Constipation: Difference between revisions
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== Background == | ==Background == | ||
*Acute constipation is intestinal obstruction until proven otherwise | *Acute constipation is intestinal obstruction until proven otherwise | ||
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**Change in stool caliber | **Change in stool caliber | ||
== Differential Diagnosis == | ==Differential Diagnosis == | ||
=== Acute === | ===Acute === | ||
#Obstruction | #Obstruction | ||
##Tumor, stricture, [[hernia]], adhesion, [[volvulus]], [[fecal impaction]] | ##Tumor, stricture, [[hernia]], adhesion, [[volvulus]], [[fecal impaction]] | ||
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#Pain rectal conditions (e.g. [[anal fissure]], [[hemorrhoids]]) | #Pain rectal conditions (e.g. [[anal fissure]], [[hemorrhoids]]) | ||
=== Chronic === | ===Chronic === | ||
#Acute causes | #Acute causes | ||
#[[Hypothyroidism ]] | #[[Hypothyroidism ]] | ||
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#[[Hypokalemia]] | #[[Hypokalemia]] | ||
== Work-Up == | ==Work-Up == | ||
#Rectal exam | #Rectal exam | ||
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#TSH | #TSH | ||
== Treatment == | ==Treatment == | ||
#Stress adequate fluid (1.5L per day), fiber (10gm per day), and exercise | #Stress adequate fluid (1.5L per day), fiber (10gm per day), and exercise | ||
Revision as of 08:42, 7 July 2016
Background
- Acute constipation is intestinal obstruction until proven otherwise
- Red flags:
- Weight loss
- Rectal bleeding/melena
- N/V
- Fever
- Rectal pain
- Change in stool caliber
Differential Diagnosis
Acute
- Obstruction
- Tumor, stricture, hernia, adhesion, volvulus, fecal impaction
- New medicine
- Opiods, antipsychotic, anticholinergic, antacid, antihistamine
- Change in exercise
- Change in diet
- Pain rectal conditions (e.g. anal fissure, hemorrhoids)
Chronic
- Acute causes
- Hypothyroidism
- Electrolytes
- Hypokalemia
Work-Up
- Rectal exam
- Guaiac
- Chemistry (hypoK or hyperCa)
- Acute abd series (if suspect obstruction)
- TSH
Treatment
- Stress adequate fluid (1.5L per day), fiber (10gm per day), and exercise
- Meds
- Fiber
- Bran: 1 cup daily
- Psyllium (metamucil): 1 teaspoon TID
- Emollient
- Docusate (colace): 100mg QD-BID (facilitates mixture of stool fat and water)
- Stimulants
- Bisacodyl (dulcolax): 10mg PR TID
- Senna: Two tab PO QD-BID
- Saline laxative
- Milk of mangesia: 15-30 mL QD-BID
- Magnesium citrate: 100-240 mL QD-BID
- Hyperosmolar agents
- Lactulose 15-30 mL QD-BID
- Polyethylene glycol: 1 gallon/4h
- Miralax: 17gm
- Fiber