EXAM #2: CONSTIPATION Flashcards Preview

Gastrointestinal System > EXAM #2: CONSTIPATION > Flashcards

Flashcards in EXAM #2: CONSTIPATION Deck (28):
1

What are the Rome III Criteria for constipation?

2+ of the following for 3 months:
1) Straining for 0.25% of defecations
2) Lumpy or hard stool in 0.25% of defecations
3) Sensation of incomplete evacuation
4) Sensation of anorectal blockage
5) Manual maneuver to help with 0.25% of defecations
6) Fewer than 3 defecations per week
7) Rare loose stools without laxatives

2

List the red flags relating to constipation.

- Hematochezia
- Positive occult blood
- Obstructive sx.
- Acute constipation
- Weight loss (more than 10 lbs.)
- FMHx of colon cancer
- Anemia
- Lack of response to treatment

3

What are important historical questions to ask adults with constipation?

1) Alternating diarrhea and constipation
2) Any neuro, GI, or endocrine diagnosis
3) Past GI surgery
4) Medications

4

List the key parts of the physical exam in a patient with constipation.

1) Compare weight
2) Signs of dehydration?
3) Full abdomen and rectal exam
4) Guaiac?

5

What labs should you consider ordering for a patient with constipation?

1) CBC
2) CMP
3) TSH (hypothyroid?)
4) Hgb A1C (DM?)

6

What imaging studies should you consider for a patient with constipation?

Abdominal x-ray at a minimum

7

What are the classes of drugs that are used to treat constipation?

1) Bulk laxatives
2) Osmotic laxatives
3) Stimulant laxatives
4) Enema/ stool softeners/ suppositories

8

In addition to pharmacologic therapy, what other treatment options are there for patients with constipation?

- Biofeedback
- Fecal disimpaction

9

What are the common drug classes that can cause constipation?

Antihistamines
Antispasmodics
Antidepressants
Antipsychotics
Iron supplements
Aluminum antacids
Opiates
Ca++ blockers
Beta blockers

10

What is encoporesis?

- Chronic stool withholding
- Stool finds somewhere to go i.e. there is "overflow"

11

Describe the bowel habits of infants less than 6 months old.

- Straining/crying is common
- This is NOT constipation

This is referred to as "infantile dyschezia"

12

When are most children potty trained?

4 years old

13

What is the most important thing to remember about potty training?

Need to praise the child and be a positive role model

14

What is the most common cause of constipation in children?

Function i.e. voluntary withholding
- Pain with pooping= hold it

15

What is the result of functional constipation?

Encopresis

16

What are the pathologic causes of constipation?

1) Spinal cord damage
- Spinal dysraphism i.e. malformation e.g. spina bifida
- Tumor
- Trauma
2) Endocrine
- Hypothyroid
- Hypoparathyroid
3) Hirschsprung
4) Meconium Ileus/ Cystic Fibrosis

17

When should a child have their first poop?

Within 24 to 48 hours of life

18

What are you worried about if a neonate does not have a BM within 48 hours of life?

Hirchsprung's Disease
Meconium Ileus

19

What is Meconium Ileus?

Delayed passage of meconium in children with CF
- One of the first manifestations of CF

20

What is a common cause of constipation in older children?

Sexual or rectal abuse

21

What are the red flags of constipation in children?

1) No BM within 24-48 hours of birth
2) Vomiting + constipation
3) Abnormal neuromotor development
4) Abnormal growth
5) PE not consistent with functional constipation

22

What are the three phases of medical management in functional constipation?

1) Disimpaction/ evacuation
2) Sustained evacuation
3) Weaning from intervention

23

How is disimpaction accomplished in children?

- Enemas
- Oral meds e.g. mineral oil or milk of magnesia

24

What children cannot take mineral oil?

Kids less than 1 year--risk of aspiration

25

How is sustained evacuation of stool maintained?

Stool softeners for 3-9 months

26

What is weaning in the treatment of functional constipation?

Gradually taking a child off oral laxatives

****Child should be off meds by roughly 1 year

27

What are the two phases of nutritional management in functional constipation?

1) Initially avoid dairy and starch
2) Once tone has been restored, then start additional fiber

****Don't start additional fiber initially*****

28

How is milk of magnesia dosed?

- 1 ounce per year of age
- Take for 3-5 days

Max 240mL/day