Chronic Constipation Overview

Questions and Answers

What is a primary characteristic of chronic constipation as per the Rome IV Functional Constipation Criteria?

More than 5 bowel movements per week

Presence of abdominal pain

Loose stools classified as Bristol 5-7

Straining with bowel movement (correct)

Which of the following symptoms is NOT typically associated with chronic constipation?

Sensation of incomplete evacuation

Severe abdominal pain (correct)

Need for manual maneuvers to facilitate evacuation

Hard stools

What is a common risk factor for developing Small Intestinal Bacterial Overgrowth (SIBO) in patients with IBS?

Changes in gut microbiota (correct)

Compromised blood flow to the intestines

High fiber diet

Increased gut motility

Which of the following statements is accurate regarding food sensitivity testing in IBS?

It can help identify specific food triggers in patients. Signup and view all the answers

What defines a red flag feature in constipation?

Presence of blood in stool Signup and view all the answers

Which is a false statement regarding the epidemiology of chronic constipation?

It is equally prevalent among males and females. Signup and view all the answers

What are the most common symptoms of chronic constipation?

Straining and hard stools Signup and view all the answers

Patients with IBS have a higher likelihood of testing positive for SIBO using which of the following tests?

Glucose Hydrogen Breath Test (GHBT) Signup and view all the answers

What is a common characteristic of Small Intestinal Bacterial Overgrowth (SIBO)?

Increased gas and bloating Signup and view all the answers

Which test is commonly used to identify food sensitivities in patients with chronic gastrointestinal symptoms?

Serum antibody test Signup and view all the answers

What is the primary symptom associated with Irritable Bowel Syndrome (IBS)?

Recurrent abdominal discomfort Signup and view all the answers

Which of the following is a recognized feature of chronic constipation?

Straining during at least 25% of bowel movements Signup and view all the answers

What has been suggested as a personalized intervention for patients with IBS based on microbiome analysis?

Tailored probiotic supplementation Signup and view all the answers

Which mechanism is primarily involved in chronic diarrhea as per current research?

Altered gut permeability Signup and view all the answers

Which of these conditions is often misdiagnosed as IBS due to similar symptoms?

Celiac disease Signup and view all the answers

What is a potential complication in patients with chronic constipation?

Diverticulitis Signup and view all the answers

Which symptom is considered an alarm feature when assessing IBS-D?

Nocturnal diarrhea Signup and view all the answers

Which stool types indicate IBS-C according to the Rome IV criteria?

Types 1, 2, 6, and 7 Signup and view all the answers

What is the minimum duration for symptoms to be diagnosed as IBS?

6 months Signup and view all the answers

What is a common purpose of food sensitivity testing in IBS management?

To find specific food triggers Signup and view all the answers

Which of the following is NOT typically associated with chronic constipation features?

Loose stools present at times Signup and view all the answers

In patients suspected of having IBS-D, which test is recommended?

Celiac disease screening Signup and view all the answers

Which of the following would likely classify a patient as IBS-U?

A patient exhibiting both diarrhea and constipation Signup and view all the answers

What percentage of bowel movements must consist of Bristol stool types 6 and 7 to meet IBS-C criteria?

More than 25% Signup and view all the answers

What is the most significant laboratory finding indicative of acute pancreatitis?

Lipase levels > 3 times the upper limit of normal Signup and view all the answers

In chronic pancreatitis, which symptom is most commonly reported by patients?

Disabling mid-epigastric postprandial pain Signup and view all the answers

Which of the following signs is considered rare in the presentation of pancreatitis?

Cullen sign Signup and view all the answers

Which finding would suggest that acute pancreatitis is unlikely?

AST levels < 50 international units/L Signup and view all the answers

What does steatorrhea primarily indicate in chronic pancreatitis?

Malabsorption due to pancreas dysfunction Signup and view all the answers

What is a common complication associated with chronic pancreatitis?

Pancreatic cancer Signup and view all the answers

Which of the following statements about pain characteristics in pancreatitis is accurate?

