Constipation Adynamic Ileus

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Constipation (nejm 2003:349 1360)

• Definition (Rome III criteria): must include 2 of the following (in at least ' 4 of BMs):

straining during defecation, lumpy hard stools, incomplete evacuation, sensation of anorectal obstruction blockage; stool frequency <3 per wk

• Etiology: fxnal (nl transit, slow transit, pelvic floor disorders. IBS); obstruction

(cancer, stricture); metabolic (DM. hypothyroid. hypoK. preg.. panhypopiL. hyperCa); meds (opioids, anticholinergics ind.TCAs & antipsychotics, iron. CCB); neurogenic (Parkinson's. Hirschsprung's, amyloid. MS. Chagas. autonomic neuropathy)

• Treatment (fiber supplementation — osmotic laxative -♦ stimulant laxative)

bulk laxatives (psyllium, methylcellulose. polycarbophil): t colonic residue, t peristalsis osmotic laxatives (Mg, sodium phosphate, lactulose, etc.): draw water into intestines stimulant laxatives (senna, castor oil. bisacodyl. docusate sodium): Î motility & secretion rectal enema suppository (phosphate, mineral oil, tap-water, soapsuds, bisacodyl) tegaserod: Î motility, but recently withdrawn from market b c ? CV toxicity lubiprostone: î secretion (useful for severe constipation)

Adynamic ileus

• Definition: loss of intestinal peristalsis in absence of mechanical obstruction

Ogilvie's = acute colonic adynamic ileus in presence of competent ileocecal valve

• Précipitants: intra-abd. process (surgery, pancreatitis, peritonitis); severe medical illness

(eg. PNA. sepsis); intestinal ischemia; meds (opiates, anticholinergics); electrolyte abnl

• Clinical manifestations: abd. discomfort, N V. hiccups, abd. distention. 1 or absent bowel sounds, no peritoneal signs (unless perforation); cecum ^10-12 cm * rupture

• Dx: supine & upright abdominal films gas-filled loops of small & large intestine; must exclude mechanical obstruction (absence of gas in rectum); consider abd. CT

• Treatment: NPO. mobilize (walk. roll), d c drugs that i intestinal motility, enemas;

decompression (NGT. rectal tubes, colonoscope); erythromycin, neostigmine

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Constipation Prescription

Constipation Prescription

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