LECTURE 66 & 67 - constipation / IBS Flashcards
(66 cards)
List common causes of constipation
- Dietary:
— Poor fluid intake
— Decreased calorie intake - Failure to heed defecation reflex
- Impaired physical mobility
- Lack of privacy (LTCF)
- Increased physiological distress
- Disease states that slow down GI motility
List disease states that slow down GI motility
Diabetes
Parkinson’s
CNS injury or disease
MS
List medications that could cause constipation
- Analgesics (opioids, NSAIDs)
- Antacids
- Agents with strong anticholinergic properties
(antihistamines, antimuscarinics, amitriptyline) - Verapamil, Clonidine, Ca Channel blockers
- Iron preparations
- Diuretics
What is considered a normal GI transit time?
30-40 hours
up to 72 hours
Describe the effect that slow GI transit time has on the movement of water in/out of stool
- Slow transit results in more time for colon to absorb water from waste
- Resulting in stool becoming hard & difficult to push out
Define constipation
Disorder of colonic motility and/or anorectal function
Usually involves both decreased frequency plus signs & symptoms
List common symptoms of constipation
Cramping
Bloating
Lumpy/hard dry stools
Straining
Sensation of incomplete evacuation or blockage
List the key features of acute constipation
- Stools are dry & hard
- Bowel movements (BMs) are painful & stools difficult to pass
- Feeling that bowels have not been fully emptied
Describe causes of acute constipation
Usually brought on by change in condition or drug
Define acute constipation
A noticeable change in normal bowel movement pattern
Less than 3 bowel movements / week
Define chronic constipation
- Symptoms lasting > 6 weeks
- May respond to laxatives, but returns when d/c meds
- Does not respond to dietary changes alone
List primary causes of chronic constipation
- Normal transit “functional” + symptomatic
- Slow transit
- Evacuation disorder
List secondary causes of chronic constipation
- Medications
- Obstruction (cancer, stricture)
- Metabolic (hypothyroid, hypercalcemia)
- Neurological (parkinsonism, MS)
- Systemic (scleroderma, amyloidosis)
- Psychiatric (depression, eating disorders)
List the Rome III criteria for functional constipation
2+ of the following:
Straining
Lumpy / hard stools
Sensation of incomplete evacuation
Sensation of anorectal obstruction / blockage
Manual maneuvers to facilitate defecations
< 3 defecations per week
What types of medications are used for GI procedure prep?
Hyperosmotics or saline laxatives
What type of diet should patients start the day prior to a GI procedure?
Clear liquid diet
ex) jello, broth, popsicles, gatorade, clear juices, coffee
When should patients begin GI procedure prep (generally)?
afternoon / evening prior to procedure
What is KEY to prepping correctly for a GI procedure?
Drinking large quantities of fluids
Describe correct dosing of Polyethylene Glycol for oral prep for GI procedures
2-4 L
8 oz q10 minutes
refrigerate
Describe the procedure for SAS prep
day before procedure
1. enjoy clear liquids all day
2. mix 1 bottle of MiraLAX into 2 bottles of gatorade (refrigerate)
3. drink an extra 8 oz of clear fluid every hour while awake
4. take 4, 5mg bisacodyl tabs at 12pm (noon)
5. at 2pm, drink 1st bottle of MiraLAX/gatorade solution over 1 hour (8oz q10-20 minutes)
6. wait 30 minutes
7. drink 2nd bottle at the same rate
Describe habits that promote regular bowel habits
- include ample fluids & fiber in diet
- PRUNES !!!
- Do NOT ignore the urge to defecate
- Establish a regular, unhurried time for bowel movements
- Encourage pts to defecate when colonic activity is greatest
Explain how patients can ensure ample fiber in diet / start including more fiber
20-30 g fiber/day
Add high-fiber foods to diet SLOWLY
(increase over 7-10 days)
How much fluids should patients consume
6-8 glasses of water per day
Give examples of high-fiber foods
Vegetables, fruit, beans, whole grains
Fresh green kiwifruit → 2 / day
Dried pitted prunes → 12 g / day
Powder psyllium → 12 g / day