Pain may be relieved by sitting forward Signup and view all the answers

What imaging study is recommended for all patients suspected of having acute pancreatitis?

Transabdominal ultrasound Signup and view all the answers

What is the estimated prevalence of Peptic Ulcer Disease (PUD) in patients aged 75 years with current NSAID use?

20% Signup and view all the answers

Which of the following is a common life-threatening complication associated with Peptic Ulcer Disease?

Perforation Signup and view all the answers

What percentage of patients with serious complications from Peptic Ulcer Disease had no prior symptoms?

<blockquote> 50% </blockquote> Signup and view all the answers

Which test is NOT typically used for screening H. pylori infection in patients suspected of have Peptic Ulcer Disease?

X-ray imaging Signup and view all the answers

What is the typical rate of asymptomatic NSAID-associated ulcers in patients?

60% Signup and view all the answers

Which symptom is least likely associated with Peptic Ulcer Disease?

Chronic fatigue Signup and view all the answers

In the context of Ectopic Pregnancies, what is the expected percentage recurrence rate for tubal pregnancies?

10% Signup and view all the answers

Which of the following is the most common cause of acute pancreatitis?

Alcohol abuse Signup and view all the answers

What type of imaging is considered most accurate for diagnosing nephrolithiasis?

Non-contrast renal CT Signup and view all the answers

Which laboratory finding is commonly associated with cholecystitis?

Cholelithiasis in 84-99% of patients Signup and view all the answers

Which symptom is NOT typically associated with nephrolithiasis?

Abdominal tenderness Signup and view all the answers

What percentage of patients with acute pancreatitis have low-grade fevers?

60-70% Signup and view all the answers

What is the most common type of kidney stone?

Calcium oxalate stones Signup and view all the answers

Which factor is considered a risk factor for developing nephrolithiasis?

Positive family history Signup and view all the answers

Which of the following complications can arise from untreated cholecystitis?

Gangrene Signup and view all the answers

Study Notes

Chronic Constipation

Defined as difficult, unsatisfactory, or infrequent defecation.
More prevalent in females and increases with age.
Genetic predisposition can play a role.

Signs and Symptoms

Frequent symptoms include straining and hard stools.
Differentiate between chronic constipation and IBS-C, which presents without pain or visceral hypersensitivity.
Digital rectal exam can identify stool, masses, hemorrhoids, fissures, prolapse, and rectoceles.

Rome IV Functional Constipation Criteria

Straining during bowel movements and hard stools (Bristol types 1-2).
Sensation of incomplete evacuation and anorectal obstruction.
Manual maneuvers required for evacuation.
Less than three spontaneous bowel movements per week, with a 25% prevalence in bowel movements.
Abdominal pain is absent.

Red Flag/Alarm Features

Presence of blood in stool, significant weight loss, and anemia.
Family history of colon cancer, celiac disease, or inflammatory bowel disease.
Acute onset after age 50, significant abdominal pain, recurrent vomiting, or fever.

Irritable Bowel Syndrome (IBS) Prognosis

No increased risk for colorectal cancer.
Slightly elevated risk for celiac disease and inflammatory bowel disease within five years post-diagnosis.
Quality of life is a crucial consideration for management.

IBS Additional Investigations

IgG food sensitivity testing may be conducted.
Small Intestinal Bacterial Overgrowth (SIBO) testing is also relevant.

Small Intestinal Bacterial Overgrowth (SIBO)

Patients with IBS show a significantly higher likelihood (2.6 to 8.3 times) of positive SIBO tests compared to healthy individuals.
Diagnostic methods include Glucose Hydrogen Breath Test (GHBT) and jejunal aspirate culture.

Rome IV IBS Subtypes

IBS-C (Constipation dominant): At least 25% of bowel movements are Bristol stools 1 and 2.
IBS-U (Unclassified): Patients meeting IBS criteria without clear classification into other types.

