diagnosis of constipation
TRANSCRIPT
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ConstipationPresented by:
Ghaida Al-Rashed
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Diagnosis of constipation
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Learning objectives
• Investigations
• Treatment
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Diagnosis
Constipation is a very common condition.
Your GP will not usually need to carry out any tests or procedures, but will confirm a diagnosis of constipation based on:
• Symptoms • Medical history
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• If the patient experiencing severe symptoms, your doctor may request further tests and investigations .
• Indications for investigation include:• Age >40 years.• A recent change in bowel habit.• Associated symptoms (weight loss, rectal bleeding, mucous
discharge).
Further tests
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Do You Order Additional Laboratory Studies or Other Investigations?
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Laboratory Studies• Blood tests, Serum chemistry and thyroid tests, to
diagnose or rule out other conditions.
• Fecal occult blood test.
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Flexible Sigmoidoscopy or Colonoscopy
Both tests have similar procedure.
• Flexible Sigmoidoscopy: to view just the rectum and sigmoid until the splenic flexure is identified.
• Colonoscopy : to view the rectum and entire colon.
Initially Sigmoidoscopy if reveals no abnormal findings we will use Colonoscopy.
o During these tests, the doctor may perform a biopsy (several small pieces of tissue from different areas) .
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Colorectal transit studieso Tests show how the stool moves through your colon.
o Determined in patients suspected of having a colonic motility disorder.
o Achieve by observing the passage of orally administered radioactive markers and more X-rays are taken
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Con ..
• A patient with outlet obstruction tends to retain the markers in the left colon and sigmoid, whereas a patient with colonic dysmotility may move the markers throughout the colon.
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:Type of radioactive marker
Radiopaquemarkers
Scintigraphy
the patient will swallow capsules with small radioactive markers.
the patient will eat a meal that contains radioactive substances.
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Anorectal Function TestsAnorectal Manometry Insert a thin tube that has pressure sensors + balloon that
attached to one end is inserted into your rectum and is attached to a machine to check:
1. Sensitivity of your rectum is and how well it works.2. The tightness of the muscles around your anus.
3. How well they respond to nerve signals.
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Lower GI series• X-ray exam of colon to help diagnose
problem.
• Determined in patients suspected of having obstructing colon cancer in the setting of chronic constipation
• Before procedure Follow a clear liquid diet for 1 to 3 days before the procedure.
• During the procedure the doctor will fills the patient’s colon with barium, to make the colon problem more visible on x-rays
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Defecography• X-ray of the rectum during defecation.
• Should be performed if an obstruction is suspected at the level of the anal canal.
• During this procedure, the doctor inserts a soft paste made of barium into the patient’s rectum, then pass the barium paste as you would stool.
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Computed Tomography
• Abdominal CT can reveal abdominal tumor.
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Treatment
Suppose your additional studies do not provide a clue to underlying disorders, which treatment options do you
discuss with this patient?
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Treatment For Constipation may Include The Following:
oGeneral management:• Treat the cause.• Diet and lifestyle changes.
• Drug therapy (Consider drugs only if the above measures fail)
If failed
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Diet and Lifestyle Changes1. Increased fluid intake.2. Eating more fruits and vegetables .3. Eating more fiber. 4. Exercise most days of the week.5. Don't ignore the urge to have a bowel movement.
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Drug therapy Laxatives:
• Use laxatives only if a doctor says you should.
• There is Several types of laxatives each one have different mechanism.
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Laxatives Therapy
I. Fiber supplements are best choice
• Absorb water and make stool softer.• Safe to use everyday.• Be sure to drink at least 8 to 10
glasses of water everyday.
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Con..• Other types of laxatives should only be used for
a short timeI. Lubricants (mineral oil)• Soften and lubricate stool.
II. Stool Softeners• Provide moisture to stool.
III. Stimulants• Cause muscle contractions in intestines
IV. Saline laxatives• Draw water into colon.
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Points to Remember
• Eat a variety of foods. whole grains, and fresh fruits and vegetables.• Drink plenty of liquids.• Exercise regularly.• Don’t ignore the urge to have a bowel movement.• Most people do not need laxatives. Your doctor may
recommend them for a limited time only.• Some Medicines may cause constipation
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Summary
What can we do to treat the
constipation ?
When we do
additional
investigation ?
How can we
diagnose the
constipation?
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References • http://
www.mayoclinic.org/diseases-conditions/constipation/basics/treatment/con-20032773
• http://emedicine.medscape.com/article/184704-treatment#aw2aab6b6b2
• http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/constipation/Pages/treatment.aspx
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