B5-036 CBCL: Constipation

Question 1

Rome IV criteria for functional constipation

8

Answer 1

1. straining in 25% of defecations
2. lumpy or hard stools 25% of the time
3. sensation of incomplete evacuation 25% of the time
4. sensation of anorectal obstruction/blockage 25% of time
5. manual maneuvers to facilitate more than 25% of defecations
6. fewer than 3 SBM/week
7. loose stools rarely present without use of laxatives
8. insufficient criteria for IBS

must have two or more

Question 2

Rome IV for opiod induced constipation

Answer 2

1. straining in >25% of defecations
2. lumpy, hard stools >25% of defecations
3. sensation of incomplete evacuation >25% of defecations
4. sensation of anorectal obstruction/blockage in >25% of defecations
5. manual maneuvers to facilitate more than 25% of defecations
6. fewer than 3 SBM/week

two or more of the above, new or worsening with opiod therapy

Question 3

Rome IV for IBS

Answer 3

1. Abdominal pain at least 1 day per month over at least 3 months associated with one or more of the following:
2. Related to defecation
3. A change in frequency of stool
4. A change in form (appearance) of stool

Symptom onset should occur 6 months before diagnosis and symptoms should be present within past three months.

must have all

Question 4

for IBS diagnosis, criteria need to occur for at lease

length of time

Answer 4

3 months

Question 5

stimulant laxatives act by

Answer 5

stimulating enteric nerves to induce peristalsis

Question 6

activating enteric mu receptors is a mechanism of what drug class?

Answer 6

antidiarrheal

loperamid, difenoxin, diphenooylate, etc

Question 7

mu agonists are selective for […] opiod receptors

Answer 7

intestinal

Question 8

decrease parasympathetic drive and inhibit ACh release resulting in decreased motility

what drug class

Answer 8

anti-diarrheals
(mu agonists)

Question 9

dietary supplements that add bulk and hold water to expand intestinal contents

what drug class

Answer 9

bulk forming laxatives

Question 10

constipation is [more or less] common in the elderly

Answer 10

more

Question 11

what receptor is responsible for mediating opiod induced constipation?

Answer 11

mu opioid receptor

Question 12

what neurotransmitter is used to induce smooth muscle cell contraction during peristalsis?

Answer 12

ACh

Question 13

what is the consequence of chloride secretion into the lumen?

Answer 13

water is drawn into intestinal lumen

Question 14

what neurotransmitters relax the receiving segment of the intestine distal to the bolus?

Answer 14

NO, VIP

Question 15

what transporter maintains cellular Cl- concentrations?

Answer 15

basolateral Na/K/Cl transporter

Question 16

Na and water are drawn into the lumen through the paracellular pathway by

Answer 16

lumen negative transepithelial voltage

Question 17

psychosocial disturbances are associated with

Answer 17

IBS

Question 18

associated with psychiatric stress, sleep disturbance, affective culnerability, and over adjustment to environment

Answer 18

IBS

Question 19

gastrocolin and duodenocolic reflexes intiate […], moving fecal matter to rectum

Answer 19

power propulsions

Question 20

rectoanal reflex relaxes the

Answer 20

internal anal spinchter

Question 21

the voluntary decision to defecate results in the relaxation of

2

Answer 21

puborectalis muscle
external anal sphinchter

Question 22

the colon is sacculated in small pouches called

Answer 22

haustra

Question 23

motor patterns with the haustra are involved in

Answer 23

mixing and stool formation

Question 24

decreased effectiveness of medicine over time

Answer 24

tolerance

Question 25

abberant behavioral response that is characterized by craving a substance, obsessive thinking and poor inhibitory control relating to a substance

Answer 25

addiction

Question 26

clinical phenomenon associated with chronic low mood, vegetative symptoms, and mild cognitive dysfunction

Answer 26

depression

Question 27

intentional or accidental misuse of a substance

Answer 27

substance abuse

Question 28

clinical phenomena associated with negative and intrusive thinking and physiological arousal

Answer 28

anxiety

Question 29

predicatable responses associated with opioids that affect most patients | 2

Answer 29

tolerance and dependence

Question 30

risk factors associate with an increased risk of addication | 2

Answer 30

hx of depression hx of substance abuse

Question 31

common adverse effect of aluminum antacids

Answer 31

constipation

Question 32

common adverse effects of magnesium antacids

Answer 32

diarrhea

Question 33

dry mouth can be a side effect of [....] as they can limit acid secretion

Answer 33

anti cholinergic

Question 34

when given orally, has extensive first pass metabolism and can reduced OIC

Answer 34

naloxone

Question 35

mu selective antagonist incapable of crossing the blood brain barrier

Answer 35

methylnatrexone

Question 36

side effects of iron supplement | 2

Answer 36

constipation darken stool

Question 37

magnesium salts cause

Answer 37

diarrhea

Question 38

pain with defecating is more consistent with what diagnosis?

Answer 38

IBS

Question 39

fewer than [...] bowel movements per week is criteria for functional constipation

Answer 39

3

Question 40

pain during defecation change in stool

Answer 40

IBS

Question 41

for constipation to be attributed to opioid use, what criteria must be met

Answer 41

new or worsening constipation after initiating, changing or increasing opiod use

Question 42

what is the mechanism of OIC?

Answer 42

hypolarization by activating K+ channels causes decreased release of neurotransmitters involved in peristalsis

Question 43

opioids cause hyperpolarization via activation of [...] channels

Answer 43

potassium

Question 44

adenylate cyclase is [...] with opioid use | increased or decreased

Answer 44

decreased

Question 45

opioid use [...] Ca channels | inhibits or upregulates

Answer 45

inhibits

Question 46

opioid inhibition of VIP and ACh results in

Answer 46

less intestinal secretions

Question 47

slow intestinal transit time allowing for greater absorption of water

Answer 47

opioids

Question 48

activation of CFTR results in [...] secretions | increased or decreased

Answer 48

increased

Question 49

opioids can diminish the perception of sensation for urgency for defecation by

Answer 49

increasing the threshold for pain

Question 50

opioids increase the threshold for pain sensation resulting in the decreased sensation for the

Answer 50

urgency to defecate

Question 51

why do bulk forming laxatives + opioids cause abdominal distension?

Answer 51

opioids decrease perstalsis what cause a much lower transit time giving the bulk forming laxative more time to accumulate and distend the intestine

Question 52

does not develop tolerance to opioids

Answer 52

GI tract

Question 53

potential contributors to the development of IBS | 4

Answer 53

* altered intestinal mobility * altered microbiota * disturbance of brain/gut function * immune dysfunction

Question 54

pathophysiologic changes causing constipation in the aging bowel | 3

Answer 54

* depletion of interstitial cells of Cajal * increased deposit of collagen in ascending colon * slow transit constipation

Question 55

PEG requires adequate

Answer 55

hydration

Question 56

if a patient is not experiencing an adequate response to PEG, what is the initial advise?

Answer 56

drink more water

Question 57

what do lubiprostone and linacoltide do?

Answer 57

increase water content of stool

Question 58

stimulate secretion of chloride into the lumen resulting in the passive diffusion of Na+ and water

Answer 58

lubiprostone

Question 59

stimulate secretion of chloride into the lumen resulting in the passive diffusion bicarb and water

Answer 59

lubiprostone