Constipation Flashcards

1
Q

What must you elucidate when a patient say they are constipated?

A

Frequency
Ease of passage
Volume

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2
Q

What are the differential diagnoses in a patient with constipation due to abnormal bowel peristalsis?

A

IBS
Medications

Hypothyroidism
Hypercalcaemia
Hypokalaemia
Spinal cord compression
MS
Parkinson's disease
Diabetic neuropathy
Idiopathic megacolon/slow transit
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3
Q

What are the differential diagnoses for hard faeces?

A

Lack of dietary fibre

Dehydration

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4
Q

What are the differential diagnoses of bowel obstruction?

A

Colorectal adenocarcinoma
Sigmoid volvulus

Other pelvic masses
Colonic strictures

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5
Q

What are the differential diagnoses of a patient not pushing?

A

Haemorrhoids
Anal fissure
Pelvic floor dysfunction (eg after hysterectomy)

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6
Q

What are the red flags in a patient with constipation?

A

Severe, persistent constipation that is unresponsive to treatment

Rectal bleeding, tenesmus, or intermittent mucoid diarrhoea

Significant weight loss, iron-deficiency anaemia, and/or night sweats

PMH of UC or polyps

Strong family history of colon caner or colonic polyps

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7
Q

What does intermittent diarrhoea and constipation suggest?

A

IBS

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8
Q

What does tenesmus suggest?

A

Persistent mass in the rectum

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9
Q

Why would you ask about polyuria or thirst in a patient with constipation?

A

These would suggest hypercalcaemia

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10
Q

What is the faecal occult blood test (FOBT) used for?

A

Screening for colon cancer

May also be due to colonic angiodysplasia, colonic polyps, haemorrhoids, aspirin or warfarin

Warrants further investigation

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11
Q

What are Carcinoembryonic antigen (CEA)/CA19-9/CA125?

A

Markers of colon cancer

But they lack specificity

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12
Q

What is the constellation of symptoms in hypercalcaemia?

A

Moans (depression), groans (aches and pain), bones, and stones (renal stones)

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13
Q

What can the underlying causes of the hypercalcaemia be?

What would the blood tests results be for each of these?

A

Bone metastases
- High ALP, low PTH and high phosphate

Myeloma
- Normal ALP, low PTH and high phosphate

Hyperparathyroidism
- Normal/high ALP, normal/high PTH and low phosphate

Vit D overdose
- Low ALP, low PTH and high phosphate

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