool
  • Anorexia
  • Dull Headache
  • Lassitude (lack of energy / awareness)
  • Lower Back pain
  • Abdominal Distention

6

EX-ST of Constipation

  • SIGNIFICANT abdominal pain / distention / cramping
  • Marked or unexplained flatulence
  • FEVER + N/V
  • Paraplegia / Quadriplegia
  • Changes in bowel habits
  • Bloody / Dark / Tarry stools
    • change in CALIBER o stool
  • ​Symptoms perisiting fo>2 weeks or recur over 3 months
  • H/o of IBD
  • Daily laxative use

7

Non-Pharmacologic Treatment

of Constipation

  • Regular bowel habits
  • Increase DIETARY INSOLUBLE FIBER
    • Wheat / grains / oats / fruits / veggies
      • 14g/1000kcal
  • Increase WATER intake
  • Avoid constipating foods
  • Regular EXERCISE
  • Stress management

8

Pharmacologic intervention if quicker relief is needed!

  • Bulk forming Laxatives
  • Lubricants / Emollient
  • Stimulants
  • Saline Laxatives
  • Hyperosmotic Laxatives

9

Bulk-Forming Laxatives

Onset / Use

Metamucil / Fibercon

Psyllium / calcium polycarbophil / methylcellulose

Onset is 12-24 hours

Duration of <72 hours

Used for Treatment & Prevention of Constipation

 

10

Bulk-Forming Laxatives

ADR / DI / Counseling

 

Metamucil / Fibercon

 

Cramping / Flatulence

8oz of WATER Per dose!

obstruction if inadequate fluid intake

Tetracyclines

Seperate by 1-2 hours from all medications

11

Emollient Laxatives

Onset / Use

Colace = Docusate

Used for PREVENTION

Avoid STRAINING

surfactant = increase wetting / soften fecal mass

onset is 1-3 days

 

12

Emollient Laxatives

ADR / DI / Counseling

Colace / Docusate

Abdominal Pain / Diarrhea

MINERAL OIL

1-2 times a day w/ fluids

not for children <6 y/o

13

Saline Laxatives

Onset / Use

Milk of Magnesia

Mag citrate / MgOH2 / Fleet enema

Osmotics

used for TREATMENT / BOWEL PREP

Onset = 30min - 3 hours (orally)

<1 hour (rectally)

14

Saline Laxatives

ADR / DI / Counseling

Milk of Magnesia

N/V/D

Fluid/e- imbalance + Craming

Warfarin / Digoxin / TCA's / SPS

not for pts w/ :

ileostomy / colostomy / dehydration / renal impairment / CHF

15

Stimulant Laxatives

Onset / Use

Senokot / Dulcolax

Sennosides / biscodyl / castor oil

Stimulate Peristalsis

used for TREATMENT / BOWEL PREP

Onset is 6-12 hours (orally)

15-60 minutes (rectally)

DNU for > 7 days

16

Stimulant Laxatives

ADR / DI / Counseling

Senokot / Dulcolax

DNU > 7 days

commonly abused

Cramping / Loss of normal bowel fxn

Fluid/e- imbalance

castor oil may induce LABOR

17

Hyperosmotic Laxative

Use / Onset

Miralax

PEG 3350 / Glycerin

Osmotic / Local irritant Effect (draws water into rectum)

Used for TREATMENT / PREVENTION / BOWEL PREP

Onset for glycerin is 30 min

onset for PEG = 1-3 Days

18

Hyperosmotic Laxative

ADR / DI / Counseling

Miralax

Bloating / Cramping 

Abdominal discomfort / Flatulance

Caution in renal disease

 

Glycerin is just Cramping / irritation / burning

19

Glycerin Dose / Drug Type

Hyperosmotic Laxative

for constipation

Adult dose = 3g PR

Children < 6 y/o = 1g - 1.5g PR

cramping / irritation / burning

20

Recomended Laxatives for

Acute Treatment

Bulk Forming

Metamucil / Fibercon

Hyperosmotic Laxative

Miralax (PEG)

Stimulant

Senokot / Dulcolax (biscodyl)

21

Recommended Laxatives for

CHRONIC treatment

Fluids / Dietary Changes / Physical Activity

 

Bulk Forming

Metamucil / FiberCon

Occational Stimulants

Senokot / Dulcolax

22

Senakot + Senakot S

Dose / Indication

Sennosides +/- docusate

Stimulant Laxative +/- Emollient

8.6 mg +/- 50mg docusate

2 tabs (17.2) at bedtime

2nd dose may be given during the day

23

Senakot + Senakot S

CIP / DI

Sennosides +/- Docusate

Appendicitis / Ab pain / n/v

Rectal bleeding / Failure to bowel move

DNU >7 days

24

Senakot + Senakot S

ADR / Consult

Sennosides +/- Docusate

Electrolyte/fluid deficiency

hypoKALEMIA / loss of protein

Chest pain / Malabsorption

 

Ask why they need a laxative?

Bowel habits / appearance

RECTAL BLEEDING SEE MD

Try dietary fiber / fluid intake / exercise

25

Dulcolax

Dose / Indication

Biscodyl

Stimulant Laxative

5mg Tab / 10mg suppository

2-3 tabs in single dose / day

Results in 8-12 hours if bedtime

6 hours if taken before breakfast

1 suppository = results in 1 hour

26

Dulcolax

CIP / DI

Biscodyl

Appendicitis / Ab pain / n/v

Rectal bleeding / Failure to bowel move

DNU >7 days

<6yo

milk or antacids

catharsis of drugs in colon

27

Dulcolax

ADR / Consult

Biscodyl

Electrolyte/fluid deficiency

hypoKALEMIA / loss of protein / Malabsorption

 

DO NOT CRUSH OR CHEW TABLETS

<7 days

Bowel habits / appearance

RECTAL BLEEDING SEE MD

Try dietary fiber / fluid intake / exercise

28

Colace

Dose / Indication

Docusate Sodium

Emollient Laxative

50 / 100 / 250 mg, syrup = 60mg/15ml

50-200mg qd

Results in 1-3 days after 1st dose

15 min after microenema

take liqid with milk/fruit juice

29

Colace

CIP / DI

Docusate

 

Rectal bleeding / Failure to bowel move

DNU >7 days

 

30

Colace

ADR / Consult

Docusate

Bitter Taste / Throat irritation

N/V from syrup or liquid

 

DNU <7 days

Bowel habits / appearance

RECTAL BLEEDING SEE MD

Try dietary fiber / fluid intake / exercise