Constipation

Question 1

What is the clinical criteria for diagnosing constipation from history?

Answer 1

at least 3 months of at least two of the following…
1) infrequent passage of stools
2) straining
3) passage of hard stools
4) incomplete evacuation and sensation of the anorectal passage

Question 2

Give 3 clinical presentations associated with constipation:

Answer 2

1) abdominal bloating
2) abdominal discomfort
3) perianal pain

Question 3

Give 5 drugs that can cause constipation?

Answer 3

1. Opiates
2. Antidepressants
3. Iron supplements
4. Calcium channel blockers
5. Antimuscarinics

Question 4

Give 2 general causes of constipation?

Answer 4

1. immobility
2. Inadequate fibre intake

Question 5

Give 2 psychological causes of constipation:

Answer 5

1) depression
2) anorexia nervosa

Question 6

Give 6 GI diseases that can cause constipation:

Answer 6

1) carcinomas
2) diverticulitis
3) Hirschsprung’s disease
4) Chagas disease
5) anal fissures
6) intestinal obstruction

Question 7

Give 2 neurological causes of constipation:

Answer 7

1) Parkinson’s disease
2) spinal cord lesions

Question 8

Give 2 functional causes of constipation:

Answer 8

1) idiopathic slow transit
2) IBS

Question 9

Give 3 metabolic causes of constipation:

Answer 9

1) diabetes
2) hypothyroidism
3) hypercalcaemia

Question 10

What is Hirschsprung’s disease?

Answer 10

congenital lack of ganglion cells in the distal colon, leading to uncoordinated peristalsis and decreased motility

Question 11

What is Chagas disease?

Answer 11

tropical parasitic disease that causes an enlarged colon and impedes on bowel emptying (trypanosoma cruzi)

Question 12

What investigations can be used to assess the cause of constipation? (2)

Answer 12

1. Colonoscopy
2. CT of the colon

Question 13

What are the three categories of constipation?

Answer 13

1) normal transit constipation
2) slow transit constipation
3) defectory disorder (pelvic floor) constipation

Question 14

What is the most common type of constipation?

Answer 14

normal transit (functional constipation)

Question 15

What is normal transit constipation?

Answer 15

where stool traverses the colon at a normal rate and stool frequency is normal yet patients believe they are constipated due to perceived difficulties on evacuation or the passage of hard stools

Question 16

What test can be used to distinguish normal transit and slow transit constipation?

Answer 16

marker studies

Question 17

Describe how marker studies can be used to distinguish between normal and slow transit constipation:

Answer 17

1) capsules containing 20 radio-opaque shapes are swallowed
2) an abdominal X-ray is obtained after 120 hours from ingestion
3) if capsules remain, there is likely slow transit

Question 18

In what patient
common: (2)

Answer 18

1. Young women
2. Elderly

Question 19

What is defectory disorder constipation?

Answer 19

dysfunction of the anal sphincter and pelvic floor can result in contraction rather than normal relaxation of the external anal sphincter which prevents defaecation

Question 20

Give an example of defectory disorder constipation:

Answer 20

anterior rectocele - where the rectum bulges into the vagina, creating an area to trap stool

Question 21

Give 2 lifestyle changes to manage constipation:

Answer 21

1) increase fibre content of the diet
2) increase fluid intake

Question 22

Give 4 types of foot that are rich in fibre:

Answer 22

1) oats
2) fruit
3) legumes
4) vegetables

Question 23

How do osmotic laxatives work?

Answer 23

They cause water retention in the stool material by the process of osmosis, increasing inflow of fluid and electrolytes to soften the stool

Question 24

Give 3 examples of osmotic laxatives:

Answer 24

1) magnesium sulphate
2) lactulose
3) macrogols

Question 25

How do stimulant laxatives work?

Answer 25

they stimulate motility and intestinal secretion

Question 26

Give 4 examples of stimulant laxatives:

Answer 26

1) phenophthalein
2) prucalopride
3) bisacodyl
4) senna

Question 27

What class of drug is senna?

Answer 27

anthraquinones

Question 29

Give two forms of enema treatments for constipation:

Answer 29

1) hypertonic phosphate
2) sodium citrate

Question 30

Give two forms of suppository treatments for constipation:

Answer 30

1) glycerol
2) bisacodyl