379651
constipation and change in bowel
habit
- common
- causes:
depression,immobility,
idiopathic, Functional,
inadequate dietary
fibre
- causes:
depression,immobility,
idiopathic, Functional,
inadequate dietary
fibre
- rare
- a) metabolic: 1) Hypothyroidism, 2)Hypercalcaemia
b)Drugs: 1)opiates, 2)Antidepressants, 3)Verapamil
and other ca2+ blockers c)Neoplasia: 1)colon
cancaer 2) Rectal cancer
- a) metabolic: 1) Hypothyroidism, 2)Hypercalcaemia
b)Drugs: 1)opiates, 2)Antidepressants, 3)Verapamil
and other ca2+ blockers c)Neoplasia: 1)colon
cancaer 2) Rectal cancer
- clinical
features
- 1) period of constipation , 2)Has the
nature of the problem change 3)
history 4)rectal bleeding 5)Dietary
history 6) Drug history
Nota:
- History obstetric in women, pelvic trauma during protracted labour,assisted delivery Drug history- opioids,calcium antagonist, anticholinergics, iron supplements, calcium containing antacids
- 1) period of constipation , 2)Has the
nature of the problem change 3)
history 4)rectal bleeding 5)Dietary
history 6) Drug history
- E & I
- a)blood test: 1)FBC, 2)ESR 3)thyroid function and
calcium b) Barium Enema or CT colonography,
c)Transit studies d)Anorectal physiology and
defecating proctography
- a)blood test: 1)FBC, 2)ESR 3)thyroid function and
calcium b) Barium Enema or CT colonography,
c)Transit studies d)Anorectal physiology and
defecating proctography
- Managements
- a) for reassurance b)Diet and hydration
c)Laxatives= 1)stimulant laxative
2)bulk-forming laxative 3)osmotic
laxative*
Nota:
- Stimulant laxative eg. SENNA , use for short term constipation due to dependant on drugs (especially during hospitalisation) ~bulk forming laxatives eg. FYBOGEL,ISOGEL. may exacerbate symptomatic bloating ~osmotic laxative (e.g MOVICOL, MgSo4) well tolerated, first line treatment over country tablets such as milk of magnesia, epsom salt, lactulose (may cause inconvenient colic and wind
- a) for reassurance b)Diet and hydration
c)Laxatives= 1)stimulant laxative
2)bulk-forming laxative 3)osmotic
laxative*
- IN OLDER PATIENTS
- Features suggestive of underlying pathlogy
- 1)Anorexia and/weight loss
2)Nocturnal Diarrhoea /pain disturbing
sleep 3)rectal bleeding
- 1)Anorexia and/weight loss
2)Nocturnal Diarrhoea /pain disturbing
sleep 3)rectal bleeding
- Examination
Nota:
- often unrewarding
- full physical examination mandatory, -
lymphadenopathy, abdominal masses,
organomegaly , rectal examination
- Management
- Serious disease is sought from FBC, ESR iron
indices, LFTs, Thyroid function, serum calcium.
TO eliminate suspicion of colorectal cancer :
colonoscopy, barium enema, ct colonography
- Serious disease is sought from FBC, ESR iron
indices, LFTs, Thyroid function, serum calcium.
TO eliminate suspicion of colorectal cancer :
colonoscopy, barium enema, ct colonography
- Features suggestive of underlying pathlogy
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