Constipation

Question 1

ROME IV Criteria

Answer 1

Diagnosing Functional Constipation: S/S > 3 months

• Straining
• Lumpy/Hard
• incomplete sensation
• obstruction sensation
• manueal manuevers to faciliatate
• <3 per week
• IBS Criteria not met

Question 2

Functional outlet obstruction

Answer 2

• reduced rectal propulsive forces and/or increased resistance to evacuation. - Pathogenesis is believed to be a result of maladaptive learning of sphincter contraction maybe initiated by pain or trauma or even neglecting the call to defecate

Question 3

Medications causing Constipation

Answer 3

• Analgesics
• Anticholinergics
• Cation-containing
• Neural-active: Opiates, hypertensives, ganglionic blockers, Vinca alkaloids, 5HT3 antagonists

Question 4

Testing for Constipation

Answer 4

• High fiber diet + Bowel Diary
• Physical exam and Anorectal exam
• Anorectal Manometry + Balloon Expulsion Test
• MRI

Question 5

Dietary Constipation management

Answer 5

• INC Fiber + Fluids
• Citrus
• Legumes

Question 6

OTC Pharm Constipation management

Answer 6

• Bulk-forming laxative: Psyllium; methylcellulose
• Soluble fiber; NOT insoluble fiber
• Osmotic Agents: Polyethylene Glycol; MOMl MagCit, Lactulose, Sorbitol
• Stimulants: Bisacodyl, Senna, Aloe, Cascara, Picosulfate
• Surfactants: Docusate Sodium

Question 7

Rx Pharm constipation Management

Answer 7

• Intestinal Secretagogues: Lubiprostoine, Linaclotide, + Plecanatide
• Prokinetics: {rucalopride
• Misoprostol
• Colchicine