CONSTIPATION

Question 1

MANAGEMENT

Answer 1

Increased dietary fiber, with a goal of 20-35 g per day

Min eight 8-ounce glasses of water per day

Polyethylene glycol 3350, 17 g every 24 hours as needed until the stools are soft; not recommended for longer than 2 weeks

Bisacodyl suppository 10 mg per rectum every
24 hours as needed; not recommended for longer than 7 days

Soap suds enema × 1 dose

Fleet Enema

INVESTIGATIONS
CBC
Lytes
Cr
Extended Lytes
TSH
+/- Serum lead or iron
+/- CXR
+/- Abdominal Flat & Erect film
+/- CT with PO and IV contrast

Question 2

DOCUMENTATION

Answer 2

CLINICAL FEATURES

Frequency (Number of bowel movements per week)
Consistency of stools
Normal Bowel Habits

Symptom Duration

Bristol Stool Chart:
Stool Caliber, Color, Consistency

RED FLAGS
Fever
Obstipation
Nausea / Vomiting
Anorexia
Rectal Bleeding / Melena
Severe Abdominal Pain
Abdominal Distension
Weight Loss
Fatigue / Dyspnea / Palpitations

PHYSICAL EXAM
Document:
Vitals
Abdominal Exam
Rectal Exam

Question 3

CRITICAL DDx

Answer 3

Bowel obstruction
Volvulus
Mesenteric ischemia
Appendicitis
Intussusception
Toxic megacolon
Diverticulitis
Stercoral colitis
Severe electrolyte abnormalities
Malignancy

Question 4

Etiology

Answer 4

r/o GI obstruction
Post Surgical Ileus
Electrolyte / Metabolic Derrangement
Endocrine Conditions
Neurologic Conditions
Rheumatologic Conditions
Toxins
Painful Rectal conditions
Meds
Sedentary Lifestyle
Inadequate Fiber Intake
Inadequate Fluid Intake