GI 14

Question 1

What is the definition of constipation?

Answer 1

Passage of hard stools less frequently than the patient’s normal pattern, often with discomfort.

Question 2

Which groups are more likely to suffer from constipation?

Answer 2

Elderly, pregnant individuals, bedridden patients, and young children.

Question 3

What are common symptoms of constipation?

Answer 3

Difficulty or pain passing stools, abdominal discomfort, bloating, wind, nausea, headache, anorexia.

Question 4

What are danger symptoms in constipation?

Answer 4

Alternating with diarrhoea, blood/mucus in motions, major habit changes (esp. >40yrs), weight loss, vomiting, fever, angina, abuse of laxatives.

Question 5

When should constipation symptoms be referred?

Answer 5

If >2 weeks with no cause, severe pain, bleeding, weight loss, sudden change over age 40.

Question 6

What are some differential diagnoses for constipation?

Answer 6

Parkinson’s, MS, cancer, GI obstruction, depression, stress, hypothyroidism, electrolyte imbalance, unwillingness to defecate.

Question 7

Which medications are associated with constipation?

Answer 7

Aluminium antacids, opioids, diuretics, calcium channel blockers, anticholinergics, iron preparations.

Question 8

What non-drug advice can help relieve constipation?

Answer 8

Increase fluid intake, increase exercise, cautiously increase fibre intake.

Question 9

What are the four main laxative types used for constipation?

Answer 9

Bulk-forming, osmotic, stimulant, and faecal softeners/lubricants.

Question 10

Describe bulk-forming laxatives and give examples.

Answer 10

Act like fibre to stimulate peristalsis. E.g., bran, ispaghula husk. Onset: 24–36 hrs. Drink plenty of fluids.

Question 11

Describe osmotic laxatives and give examples.

Answer 11

Retain fluid in bowel. E.g., macrogol, lactulose. Onset: up to 3 days.

Question 12

Describe stimulant laxatives and give examples.

Answer 12

Increase motility. E.g., senna, bisacodyl, sodium picosulfate, glycerin suppositories. Onset: 8–12 hrs.

Question 13

Describe faecal softeners/lubricants and their considerations.

Answer 13

Reduce surface tension of stools. E.g., docusate sodium. Liquid paraffin not recommended due to fat vitamin malabsorption and pneumonia risk.

Question 14

What causes haemorrhoids and what are their symptoms?

Answer 14

Caused by straining, pregnancy, poor habits. Symptoms: swelling, itching, discharge, red blood. Treatments: astringents, anti-inflammatories, local anaesthetics.

Question 15

What is the definition of diarrhoea?

Answer 15

Increased frequency of defecation with looseness of the motion.

Question 16

Which patient groups are at higher risk with diarrhoea?

Answer 16

Very young children and elderly due to dehydration risk.

Question 17

What are symptoms of diarrhoea?

Answer 17

Watery stools, abdominal cramps, flatulence, weakness, nausea, vomiting, fever.

Question 18

What are danger signs in diarrhoea that indicate referral?

Answer 18

Blood/mucus in stools, dehydration signs (lethargy, dry mouth), prolonged duration, vomiting, fever, recent travel.

Question 19

How is diarrhoea managed in children under 5?

Answer 19

Monitor hydration, continue feeds, avoid juice/carbonated drinks, use oral rehydration solutions if dehydrated, seek referral if vomiting or not drinking.

Question 20

What are some differential diagnoses for diarrhoea?

Answer 20

IBD, pseudomembranous colitis, ulcerative colitis, Crohn’s disease, diabetes, thyrotoxicosis, cancer.

Question 21

Which medications are associated with diarrhoea?

Answer 21

Magnesium antacids, antibiotics (e.g., clindamycin), metformin, NSAIDs, digoxin, PPIs, furosemide.

Question 22

What is the role of oral rehydration therapy in diarrhoea?

Answer 22

Corrects fluid and electrolyte imbalance. Does not stop diarrhoea. Not needed if adult drinks well.

Question 23

What is the main OTC antidiarrhoeal agent and its caution?

Answer 23

Loperamide. Not for children <12yrs. Slows transit time, enhances water/electrolyte absorption.