PCM Constipation flashcards.txt

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PCM Constipation flashcards.txt
2011-11-14 20:57:27
Constipation Fissures etc

Constipation lecture
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  1. What is the 3/3 rule of constipation?
    It is normal to go 3 times per week or 3 times per day or anything in between
  2. What are the 3 Fs?
    Fiber, fluid and fun
  3. What are the drugs that can cause constipation
    • analgesics and anticholinergics
    • antihistamines, antispasmodics, antidepressants, antipsychotics
    • Cation containting supplements: iron, calcium, aluminum
    • neurally active agents: opioids antihypertensives
  4. What is an Enterocele?
    Weakness in the tissue that holds the bowel in place and the bowel falls down behind the uterus and into the vagina
  5. What are some things that can weaken the wall and cause an enterocele?
    Straining, manual labor, child birth
  6. What is an anterior rectocele?
    Rectum that pushes the wall of the vagina, pelvic floor dysfunction
  7. What are the Alarm symptoms for constipation that might be colon cancer?
    • Over 50
    • unexplained weight loss
    • anemia
    • evidence of GIB
    • perisistent or progressive pain
    • FH colon cancer
    • fasting nocturnal or large volume diarrhea
  8. what are B symptoms
    • wt loss
    • low grade fever
    • night sweats
  9. A Gaping or asymetric anal opening (i.e. a �gaping asshole�) is a sign of what type of disorder?
    Neurologic disorder impairing sphincter function
  10. Having the patient strain during the rectal exam is useful for diagnosing patients with what?
    Dyssynergic defication, rectal prolapse
  11. How do you do a physical examination for a rectocele?
    Have female patient strain with the examining finger oriented anteriorly
  12. In a patient with constipation you can do a barium X ray to identify what 4 disorders
    obstruction, megarectum, megacolon, hirshsprungs disease
  13. Atonic Colon
    loss of normal colonic relfexes and sensation
  14. Adynamic colon
    colon that is dialated and the patient is unable to move through the colon, thus they are dependent on more and more laxitives for defecation
  15. Dyssynergistic defication
    • in coordination of contraction of colonic and rectal muscles and internal and external sphincters
    • leads to attempts to defecate against closed anal sphincters
    • with or without difficulty deficating strain even with soft stools
    • on examination they are inable to voluntarily relax the external sphincters on request
  16. Megacolon
    • Lifelong constipation
    • occasional passage of an enormous formed stool
    • causes are congenital (hirschsprung disease) or aquired defects in the intrinsic innervation of the colon
  17. What are some bowel diseases that can cause constipation
    IBS, slow colonic transit, pelvic floor dysfunction
  18. what are some neurological conditions that can cause constipation?
    Parkinson's, MS, colon surgery, spinal cord injury, diabetes mellitus, pseudo-obstruction
  19. What are some complications of chronic constipation
    • urinary obstruction/infection
    • spontaneous perforation
    • stercolar ulcer � ischemia on bowel wall
    • fecaliths- appendix
  20. What anticonstipation medications should be avoided unless nessisary?
    Prokinetics, lubricating agents, routine enemas
  21. What medications should be used for constipation
    • stool softeners/ bulking agents
    • osmotic agents
    • stimulating agents
  22. what are some lifestyle/diet modifications that can help constipation
    • fiber fluids fun
    • D/C or change offending meds if possible
    • bowel retraining
    • educations and reassurance
  23. What must you give with fiber/bulk laxitives?
  24. How do surfactants work?
    Lower stool surface tension and soften so that more water enters more easily not as good as laxatives
  25. What are osmotic agents?
    • Non-absorbable agents to promote fluid shift
    • intestinal water secretion increases
    • increases stool frequency
  26. Name some osmotic agents
    PEG, Lactulose, Saline
  27. How do stimulant laxatives work?
    Alter electrolyte transit at mucosa and increase motor activity
  28. What is a fecal impaction?
    • Large mass of bulky dry hard stool in the rectum secondary to chronic constipation
    • watery stool may form higher in the bowel and leak around the impaction causing soiling or diarrhea
  29. What are some complications of fecal impaction
    • dilitation- toxic megacolon
    • rectal tears
    • rectal tissue necrosis
  30. What are some symptoms of fecal impaction?
    • Urge to deficate without ability to have a BM
    • abdominal pain
    • bloated or hard abdomen
    • anorexia
    • nausea and vomiting
    • rectal discomfort
    • generally ill feeling
    • confusion
    • leakage of wet stool or thin/pencil stool
  31. What is a contraindication to manual disimpaction, suppositories and enemas for fecal impation?
    Patients who are myelosuppressed or have altered bleeding times
  32. What are some motility tests that can be done for a patient with chronic constipation
    • anorectal manometry
    • defecography
    • pelvic floor electromyography
    • anal endosonography
  33. Anal fissures found on the sides of the anus are indicative of what diseases?
    • Chron's disease
    • ulcerative colitis
    • syphillis
    • TB
    • leukemia
    • cancer
    • HIV
  34. Anal fissures that are in the verticle plain of the rectum (the top and bottom) are indicative of what?
    Acute and chronic anal fissures
  35. Your patient has a tearing pain with defecation and sometimes a throbbing pain following defecation. They also report blood on the toilet paper after they go. You diagnose
    Anal fissure
  36. Hematochezia
    blood on toilet paper or stool
  37. Chronic fissures
    • can ulcerate with internal sphincter fibers seen at base
    • may develop sentinel pile or sentinel tag
    • may require surgery
  38. Which hemorrhoids are painful internal or external
  39. what are some risk factors for hemorrhoids
    pregnancy, obesity, chronic diarrhea, loss of muscle tone, chronic constipation, portal hypertension, professions with lots of sitting
  40. First degree hemorrhoids
    dont prolapse
  41. second degree hemorrhoids
    prolapse through anus on straining but spontaneous reduction
  42. Third degree hemorrhoids
    Prolapse and may require manual/digital reduction
  43. Fourth degree hemorrhoids
    Cannot be reduced just hang out all the time
  44. What are some treatments for internal hemorrhoids
    • rubber band ligation
    • infrared coagulation
    • bipolar diathermy
    • laser photocoagulation
    • sclerotherapy
    • cryotherapy
  45. Treatment for a bleeding hemorrhoid
  46. Treatment for a iritation and pruritus from a hemorrhoid
    analgesic creams hydrocortisone suppositories sitz baths
  47. Treatment for thrombosed hemorrhoids
    acute may require surgical intervention if significant symptoms