Constipation: Difference between revisions

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==Workup==
==Workup==
===Acute===
#CBC (anemia)
#Chem7 (hypoK or hyperCa)
#TSH


 
===Chronic===
Chronic --> outpt
#outpt
 
Acute --> CBC (anemia), Chem7 (hypoK or hyperCa), TSH
 


==Differential==
==Differential==
 
#Acute
 
##Diet
I. Acute
###Dec fluids
 
###Dec fiber
    A. Diet
##Drugs
 
###Anticholinergics
          1) Dec fluids
###Antacids
 
###Antihypertensives
          2) Dec fiber
###Narcotics
 
###Symptathomimetics
    B. Drugs
###Laxative abuse
 
###NSAIDS
          1) Anticholinergics
##Daily routine
 
###Immobility/lack exercis
          2) Antacids
###Travel
 
###Stress
          3) Antihypertensives
###Failure respond to urge
 
##Disease
          4) Narcotics
###Anatomic
 
####Painful (hemorrhoids, fissure)
          5) Symptathomimetics
####Intrinsic (diverticulitis, CA, obstruction)
 
###Metabolic
          6) Laxative abuse
####Hypothyrd/adrenal
 
####Hypokal/Ca/RF
          7) NSAIDS
#Chronic
 
##Hypertonic
    C. Daily routine
###IBD
 
###Diverticulosis
          1) Immobility/lack exercis
##Hypotonic
 
###Neurogenic
          2) Travel
####Dementia/CVA
 
####DM
          3) Stress
####MS/ALS
 
####Spinal cord lesion
          4) Failure respond to urge
####Parkinson's
 
###Psychogenic (psychosis)
    D. Disease
###Debilitated
 
##Habit (toilet training)
          1) Anatomic
 
              i. Painful (hemorrhoids, fissure)
 
              ii. Intrinsic (diverticulitis, CA, obstruction)
 
          2) Metabolic
 
              i. Hypothyrd/adrenal
 
              ii. Hypokal/Ca/RF
 
II. Chronic
 
    A. Hypertonic
 
          1) IBD
 
          2) Diverticulosis
 
    B. Hypotonic
 
          1) Neurogenic
 
              i. Dementia/CVA
 
              ii. DM
 
              iii. MS/ALS
 
              iv. Spinal cord lesion
 
              v. Parkinson's
 
          2) Psychogenic (psychosis)
 
          3) Debilitated
 
    C. Habit (toilet training)
 


==Treatment==
==Treatment==
===Basic===
===Basic===
Do not use colace


#Fiber (bran not rughage)
#Increased fluids
#Bulk agents (Metamucil)
#Exercise
#Respond quickly urge to defecate


*do not use colace
===Acute===
 
#Mineral oil (peds)
1) Fiber (bran not rughage)
##15-30mL per yr of age (QD-BIDx3dy)
 
#Milk of Mag
2) Increased fluids
##15-30mL (QD-BID)
 
##cotraindicated with renal failure
3) Bulk agents (Metamucil)
#Mag Citrate
 
##200mL once
4) Exercise
##cotraindicated with renal failure
 
#Fleets Enema
5) Respond quickly urge to defecate
 
 
===Acute:===
 
 
1) Mineral oil (peds)
 
--> 15-30mL per yr of age (QD-BIDx3dy)
 
2) Milk of Mag
 
--> 15-30mL (QD-BID)
 
-cotraindicated with renal failure
 
3) Mag Citrate
 
--> 200mL once
 
-cotraindicated with renal failure
 
4) Fleets Enema
 


===Algorithm===
===Algorithm===
 
#Associate pain?
 
##Pain --> hemorrhoids?
I. Associate pain?
###Yes --> hydrocort, etc
 
###No --> fissure?
    A. Pain --> hemorrhoids?
####Yes --> (treat, ?IBD)
 
####No --> (GI ref, ?mass lesion)
          1) Yes --> hydrocort, etc
##No pain --> urge to defecate?
 
###Yes --> stool in vault?
          2) No --> fissure?
####Yes --> neuro, chronic dz
 
####No --> R/O meds, electrolyes, DM, thyroid --> IBS
              i) Yes --> (treat, ?IBD)
###No --> dementia, retardation, DM, myopathy, obstruction
 
              ii) No --> (GI ref, ?mass lesion)
 
    B. No pain --> urge to defecate?
 
          1) Yes --> stool in vault?
 
              i) Yes --> neuro, chronic dz
 
              ii) No --> R/O meds, electrolyes, DM, thyroid --> IBS
 
    2) No --> dementia, retardation, DM, myopathy, obstruction
 


==Source ==
==Source ==
3/12/06 DONALDSON (adapted from Rosen)
3/12/06 DONALDSON (adapted from Rosen)


[[Category:GI]]
[[Category:GI]]

Revision as of 05:40, 14 March 2011

Workup

Acute

  1. CBC (anemia)
  2. Chem7 (hypoK or hyperCa)
  3. TSH

Chronic

  1. outpt

Differential

  1. Acute
    1. Diet
      1. Dec fluids
      2. Dec fiber
    2. Drugs
      1. Anticholinergics
      2. Antacids
      3. Antihypertensives
      4. Narcotics
      5. Symptathomimetics
      6. Laxative abuse
      7. NSAIDS
    3. Daily routine
      1. Immobility/lack exercis
      2. Travel
      3. Stress
      4. Failure respond to urge
    4. Disease
      1. Anatomic
        1. Painful (hemorrhoids, fissure)
        2. Intrinsic (diverticulitis, CA, obstruction)
      2. Metabolic
        1. Hypothyrd/adrenal
        2. Hypokal/Ca/RF
  2. Chronic
    1. Hypertonic
      1. IBD
      2. Diverticulosis
    2. Hypotonic
      1. Neurogenic
        1. Dementia/CVA
        2. DM
        3. MS/ALS
        4. Spinal cord lesion
        5. Parkinson's
      2. Psychogenic (psychosis)
      3. Debilitated
    3. Habit (toilet training)

Treatment

Basic

Do not use colace

  1. Fiber (bran not rughage)
  2. Increased fluids
  3. Bulk agents (Metamucil)
  4. Exercise
  5. Respond quickly urge to defecate

Acute

  1. Mineral oil (peds)
    1. 15-30mL per yr of age (QD-BIDx3dy)
  2. Milk of Mag
    1. 15-30mL (QD-BID)
    2. cotraindicated with renal failure
  3. Mag Citrate
    1. 200mL once
    2. cotraindicated with renal failure
  4. Fleets Enema

Algorithm

  1. Associate pain?
    1. Pain --> hemorrhoids?
      1. Yes --> hydrocort, etc
      2. No --> fissure?
        1. Yes --> (treat, ?IBD)
        2. No --> (GI ref, ?mass lesion)
    2. No pain --> urge to defecate?
      1. Yes --> stool in vault?
        1. Yes --> neuro, chronic dz
        2. No --> R/O meds, electrolyes, DM, thyroid --> IBS
      2. No --> dementia, retardation, DM, myopathy, obstruction

Source

3/12/06 DONALDSON (adapted from Rosen)

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