Constipation

Question 1

What is the ROME III criteria for constipation?

Answer 1

Two or more of the following for at least three months:

• Fewer than 3 defecations per week
• straining
• lumpy/hard stools
• sensation of blockage/incomplete evacuation

Question 2

What do you have to r/o with constipation?

Answer 2

IBS

Question 3

If constipation alternates with normal stools/diarrhea is suggestive of what?

Answer 3

Blockage that occasionally dumps out diarrhea

Question 4

What endocrine disorder can cause constipation?

Answer 4

DM

Question 5

Why do past GI surgeries cause constipation?

Answer 5

strictures

Question 6

Do fluids really help with constipation?

Answer 6

Not really

Question 7

Onset of acute constipation in the elderly?

Answer 7

BO

Question 8

Weight loss over what amount of weight is concerning with constipation?

Answer 8

10 lbs

Question 9

What are the three major endocrine causes of constipation?

Answer 9

DM
Hypothyroidism
Hypercalcemia

Question 10

What are the three major neurological diagnoses that can lead to constipation?

Answer 10

Parkinson’s

MS

Question 11

What are the two myogenic problems that can lead to constipation?

Answer 11

Scleroderma

Amyloidosis

Question 12

What are the three psychiatric disorders that should be considered with elderly constipation?

Answer 12

Depression
Eating disorders
OCD

Question 13

What are the PE things you should pay attention to with constipation?

Answer 13

Mucus membranes (dehydration)
DRE

Question 14

What type of antacids are concerning for constipation?

Answer 14

Al containing

Question 15

What supplement may cause constipation?

Answer 15

Fe

Question 16

What two antiarrhythmics may cause constipation?

Answer 16

CCB

Beta blockers

Question 17

What are the psychiatric drugs that can cause constipation? (3)

Answer 17

Antispasmodics
Antidepressants
Antipsychotics

Question 18

What labs should be considered with constipation?

Answer 18

Thyroid

Hgb A1C

Question 19

What are the bulk laxative that are used to treat constipation?

Answer 19

Psyllium

Methylcellulose

Question 20

What are the osmotic laxatives that are used to treat constipation?

Answer 20

Lactulose

Question 21

What are the stimulant laxatives that are used to treat constipation?

Answer 21

Senna

Bisacodyl

Question 22

What type of enemas should be used for constipation in the elderly?

Answer 22

Warm water

Question 23

What muscle is working for stooling?

Answer 23

Puborectalis

Question 24

The internal and external sphincter are composed of what type of muscle?

Answer 24

Smooth

Question 25

What signals the sensation to defecate?

Answer 25

Distention of the rectum

Question 26

What is encopresis?

Answer 26

Prolonged and repetitive stool withholding and avoidance of defecation leads to large amount of retained stool in the rectum.

Question 27

What is the sign of encopresis?

Answer 27

Overflow from the rectum

Question 28

True or false: straining with the passage of soft stool in infants is normal

Answer 28

True

Question 29

Why do infants have to strain with their stool?

Answer 29

Incoordination of their rectal muscles

Question 30

Up until what age is infantile dyschezia resolve?

Answer 30

6 months

Question 31

Most children have achieved bowel and bladder control by what age?

Answer 31

4 years

Question 32

What is the best way to toilet train children?

Answer 32

Praise

Question 33

What is the most common cause of constipation in children?

Answer 33

functional fecal retention--voluntary tightening of the external anal sphincter and contraction of the gluteal muscles preventing the passage of stools

Question 34

What should be in the ddx for childhood constipation?

Answer 34

Hypothyroidism TCAs Spinal cord damage/hirschsprung's disease

Question 35

When should you have your first stool?

Answer 35

first 24 hours

Question 36

What is the early presentation of Hirschsprung's disease?

Answer 36

If stools do not occur within 24-48 hours

Question 37

Meconium of the ileus causes what?

Answer 37

delayed passage of meconium in CF

Question 38

What parts of the PE should be done with constipation?

Answer 38

DRE for sphincter tone

Question 39

What are the labs that can be done to screen for laxative abuse?

Answer 39

BMP + Mg

Question 40

What are the three phases of medical management?

Answer 40

1. complete evacuation or disimpaction 2. Sustained evacuation to restore normal colorectal tone 3. Weaning from intervention

Question 41

Why should you not use mineral oil under 1 yo?

Answer 41

Risk for aspiration

Question 42

What are the components of sustained evacuation? How long does this last?

Answer 42

Habitual toilet use, stool softeners 3-9 months

Question 43

What is involved in the weaning stage?

Answer 43

use of laxative gradually reduced, increase fiber This usually occurs when children can better understand