Constipation

Question 1

What is constipation defined as?

Answer 1

Reduced frequency of defecation to twice weekly or less.

Question 2

What are the three clinical subtypes of constipation?

Answer 2

• Normal transit with hard stools or difficulty in evacuation
• Slow colonic transit with reduced frequency or absence of urge to defecate
• Incoordination of rectum, anus, and pelvic floor

Question 3

What psychological factors can contribute to constipation?

Answer 3

• Anorexia
• Dementia
• Sexual abuse
• Grief

Question 4

What are some common drugs that can cause constipation?

Answer 4

• Analgesics like opiates
• Anticholinergics including antipsychotics
• Anti-parkinsonian drugs
• Antispasmodics
• calcium channel blockers

Question 5

What congenital conditions should be evaluated in a patient with constipation?

Answer 5

• Hirschsprung’s disease
• Meningocele

Question 6

What dietary factors contribute to constipation?

Answer 6

• Low fiber diet
• Lack of fluid intake
• Caffeine abuse
• Overuse of alcohol

Question 7

What lifestyle factors can lead to constipation?

Answer 7

• Sedentary lifestyle
• Prolonged immobility, especially in the elderly

Question 8

What endocrine disorders can cause constipation?

Answer 8

• Hypothyroidism
• Hypercalcemia
• Hypokalemia
• Phaeochromocytoma
• Glucagonoma

Question 9

What neurological diseases are associated with constipation?

Answer 9

• Neuropathy
• Multiple sclerosis
• Parkinson’s disease
• Cord compression
• Stroke

Question 10

How is the pelvic floor’s function related to constipation?

Answer 10

Animus can cause constipation, which is the failure of the pelvic floor muscles to relax during defecation.

Question 11

What are the complications of constipation?

Answer 11

• Urinary retention
• Faecal incontinence
• Rectal prolapse
• Anal fistula
• Stercoral perforation
• Volvulus

Question 12

What is faecalith?

Answer 12

A stone made of faeces, typically found in the descending and sigmoid colon.

Question 13

What diagnostic approaches are used for constipation?

Answer 13

• Colonoscopy
• Flexible sigmoidoscopy
• FBC for faecal occult blood
• Upright chest radiography
• Rectal biopsy
• Anorectal manometry

Question 14

What is the first-line treatment for managing constipation?

Answer 14

Increasing dietary soluble fiber and adequate fluid intake.

Question 15

What are sources of dietary fiber?

Answer 15

• Cereals
• Breads
• Fruits
• Vegetables
• Peanuts

Question 16

What is the diagnostic approach for constipation?

Answer 16

Colonoscopy
Flexible sigmoidoscopy
FBC for faecal occult blood and WCC count, and metabolic profile including thyroid
Upright chest Radiolohraphy to assess for megacolon and Colonic dilatation
Rectal biopsy and radiology for Hirschsprung’s disease
Anorectal manometry to evaluate function of rectal and anal muscles by inserting a catheter with pressure sensors into the anu

Question 17

Which laxatives are given for constipation?

Answer 17

bisacodyl and docusate

Question 18

What is the first line treatment for constipation?

Answer 18

isphagala husk with increasing fluid intake

Question 19

What is the role of Docusate in treating constipation?

Answer 19

Stool softener that increases the water and lipid content of stools.

Question 20

What is the second-line treatment for constipation?

Answer 20

Osmotic laxative like macrogol.

Question 21

What is prucalopride used for?

Answer 21

A last-line treatment for chronic constipation that stimulates gastric motility.

Question 22

What is the difference between a suppository and an enema?

Answer 22

A suppository is a small solid capsule; an enema is liquid medication.

Question 23

What is the ideal laxative for proximal faecal impaction?

Answer 23

Polyethylene glycol, an osmotic laxative.

Question 24

What is the first-line oral laxative for faecal loading/impaction?

Answer 24

Macrogol.

Question 25

Fill in the blank: For hard stool, the combination used is _______.

Answer 25

Bisacodyl and glycerol.

Question 26

True or False: Surgery is indicated for colonic inertia.

Answer 26

False.

Question 27

Why medication is associated with constipation?

Answer 27

Anti-depressants Amitryptilline due to its anticholinergic effects Calcium channel blockers like amlodipine Opiates Anti-psychotics Iron supplements LEVADOPA

Question 28

Which medications cause diarrhoea?

Answer 28

Metformin for diabetes NSAIDs PPI inhibitors Antibiotics Magnesium Chemotherapeutic