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Clin Med II - GI > Constipation, SBO, Toxic Megacolon Geralds > Flashcards

Constipation, SBO, Toxic Megacolon Geralds Flashcards

(46 cards)

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1
Q

Definition of constipation

A

A group of syndromes w/similar findings that include:

  • Unsatisfactory defecation (infrequent stools)
  • Difficult stool passage
  • OR both
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2
Q

What are characteristics of constipation?

A
  • Less than 3 BMs per week
  • Hard stools
  • Excessive straining
  • Prolonged time spent on commode
  • Sense of incomplete evacuation of stool
  • Abdominal discomfort or bloating
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3
Q

Epidemiology of constipation

A
  • More in children, elderly
  • Females 2:1
  • Nonwhites
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4
Q

Primary etiologies of constipation

A
  • Slow colonic transit times (normal is 35 hrs, slow is 72+ hrs)
  • Pelvic floor/anal sphincter dysfunction
  • Functional (normal transit time and sphincter function yet problems w/bloating, hard stools, pain)
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5
Q

Secondary etiologies of constipation

A
  • IBS
  • Endocrine
  • Metabolic
  • Mechanical
  • Pregnancy
  • Meds
  • Neuro disorders
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6
Q

Meds that can cause constipation

A
  • Anticholinergics (antidepressants, narcotics, antipsychotics)
  • Antacids
  • CCBs
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7
Q

Pathophys of fecal production

A
  • Food in stomach
  • Ileocecal valve relaxes
  • Chyme enters colon
  • Peristalsis moves chyme through colon
  • Na is absorbed from chyme in exchange for K and bicarb
  • Water follows
  • Chyme is converted into feces
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8
Q

Meals reach colon in:

A

4 hrs

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9
Q

Meals reach pelvic colon in:

A

8 hrs

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10
Q

What initiates the defecation reflex?

A

Rectal distension

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11
Q

Risks of constipation

A
  • Age, disability
  • Dehydration
  • Hypothyroid
  • Hypokalemia
  • Hypercalcemia
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12
Q

What are red flags of constipation that you should look out for?

A
  • New onset over 50
  • Hematochezia/melena
  • Unintentional wt loss
  • Night sweats, fever
  • Anemia
  • Neuro defects
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13
Q

How is constipation diagnosed?

A

ROME III Criteria (at least 2 for 12 wks in the past 6 months)

  • Less than 3 stools/wk
  • Straining at least 1/4 of time
  • Hard stools
  • Manual assist
  • Sense of incomplete evacuation
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14
Q

How do loose stools present in constipation?

A
  • RARELY seen w/o use of laxatives

- EXCEPT w/fecal impaction

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15
Q

How is stool classified?

A

Bristol Stool Chart

  • Types 1-2 hard/lumpy
  • Types 3-4 normal
  • Types 5-7 liquidy
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16
Q

How can colonic transit time be measured?

A
  • SITZMARK marker ingested
  • Plain films taken 5 days later
  • Retention 20+% is slow transit
  • Markers in distal colon/rectum suggest defecation disorder
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17
Q

What diagnostic procedures are useful in defecation problems?

A
  • Balloon expulsion
  • Defecography (proctogram) using barium paste
  • Anorectal manometry w/a rectal catheter
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18
Q

What is used to treat bloating, discomfort, straining?

A

Osmotic agents

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19
Q

What is used to treat hemorrhoids/fissures?

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A

Stool softeners to make defecation easier

20
Q

Non-pharm treatment of constipation

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A

If no known secondary cause, then:

  • Regular exercise
  • Increased fluid intake
  • Bowel habit training
21
Q

Pharmacologic treatment of constipation

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A
  • Bulking agents
  • Stimulant laxatives
  • Enemas
22
Q

What is important to remember when using bulking agents?

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A

Use adequate amount of liquids

23
Q

What agents are used for pre-procedural stool evacuation?

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A
  • PEG 4

- Mag Citrate

24
Q

Major complication of constipation

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A

Fecal impactions (can lead to large bowel obstruction, partial or complete)

25
Treatment of fecal impaction
Manual disimpaction
26
Define acute paralytic ileus
Neuro failure or loss of peristalsis in the intestine | *Not a true obstruction
27
What bowel obstruction is common in hospitalized pts?
Acute paralytic ileus
28
Causes of acute paralytic ileus
- Intra abdominal process (surgery, peritonitis) - Severe illness (PNA, electrolytes abnormality) - Meds (opioids, anticholinergic, phenothiazines)
29
What order does GI motility normalize post-op and when?
- Small bowel (hours) - Stomach (24-48 hrs) - Colon (48-72 hrs)
30
Post op paralytic ileus risk is reduced by:
- Use of pt controlled anesthesia - Avoidance of IV opioids - Early ambulation - Gum chewing - Clear liquid diet
31
Pain with a paralytic ileus may indicate:
Small bowel mechanical obstruction (may present as ileus first)
32
Treatment of paralytic ileus
- Restrict oral intake - NG tubes to LWS if N/V from ileus refractory - IV fluids/parenteral nutrition - Meds to reverse mu-opioid receptor antagonist
33
What is Ogilvie syndrome?
- Complication of paralytic ileus - Colonic pseudo obstruction - Disruption of intestinal motor function leading to massive dilation in absence of mechanical obstruction * NOT toxic megacolon
34
What is a complication of paralytic ileus?
Ogilvie syndrome
35
Who is affected by Ogilvie syndrome?
- 60+ yo - Men - Hospitalized - Post op CABG/THR - Meds
36
What must be excluded when evaluating for Ogilvie syndrome?
Toxic megacolon d/t C diff infection (use stool test in pts w/abdominal distension)
37
Treatment of Ogilvie syndrome
- Treat underlying disorder - Give abx if sepsis suspected - Conservative management for 24-48 hrs is preferred (if cecal diameter less than 12 cm) - Keep NPO - IV hydration
38
What pharm treatments can be given for Ogilvie syndrome?
- Neostigmine | - Antimotility agents
39
Types of small bowel obstruction
- Partial (low grade) | - Complete (high grade)
40
Causes of small bowel obstruction
- Adhesions (74% cases) - Malignancy - Hernia - IBD - Misc
41
If a patient cannot pass gas, what is suspected?
Small bowel obstruction
42
Treatment of small bowel obstruction
- Surgery indicated if peritonitis, bowel ischemia | - Close monitoring
43
What may be more effective for bowel decompression?
Transnasal ileus tube advanced endoscopically may be more effective than regular NG tube
44
Define toxic megacolon
- Life threatening complication of other intestinal conditions - Widening (dilation) of large intestine w/in 1-3 days
45
Causes of toxic megacolon
IBD (NOT IBS) - Crohn's, UC, C diff diarrhea - Toxic refers to inflamm/infection/acute
46
Treatment of toxic megacolon
- Fluids and electrolytes (not usually enough to reverse condition, used to prevent dehydration and shock) - Most cases need surgery

Clin Med II - GI (17 decks)

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