Constipation Flashcards
_____is the difficult passage of small hard
stools
Constipation
ROME Criteria for constipation
duration:
to be positive, fulfill?
12 weeks
> 2
ROME III Criteria
• infrequent passage of stools 25% of time
• sensation of incomplete evacuation >25% of time
• use of manual manoeuvres >25% of time
• sensation of ________
>25% of time
3/week
straining
anorectal obstruction/blockage
emphasis should be on the
_______rather than on the frequency
of defecation;
consistency of the stool
Constipation from infancy may be due to
_____
Hirschsprung disorder
______is the single most important factor in
preventing constipation
Diet
Unusually shaped stools (small pellets or ribbonlike)
suggest _____
irritable bowel syndrome
The ________ is far superior to the
rigid sigmoidoscope in investigation of the lower
bowel
flexible sigmoidoscope
MC cause of constipation
The commonest is ‘idiopathic’ constipation where
there is no structural or systemic disease. This is also
referred to as ‘functional’ constipation
Alarm Sx for constipation
- Recent constipation in >40 years of age
- Rectal bleeding
- Family history of cancer
In the Mx of constipation,
Ensure that the anthraquinone group of
laxatives, including_____, is never used
long term because they cause melanosis coli and
associated megacolon
‘Ford pills’
Three of the primary masquerades
are important causes of constipation, namely
______
drugs, depression and hypothyroidism
These drugs may be associated with
constipation, especially codeine and its derivatives,
___, ____ and ______
antidepressants, aluminium and calcium antacids
The metabolic causes of constipation include
1
2
3
hypothyroidism, hypercalcaemia and porphyria
Diabetes rarely can be associated with constipation
when an _______ can lead to
alternating bouts of constipation and diarrhoea.
autonomic neuropathy
Constipation may be a manifestation of an underlying
functional problem and psychiatric disorder, such
as
1
2
3
4
depression, anorexia nervosa, schizophrenia or
drug abuse
It is worth noting that 60% of polyps and
cancers will occur in the _______
and diverticular disorder should be evident with the
flexible sigmoidoscope
first 60 cm of the bowel
The presence of _____is an important
sign—it may give a pointer to the duration of the
constipation and the consequent chronic intake
(perhaps denied) of anthraquinone laxatives
melanosis coli
Labs for constipation work-up. What blood chem?
— thyroid function tests
— serum calcium
— serum potassium
— carcinoembryonic antigen (a tumour marker)
Radiological findings — CT colonography (virtual colonography) —\_\_\_\_\_\_\_\_\_ (especially for primary colonic disease, e.g. megacolon) — \_\_\_\_\_\_\_\_, using radio-opaque shapes taken orally and checking progress by abdominal X-ray or stool collection
double contrast barium enema
bowel transit studies
Physiological tests:
— \_\_\_\_\_\_\_\_—test anal tone — rectal sensation and compliance, using an \_\_\_\_\_\_\_\_\_ — \_\_\_\_\_\_\_\_\_, to determine disorders of defecation — Rectal biopsy, to determine \_\_\_\_\_\_
anal manometry
inflatable rectal balloon
dynamic proctography
aganglionia
__________or faecal incontinence is the
inappropriate passage of normal stool
encopresis
constipation is difficulty or delay in passing the
stool with incomplete emptying of the rectum:
this can present as _______, due to faecal retention
with overflow of liquid faeces (paradoxical
diarrhoea)
soiling
consider if stool hard and associated with pain or
bleedin
Anal fissure in infants
