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24 Cards in this Set
- Front
- Back
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Most common GI complaint how it is defined?
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Constipation- less than 3 bm's per week
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Most common Constipation in?
gender? Race? Age? Lifestyle Income Education |
Women
Black >60yr >stationary >poor >ignorant |
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Causes general of Constipation
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1. Obstruction of outflow from colon
2. Metabolic/Endocrine disorders 3. Idiopathic 4. Neurological |
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Causes of constipation Outflow obstruction?
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1. Obstruction- usually advanced and distally located
2. Stricture- diverticulitis, ischemia, IBD 3. Anal narrowing- strictures, fissures, carcinoma, foreign bodies, hemorrhoids |
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most common metabolic/endocrine disorder causing constipation:
other causes? Two common causes of constipation in elderly? |
DM (60%)
pregnancy, hypothyroidism, hyper calcemia, hypokalemia idiopathic (multifactorial) - straining, fecal impaction |
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Most common cause of constipation in children?
known as? |
functional (idiopathic) - painful BM, they train external sphincter not to open due to past experience
"Rectosphincteric dyssynergia" |
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Mechanism of Hirschprungs?
Diagnose how? |
absence of ganglion cells in submucosal and myenteric plexi of the colon, poop gets stuck, colon dilates
RECTAL BIOPSY- gold standard Barium enema, anorectal manometry, Abd radiograph |
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Middle aged adults most common cause of constipation
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Typically women
• Pscyhosocial stress (Irritable bowel syndrome) • May have a motility disorder. |
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Adbominal radiograph for Hirschprungs?
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will show decreased or absent air in the distal colon with dilated loops of bowel proximal
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Other than Hirschprung's what are neurological related causes of Constipation?
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1. – Parkinson’s disease
2. Dementia 3. Multiple Sclerosis Spinal cord lesions depend on below or above L1-2 (conus medullaris) |
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Deposition of dark pigmentation in the colonic mucosa after long standing use of anthraquinone containing laxatives
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melanosis coli
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What is melanosis coli?
Effects? |
dark pigmentation deposited in colonic mucosa post long-term laxative (containing anthraquinone) use
- damage to myenteric plexus, excessive loss of fluids, electrolytes from lumen, mucosal hypertrophy |
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Tx of constipation?
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Treat underlying condition (meds, length of problem, coexistent symptoms, endocrine, underlying disease "DM")
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If idiopathic, then what is treatment?
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If idiopathic, then change diet, increase insoluble fiber (add bulk), increase H2O intake, change behaviors, laxatives (bulk-forming, osmotic, stimulant)
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For PE for constipation what do you need to do and what are you looking for?
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Physical examination:
1. – Include careful neurologic evaluation. 2. – Anorectal exam: fissures, hemorrhoids, mass; tone of anal sphincter. 3. – Guaiac testing- blood in stool 4. – Pelvic examination: rectocele- rectum in vagina |
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For Lab for constipation what do you need to do and what are you looking for?
Best go to imaging? |
Colonoscopy (most common)
- CBC, Fasting sugar, Ca, TSH, |
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If high cholesterol and high sugar what type of fibers do you want pt to use?
ex? |
soluble fibers- oat bran, pectin, beans, nuts, seeds
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What are the insoluble fibers and what do they serve as?
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Cellulose (plants), wheat bran, whole grains
- add bulk and soften stools |
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Pharmacologic therapies for constipation
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1. bulk- forming laxatives (best)
2. Mineral oil 3. Osmotic laxative 4. Magnesium 5. Stimulant- be careful 6. Prokinetic- never in Old pts 7. Surgery- only for Hirschsrpung |
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most common metabolic/endocrine disorder causing constipation:
other causes? Two common causes of constipation in elderly? |
DM (60%)
pregnancy, hypothyroidism, hyper calcemia, hypokalemia idiopathic - straining, fecal impaction |
|
Most common cause of constipation in children?
Mechanism of Hirschprungs? |
idiopathic, functional - painful BM, they train external sphincter not to open
absence of ganglion cells in submucosal and myenteric plexi of the colon, poop gets stuck, colon dilates |
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How to dx Hirschprungs?
Neurological causes of constipation? Tx of choice for Hirschprungs? |
BE, AXR, anorectal manometry, rectal biopsy
Parkinson's, dementia, MS, spinal cord lesions/injuries, trauma surgery, resection |
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What is melanosis coli?
Effects? |
dark pigmentation deposited in colonic mucosa post long-term laxative (containing anthraquinone) use
damage to myenteric plexus, excessive loss of fluids, electrolytes from lumen, mucosal hypertrophy |
|
Tx of constipation?
If idiopathic, then what? |
Treat underlying condition
If idiopathic, then change diet, increase insoluble fiber (add bulk), increase H2O intake, change behaviors, laxatives (bulk-forming, osmotic, stimulant) |
