Flashcards in Week 209 - Constipation/IBS Deck (34):
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Week 209 - Constipation/IBS: How much water on average does the colon absorb?
Converts 2l into 200ml
2
Week 209 - Constipation/IBS: The colon can be divided into two main parts, the proximal and distal, what is the function of each?
• Proximal - absorbs fluids/electrolytes, bacterial fermentation.
• Distal - reservoir.
3
Week 209 - Constipation/IBS: What is the normal colonic transit time?
25-40hrs.
4
Week 209 - Constipation/IBS: What are the two types of motility that occur in the proximal colon?
• Non-propulsive segmentation - generated by slow-wave activity which produces circular muscle contraction - mixing/absorption of contents.
• Mass peristalsis - (1-3x/day) simultaneous smooth muscle contraction propels contents.
5
Week 209 - Constipation/IBS: What are the three controlling factors of colonic motility?
• Intramural plexi - directly controls contractile behaviour.
• Extramural - modulate function.
• Transmitters - Stimulatory - Acetycholine and substance P. Inhibitory - VIP and Nitric Oxide.
6
Week 209 - Constipation/IBS: What is the definition of constipation?
• Infrequent passage of small amount of faecaes, leading to symptoms.
• Is not the same as obstructed defaecation.
7
Week 209 - Constipation/IBS: What are the main two mechanisms for constipation?
• Luminal residue insufficiency.
• Abnormalities of neuromuscular activity.
8
Week 209 - Constipation/IBS: What are the causes of chronic constipation?
• Diet
• Purgative abuse
• Idiopathic bowel disease (IBS, slow transit, mega-colon)
• Metabolic (Hypothyroidism, hypercalcaemia, hypokalaemia, uraemia)
• Drugs (opiates, iron, ganglion-blockers, anticholinergics)
• Neuromuscular disease
• Psychiatric
9
Week 209 - Constipation/IBS: Which nerve supplies the external anal sphincter?
Pudendal nerve
10
Week 209 - Constipation/IBS: What occurs to allow defaecation?
• Cortical perception of rectal filling.
• Voluntary decision
• Straining
• Decreased tone in pelvic floor and sphincters.
• Anorectal angle is reduced.
• Increase in abdominal tone.
• Passage of stool.
11
Week 209 - Constipation/IBS: What are the five factors that help to ensure continence?
• Central control.
• Functioning reservoir.
• Strong pelvic floor.
• Intact sphincter mechanism.
• Absence of peripheral neuropathy.
12
Week 209 - Constipation/IBS: What are the causes of incontinence?
• Neonatal
• Cerebral - Old age, psychiatrically disturbed.
• Degenerative - Autonomic neuropathy, Wasting diseases.
• Trauma - Obstetric, surgical, accidents.
• Idiopathic
• Diseases
13
Week 209 - Constipation/IBS: What are the four causes of obstructed defaecation?
• Rectocoele
• Rectal intussusception
• Anismus
• Idiopathic megarectum
14
Week 209 - Constipation/IBS: What is a rectocoele?
Protrusion of anterior wall of rectum, commonly follows childbirth.
Herniation may lead to obstructed defaecation.
15
Week 209 - Constipation/IBS: What is rectal intussusception?
• Preliminary stage to rectal prolapse.
• Rectal fullness or pressure.
• Tenesmus.
• Perineal pain.
16
Week 209 - Constipation/IBS: What are the symptoms of obstructed defaecation syndrome?
• Straining
• Laxative/enema dependancy
• Incomplete evacuation
• Fragmented defaecation
• Rectal Pain
• Perineal support
17
Week 209 - Constipation/IBS: What is the initial investigation for a patient presenting with chronic constipation? What are the possible findings?
Barium enema/colonoscopy
• Excludes carcinoma.
• Normal calibre colon/rectum.
• Megacolon/rectum
18
Week 209 - Constipation/IBS: Following a barium enema for the investigation of chronic constipation, you find that the colon/rectum is of normal calibre. What are the follow-up investigations?
• Defaecating proctogram.
• Colonic transit study.
• Anorectal physiology.
• Endoanal ultrasound.
19
Week 209 - Constipation/IBS: What are the techniques used for anorectal physiology analysis?
• Manometry
• Balloon inflation.
• Pudendal nerve terminal motor latency.
• EMG recording.
20
Week 209 - Constipation/IBS: What is functional constipation?
This is chronic constipation without a known cause, also known as primary and idiopathic constipation.
21
Week 209 - Constipation/IBS: What is secondary constipation?
Constipation caused by a drug or medical condition, also known as organic constipation.
22
Week 209 - Constipation/IBS: What is the difference between chronic constipation and IBS-constipation dominant?
IBS-C, has more pain associated with it. Patients with less pain are classified as chronic constipation.
23
Week 209 - Constipation/IBS: What is the diagnostic criteria for IBS?
At least 12 weeks of the last 12 months with abdo. pain/discomfort and two of the following symptoms;
- Relieved with defaecation.
- And/or change in stool frequency.
- And/or change in stool form.
24
Week 209 - Constipation/IBS: What are the four types of laxatives?
• Bulk-forming laxatives.
• Osmotic laxatives.
• Stimulant laxatives.
• Surface-wetting laxatives.
25
Week 209 - Constipation/IBS: How do bulk-forming laxatives work? Give examples.
• Retain fluid within the stool, increasing faecal mass, stimulate peristalsis.
• Ispaghula husk, Methylcellulose.
26
Week 209 - Constipation/IBS: How do osmotic laxatives work? Give examples.
• Increase fluid in large bowel, causing secretion and stimulation of peristalsis.
• Macrogols, lactulose.
27
Week 209 - Constipation/IBS: How do stimulant laxatives work? Give examples.
• Peristalsis by stimulating colonic nerves (Senna)
• Or by stimulating colonic and rectal nerves (bisacodyl, sodiumpicosulfate).
28
Week 209 - Constipation/IBS: How do surface-wetting laxatives work? Give examples.
• Reduce the surface tension of the stools allowing water to enter.
• Docusate, poloxamer.
29
Week 209 - Constipation/IBS: How should short duration constipation be managed in adults?
• Adjust any constipation-inducing medication.
• Dietary advice (Fluids, fibre)
• And oral laxatives if these are ineffective, beginning with a bulk-forming laxative.
30
Week 209 - Constipation/IBS: Aside from laxatives, what other medications should be offered for the treatment of Constipation predominant IBS?
• Pain management.
• Antidepressants.
• Probiotics.
31
Week 209 - Constipation/IBS: What pain management medication should be offered to those suffering from constipation predominant IBS?
Anti-spasmodics.
- Anti-cholinergic agents.
- Anti-muscarinics.
- Peppermint oil
Anti-depressants (They have anti-cholinergic properties)
32
Week 209 - Constipation/IBS: What is the dietary management of constipation predominant IBS?
• at least 1.5l water /day.
• Avoid too many carbohydrates and alcohol sugars, these can exacerbate symptoms.
33
Week 209 - Constipation/IBS: What are the surgical options for dysmotility?
• Colectomy and ileorectal anastomosis.
• Sacral nerve stimulation.
• Antegrade colonic enema.
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