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Abdel > constipation > Flashcards

constipation Flashcards

1
Q

2 types of constpation

A

primary/functional

secondary/organic

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2
Q

What must functional constipation include (2 or more of)?

A
  • straining >25%
  • lumpy/hard > 25%
  • sensation of incomplete evacuation in >25%
  • sensation of blockage/obstruction >25%
  • manual maneouvres >25%
  • < 3 per week
  • loose stools rarely present without laxatives
  • insufficient criteria for IBS
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3
Q

How long must symptoms have been present for?

A

criteria fulfilled for 3 months

symptom onset > 6 months

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4
Q

What causes organic constipation?

A

medication
metabolic diseases
neuropathies
myopathies

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5
Q

When should further investigations take place?

A 
unexplained constipation
abdominal pain
vomiting
blood/mucous
straining (tenesmus)
long standing
unresponsive to treatment
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6
Q

What are the further investigations?

A
  • colonic and anorectal manometry
  • stool analysis
  • flexible sigmoidoscopy
  • colonoscopy
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7
Q

What is 1st line therapy?

A

non-drug treatment

advice on diet and exercise

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8
Q

What diet and lifestyle advice?

A

adequate fluid and fiber intake
regular exercise
no tea/coffee (diuretics, can worsen it)

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9
Q

What is given in patients who don’t respond to lifestyle/diet changes?

A

laxatives

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10
Q

laxatives don’t work

A

diagnostic testing

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11
Q

main treatment for dyssynergic defecation

A

biofeedback therapy

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12
Q

When is drug treatment given?

A

associated with illness
pregnancy
or
poor diet

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13
Q

4 types of laxatives

A

bulk forming
stimulants
osmotic
faecal softeners

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14
Q

4 examples of bulk forming agents

A

wheat bran
ispaghula husk
methylcellulose
sterculia

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15
Q

When do bulking agents control fecal consistency?

A

IBS (diarrhoea)
ileostomy
colostomy

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16
Q

3 MOA of bulk forming agents

A
  1. hydrophilic action
  2. proliferation of colonic bacteria
  3. degradation of polysaccharides
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17
Q

How does hydrophilic action work in bulking agents?

A

causes water retention in gut lumen

expands and softens feces

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18
Q

Proliferation of colonic bacteria in bulking agents?

A

increases fecal bulk
stimulates colonic mucosal receptors
promotes peristalsis

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19
Q

Degradation of polysaccharides in bulking agents?

A

degradation of polysaccharides in sterculia

to substances that have an osmotic laxative effect

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20
Q

How long do bulking agents take to work?

A

24hrs

21
Q

When are bulking agents commonly used?

A

chronic constipation
diverticular disease
IBS

22
Q

When to avoid bulking agents?

A

if colon is atonic

fecal impaction

23
Q

4 examples of stimulant laxatives

A

senna
bisacodyl
danthron
sodium picoslfate

24
Q

2 components in Senna

A

sennosides A and B

anthrone glycosides

25
Q

What are sennosides A and B metabolised by gut bacteria to?

A

rheinanthrone

26
Q

What does rheinanthrone do?

A

increases COX 2 expression in macrophage cells
increases prostaglandin E2
PEG2 decreases aquaporin 3 expression in large intestine and epithelial cells
and
stimulates peristalsis

27
Q

What does a dec in aquaporin 3 cause?

A

restricts water absorption

increases fecal water content

28
Q

What is bisacodyl hydrolysed BY?

A

hydrolysed by intestinal brush border enzymes and colonic bacteria

29
Q

Active metabolite of bisacodyl

A

BHPM

30
Q

How does BHPM work?

A

directly on colon mucosa
stimulates nerve endings in intestine/rectum walls to produce peristalsis
causes defecation

31
Q

What is a contact laxative?

A

increases fluid and salt secretion

32
Q

onset time for stimulant laxatives?

A

8-12 hours

33
Q

when should stimulants be taken

A

at bed time

34
Q

stimulant laxatives suppositories onset time

A

20 - 60 mins

35
Q

Can stimulant laxatives be used in pregnancy?

A

no

can cause uterine contraction

36
Q

chronic use of stimulant laxatives

A

atonic colon

37
Q

6 examples of osmotic laxatives

A 
Mg salts
lactulose
lacitol
PEG
sodium citrate enemas
phosphate enemas
38
Q

How do osmotic laxatives work?

A

retain fluid in the colon by osmosis

39
Q

time onset for phosphate enemas

A

30 mins

40
Q

when are phosphate enemas used

A

prior to surgery or sigmoidoscopy

41
Q

time onset of lactulose/lacitol (sugars)

A

up to 48 hours

42
Q

example of softener

A

docusate sodium

43
Q

What is docusate sodium?

A

a surfactant

44
Q

How do softeners work?

A

decrease surface tension and emulsification of fecal matter
allows water to penetrate and mix with stool
softens the stool

45
Q

When can rectal preparations of softeners not be used?

A

in haemorrhoids

46
Q

What drug can be used after 2 failed treatments?

A

libiprostone

47
Q

What is lubiprostone?

A

a bicyclic fatty acid derived from prostaglandin E1

48
Q

How does lubiprostone work?

A

activates ClC-2 chloride channel on apical aspect of GI epithelial cells
produces Cl rich fluid secretions

49
Q

What is lubiprostone used to treat?

A

chronic idiopathic constipation in adults
tried at least 2 laxatives from different classes at highest tolerated dose
for at least 6 months
failed to provide relief
and
opioid constipation

Abdel (3 decks)

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