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