Gastroenterology Book

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Constipation in AdultsAka: Constipation

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  1. See Also
    1. Constipation in Children
    2. Constipation in Infants
    3. Constipation in Cancer
  2. Definition
    1. Derived from latin constipare (to crowd together)
    2. Difficult stool passage
      1. Sensation of incomplete evacuation
      2. Straining at stool
    3. Decreased stool frequency
      1. Normal frequency difficult to define
      2. In U.S., 95% of people pass >3 stools per week
  3. Physiology
    1. See Defecation
  4. Causes
    1. See Constipation Causes
    2. See Functional Constipation (most common cause)
  5. History
    1. Stool History
      1. Stool caliber
      2. Stool frequency
      3. Stool consistency
    2. Duration of constipation
      1. Organic causes present as Acute Constipation
      2. Functional causes present as Chronic Constipation
    3. Age may direct causes
      1. Consider Hirschsprung's Disease in younger patients
      2. Consider Colorectal Cancer in older patients
    4. Medication History
      1. See Medication Causes of Constipation
      2. Laxative Abuse (Phenolphthalein, senna, castor)
    5. Habits
      1. Dietary Fiber intake
      2. Clear fluid intake per day
      3. Caffeine intake
      4. Physical Exercise
      5. Ignoring urge to defecate
    6. Abdominal surgery history
      1. Risk of intra-abdominal adhesions
    7. Red flags suggestive of Organic Constipation
      1. Acute or recent onset Constipation
      2. Weight loss
      3. Abdominal Pain or cramping
      4. Rectal bleeding or Melena
      5. Nausea or Vomiting
      6. Rectal Pain
      7. Fever
      8. Change in stool caliber
  6. Exam
    1. General Physical Exam
      1. Signs of Hypothyroidism (skin dry, edema, pallor)
      2. Neurologic Exam
    2. Abdominal Exam
      1. Abdominal Mass
      2. Bowel sounds (high-pitched or absent)
    3. Perianal changes
      1. Hemorrhoids
      2. Anal Fissures
      3. Anal stenosis or stricture
    4. Digital Rectal Exam!
      1. Fecal Occult Blood testing
      2. Rectal Mass
      3. Amount and consistency of stool in rectum
      4. Anal sphincter tone
        1. Poor sphincter tone suggests neurologic deficit
  7. Management
    1. No red flag symptoms or signs
      1. See Functional Constipation (Chronic Constipation)
      2. Treat empirically
      3. If no improvement consider Organic Constipation
    2. Red Flag symptoms or signs above suggest organic cause
      1. See Organic Constipation (Acute Constipation)
  8. References
    1. Cheskin in Barker (1995) Ambulatory Medicine, p.476-81
    2. Sartor in Dornbrand (1992) Ambulatory Care, p. 221-5
    3. Arce (2002) Am Fam Physician 65(11):2283
    4. Borum (2001) Prim Care 28(3):577
    5. Wald (2000) Med Clin North Am 84(5):1231

Constipation (C0009806)

Definition (MSH)Infrequent or difficult evacuation of FECES. These symptoms are associated with a variety of causes, including low DIETARY FIBER intake, emotional or nervous disturbances, systemic and structural disorders, drug-induced aggravation, and infections.
Definition (CSP)condition in which bowel movements are infrequent or incomplete.
Definition (NCI)Constipation; irregular and infrequent or difficult evacuation of the bowels.
ConceptsSign or Symptom (T184)
ICD9564.0, 564.00
MSHD003248
BasqueESTITIKEZA
DanishObstipation
DutchObstipatie
EnglishCN - Constipation, Constipated, Constipation, Constipation symptom, Costive symptom, Costiveness, Difficult passing motion, Difficulty defaecating, Difficulty defecating, Difficulty opening bowels, Difficulty passing stool, Unspecified constipation
FinnishUMMETUS
FrenchConstipation
GermanVerstopfung/Obstipation
Hebrewatzirut
Hungarianszekrekedes
ItalianStipsi
NorwegianTREG MAGE/FORSTOPPELSE/OBSTIPASJON k59.0
PortugueseObstipacao
Spanishconstipacion, dificultad para evacuar el intestino, estrenimiento
SwedishFORSTOPPNING
Parent ConceptsDigestive symptom (C0476288), Other and unspecified gastrointestinal disorders (C0810319), Intestinal Diseases (C0021831), Parasympatholytics (C0030511), Entercolon (C0549524), SMALL/LARGE BOWEL (C0549617), Constipation (C0009806), Functional digestive disorders, NEC in ICD9CM_2008 (C0302382), Gastrointestinal system (C0012240), Symptoms and Complaints Component (C0497525), Signs and Symptoms, Digestive (C0037089), Disturbance in Bowel Function (C1333310), Colonic Diseases (C0009373), Functional disorder of intestine (C0016807), Duplicate concept (C1274013), Ambiguous concept (C1274012)
SourcesAOD, CCS, COSTAR, CSP, CST, DXP, ICD9CM, ICPC, ICPCBAQ, ICPCDAN, ICPCDUT, ICPCFIN, ICPCFRE, ICPCGER, ICPCHEB, ICPCHUN, ICPCITA, ICPCNOR, ICPCPOR, ICPCSPA, ICPCSWE, LCH, LNC, MEDLINEPLUS, MSH, MTH, NCI, NDFRT, OMIM, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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