1/
Constipation
We have all experienced it.
Viewed as a benign diagnosis (though not benign to the person experiencing it).
You need to know when it is not a "benign" diagnosis but rather a proximal clue to a sinister diagnosis.
Constipation
We have all experienced it.
Viewed as a benign diagnosis (though not benign to the person experiencing it).
You need to know when it is not a "benign" diagnosis but rather a proximal clue to a sinister diagnosis.
2/
During 28-hour calls in the hospital, I definitely experienced constipation, likely reflecting my lack of fluid intake. And trust me it was not benign to me though increasing fluid intake resolved this problem.
ncbi.nlm.nih.gov
During 28-hour calls in the hospital, I definitely experienced constipation, likely reflecting my lack of fluid intake. And trust me it was not benign to me though increasing fluid intake resolved this problem.
ncbi.nlm.nih.gov
3/
Red flags that should prioritize a secondary etiology as opposed to a functional cause include
🫵Acute onset without prior history
🫵Inflammation
🫵Iron deficiency anemia (? 2/2 colon cancer)
🫵Neuro symptoms (? 2/2 myelopathy or cauda equina syndrome)
🫵Obstructive symptoms (? 2/2 colon cancer)
Red flags that should prioritize a secondary etiology as opposed to a functional cause include
🫵Acute onset without prior history
🫵Inflammation
🫵Iron deficiency anemia (? 2/2 colon cancer)
🫵Neuro symptoms (? 2/2 myelopathy or cauda equina syndrome)
🫵Obstructive symptoms (? 2/2 colon cancer)
4/
1st step is to review meds for iron, opioids, or anticholinergics
Tests to order in most
🫵CBC (look for anemia, if present then iron studies)
🫵Comprehensive metabolic panel (look for hyperglycemia, hypercalcemia, hypokalemia)
🫵TSH (look for hypothyroidism)
Other tests based on unique findings
+/- CT-abd/pelvis (acute onset, obstructive signs)
+/- Colonoscopy (iron deficiency)
+/- MRI (neuro findings)
1st step is to review meds for iron, opioids, or anticholinergics
Tests to order in most
🫵CBC (look for anemia, if present then iron studies)
🫵Comprehensive metabolic panel (look for hyperglycemia, hypercalcemia, hypokalemia)
🫵TSH (look for hypothyroidism)
Other tests based on unique findings
+/- CT-abd/pelvis (acute onset, obstructive signs)
+/- Colonoscopy (iron deficiency)
+/- MRI (neuro findings)
5/
No red flags then likely dealing with/ an idiopathic or functional cause of constipation like slow transit defecation, dyssynergic defecation, or IBS-C (+/- mild abdominal pain)
No red flags then likely dealing with/ an idiopathic or functional cause of constipation like slow transit defecation, dyssynergic defecation, or IBS-C (+/- mild abdominal pain)
6/
Complications of constipation?
Fecal impaction → incresed pressure of mucosal wall → decreased blood -> stercoral ucler → bleeding +/- anemia and/or perforation
Straining → hemorrhoids, anal fissure
Sigmoid volvulus
Complications of constipation?
Fecal impaction → incresed pressure of mucosal wall → decreased blood -> stercoral ucler → bleeding +/- anemia and/or perforation
Straining → hemorrhoids, anal fissure
Sigmoid volvulus
7/
In summary
🫵no symptom is ever benign to the person who has the symptom
🫵need to know when constipation is likely a proximal clue to a secondary (nonfunctional) cause
🫵constipation independent of its etiology can lead to complications
Study this amazing figure created by the greatest schema creator of all time @rabihmgeha
clinicalproblemsolving.com
In summary
🫵no symptom is ever benign to the person who has the symptom
🫵need to know when constipation is likely a proximal clue to a secondary (nonfunctional) cause
🫵constipation independent of its etiology can lead to complications
Study this amazing figure created by the greatest schema creator of all time @rabihmgeha
clinicalproblemsolving.com
8/
BTW what prompted this thread is a soon-to-be-released RLRCPSolvers.com episode. We tackle bread and butter with the hope of promoting excitement for clinical reasoning and better patient care through higher diagnostic accuracy.
BTW what prompted this thread is a soon-to-be-released RLRCPSolvers.com episode. We tackle bread and butter with the hope of promoting excitement for clinical reasoning and better patient care through higher diagnostic accuracy.
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