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Constipated Cases

Constipated Cases. Edward Warren, MD, Chair Geriatrics Carolinas Campus, January 2012. Case 1. Your patient complains of constipation because her bowels move only every 2 to 3 days. . Question 1. You tell her If there is no pain nor straining, then this may be normal.

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Constipated Cases

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  1. Constipated Cases Edward Warren, MD, Chair Geriatrics Carolinas Campus, January 2012

  2. Case 1 Your patient complains of constipation because her bowels move only every 2 to 3 days.

  3. Question 1 You tell her • If there is no pain nor straining, then this may be normal. • She needs an urgent colonoscopy. • Take large doses of laxitives every day. • She needs referral to a specialist.

  4. Case 2 You are seeing a 67 year old man who has had a marked decrease in bowel movement frequency to once every 5 or 6 days. They are painful and hard. The stools have also turned black. On exam fecal occult blood testing is positive.

  5. Question 2 You advise • Senokot S ii po bid • Colonoscopy to check for malignancy • 3 prunes for breakfast every day • 5 prunes for breakfast every day

  6. Case 3 • You are seeing an 83 year old lady who has cut way back on her fluids to help manage urinary incontinence. She is now constipated with hard stools.

  7. Question 3 You advise • Drink fluids anyway and let you help treat the bladder incontinence. • Take large doses of milk of magnesia daily. • Initiate a program of daily enemas. • Eat less food to cut down on the stools.

  8. Case 4 You are asked to see a 77 year old woman who just fractured her hip. She now is having constipation with no stool in 6 days and pain in the abdomen.

  9. Question 4 Causes of the constipation might be • Hydrocodone/APAP 5/325 q4h • Immobility from the fracture • Total lack of bowel meds in her regimen • All of the above

  10. Case 5 You are asked to see a 65 year old man who is writhing in pain. His bowels have not moved for a week. Today he began to have vomiting. The abdominal xray suggests dilation of the descending colon.

  11. Question 5 You diagnose • Constipation • Impaction • Urinary tract infection • Appendicitis

  12. Question 6 You feel a softball of hard stool in the rectum and give this urgent order: • Nurse to manually dig the stool out. • 30 ml MOM po now C. Docusate 100 mg po bid D. Encourage fluids

  13. Question 7 With my doctor a loud confrontation Engendered extreme consternation He’d treated me for a Severe diarrhea And now I’ve acute _________________

  14. Answers • A • B • A • D • B • A • Constipation

  15. Answers • If it ain’t broke, don’t fix it. • This is a red flag in a man over age 50. He needs to be checked for malignancy. • She has shot herself in the foot. You need to help address the primary bladder problem in a more effective manner. The other options would be harmful.

  16. Answers • All options are correct. You need to give a laxative to counter the opioid and get her mobilized some. • This is the picture of a bowel obstruction. It could be a tumor, but impaction is likely. None of the other choices would cause bowel dilation and vomiting.

  17. Answers • This is an impaction and will need to be removed. It is possible to irrigate an impaction out with a prolonged irrigating enema. • It’s a limerick, what can I say. Remember that constipation can present as diarrhea.

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