constipation and change in bowel habit

newawa
Mind Map by newawa, updated more than 1 year ago
newawa
Created by newawa over 6 years ago
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Resource summary

constipation and change in bowel habit
1 common
1.1 causes: depression,immobility, idiopathic, Functional, inadequate dietary fibre
2 rare
2.1 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
3 clinical features
3.1 1) period of constipation , 2)Has the nature of the problem change 3) history 4)rectal bleeding 5)Dietary history 6) Drug history

Annotations:

  • History  obstetric in women, pelvic trauma during protracted labour,assisted delivery  Drug history- opioids,calcium antagonist, anticholinergics, iron supplements, calcium containing antacids
4 E & I
4.1 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
5 Managements
5.1 a) for reassurance b)Diet and hydration c)Laxatives= 1)stimulant laxative 2)bulk-forming laxative 3)osmotic laxative*

Annotations:

  • 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
6 IN OLDER PATIENTS
6.1 Features suggestive of underlying pathlogy
6.1.1 1)Anorexia and/weight loss 2)Nocturnal Diarrhoea /pain disturbing sleep 3)rectal bleeding
6.2 Examination

Annotations:

  • often unrewarding
6.2.1 full physical examination mandatory, - lymphadenopathy, abdominal masses, organomegaly , rectal examination
6.3 Management
6.3.1 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
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