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Flashcards in Constipation Deck (30)
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1
Q

Physiological elements needed for an effective, soft stool

A

Neurological input for defecation and the urge to push intact (no pain)
Effective peristalsis
Soft stool

Think of a tube with a head on the end

2
Q

Red flags of constipation

A
Acute change in bowel habit 
Blood
No flatus
FLAWS
Severe, persistent constipation
3
Q

Is constipation more likely to be serious if acute or chronic?

A

Acute

Chronic is usually dehydration or lifestyle

4
Q

What is tenesmus and what may it indicate?

A

It’s the feeling of incomplete emptying. May indicate a persistent mass in the rectum, e.g. a tumour

5
Q

If the patient reports bleeding PR, what important questions need asking?

A

Colour
When you noticed
How much
On the tissue?

6
Q

FH of bowel cancer conditions

A

FAP

HNPCC

7
Q

Which drugs can cause constipation?

A

Opiates, anticholinergics, TCA antidepressants, CCB, iron supplements

8
Q

In all abdominal pathology, which lymph node should you check?

A

Virchows

9
Q

If constipated, what examination should you consider?

A

DRE, checking for impacted faeces

10
Q

If you find lax anal tone on DRE, what may it indicate?

A

Neuropathy, e.g. diabetic neuropathy or MS

11
Q

Which cancer marker is indicated in bowel cancer?

A

CEA

12
Q

Which cancer marker is indicated in ?ovarian cancer?

A

CA125

13
Q

Which electrolyte disturbances can cause constipation

A

Hypercalcaemia

Hypokalaemia

14
Q

What may you find on FBC in cancer?

A

Micro cystic anaemia (Fe deficiency from blood loss)

15
Q

What investigations are available to look at the colon?

A
Protoscopy 
Rigid sigmoidoscopy 
Flexible sigmoidoscopy
Colonoscopy
CT colonography 
OGD for the top bit
16
Q

How can we treat chronic constipation?

A

Lifestyle changes, e.g. more fluid, exercise, fibre.
Can give bulk producers such as fibre supplements
Stool softeners
Laxatives

17
Q

Patient with long standing constipation, heavy periods, fatigued, positive talen test. Likely diagnosis?

A

Hypothyroidism

18
Q

Likely cause of hypothyroidism in a young woman

A

Autoimmune = Hashimoto’s thyroiditis

19
Q

Which antibodies are present in Hashimoto’s?

A

Anti TPO

20
Q

Patient with constipation, aches and pains all over his body, polyuria, polydipsia, normal capillary glucose, lethargy and low mood.
Likely diagnosis

A

Hypercalcaemia

Moans, bones, groans and stones

21
Q

A patient is found to have hypercalcaemia, how do we find a cause?

A

Blood tests
ALP, PTH, phosphate
Calcium profile

Bone cancer increases turnover of bones -> raised ALP and phosphate
Hyper parathyroidism, high ALP. High calcium should inhibit ALL PTH! So normal is still high.

22
Q

In metastatic breast cancer, what drug can you take to protect your bones?

A

Alendronate or pamidronate

23
Q

What drug can you give for nausea from morphine?

A

Cyclizine

24
Q

Neurological cause of constipation?

A

Cauda equina or other cord compression

25
Q

What drug can you give for morphine induced constipation?

A

Methylnaltrexone

26
Q

Coffee bean sign =

A

Sigmoid volvulus

27
Q

Management of sigmoid volvulus

A

Drip and suck = IV fluids and an NG tube

Referral to surgeons for removal of obstruction

28
Q

TNM classification

A
T = 1-4 local invasion and size 
N = nodes 1-3 (3 being distant nodes)
M = 0/1 if metastasised
29
Q

Dukes classification

A
A= muscularis propria
B = beyond 
C = lymph nodes
D = other organs
30
Q

The sigmoid colon derives its arterial supply from which branch of the abdominal aorta?

A

Inferior mesenteric artery