IBS-Diarrhea Investigations

Recommended limited blood testing for suspected IBS-D or functional diarrhea in the absence of alarm features.
Essential tests include Complete Blood Count, C-reactive protein, and celiac disease screening.

IBS-Diarrhea Alarm Features

Unintentional weight loss, nocturnal diarrhea, tenesmus, and bright red blood in stool.
High-volume diarrhea and concerns about malnutrition.
Family history of colorectal cancer warrants further investigation.

H. Pylori Infection

Esophagogastroduodenoscopy (EGD) recommended for individuals over 60 or with alarming symptoms.

Cholecystitis

Inflammation of the gallbladder or bile ducts, usually due to cystic duct obstruction.
Accounts for one-third of patients over 55 presenting with acute abdominal pain.

Signs & Symptoms

Murphy’s sign shows high likelihood of cholecystitis (LR+ 5.0).
Right upper quadrant pain (LR+ 2.5) and fever (LR+ 1.8) also indicative.
Jaundice has neutral likelihood (LR 1.0), with nausea/vomiting commonly present.

Investigations

Leukocytosis, defined as >10,000/mcL, in 52–63% of patients.
Ultrasound shows presence of cholelithiasis in 84–99% of cases.
Cholecystitis does not significantly elevate lipase or liver tests.

Prognosis

Untreated cholecystitis can lead to necrosis, infection, and gangrene.

Nephrolithiasis

Also referred to as kidney stones, with a 35–50% recurrence rate at 5 years.
More prevalent in men (2-3 times more than women), family history increases risk (relative risk 2.6).

Signs & Symptoms

Excruciating back and flank pain, possibly radiating to the abdomen or groin.
Associated discomfort with nausea, vomiting, dysuria, and urinary frequency; hematuria can be present but is not definitive.

Investigations

Non-contrast renal CT most accurate for diagnosis (LR+ 48; LR− 0.05).
Stone composition analysis recommended for prevention of recurrence.

Types of Kidney Stones

Calcium oxalate (75%), calcium phosphate (5%), uric acid (5–10%), struvite (5–15%), as well as cystine and indinavir stones.

Prognosis

Risks include ureteral obstruction, pyelonephritis, sepsis, and rare acute kidney injury.

Acute Pancreatitis

Major causes include alcohol abuse and choledocholithiasis (80% of cases).
15-25% are idiopathic, potentially due to microlithiasis or sphincter dysfunction.

Signs & Symptoms

Low-grade fevers in 60% of cases; pain may radiate to the back and is worsened in the supine position.
Nausea and vomiting present in 75%; rebound tenderness is rare.

Investigations

Blood tests show lipase > three times upper limit of normal; elevated amylase indicative.
Transabdominal ultrasound for gallstones or common bile duct dilation.

Chronic Pancreatitis

Often a consequence of recurrent acute pancreatitis, primarily due to alcohol abuse (70% of cases).

Signs & Symptoms

Chronic mid-epigastric pain post-meal, radiating to the back.
Symptoms may include abdominal bloating, weight loss, diarrhea, and steatorrhea.

Steatorrhea

Characterized by difficult-to-flush oily stools; may indicate malabsorption.

Gynecological Emergencies: Ectopic Pregnancy

Recurrence rate of repeat tubal pregnancy is about 10%.
Mortality is rare if managed before rupture; consider high-dose NSAIDs and concurrent H. pylori infection risks.

Peptic Ulcer Disease (PUD)

Prevalence in dyspeptic patients increases with age and NSAID/H. pylori use.

Signs & Symptoms

60% of NSAID-related ulcers asymptomatic; unintentional weight loss noted in 31–55% of benign gastric ulcer cases.

Prognosis

Life-threatening complications may arise without prior symptoms, including severe hemorrhage or perforation.

Investigations

Screen for H. pylori using urea breath test, stool antigen test, or blood test (antibodies not distinguishing between past or current infection).

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Description

This quiz explores the definition, epidemiology, and symptoms of chronic constipation. Understanding the key differences between chronic functional constipation and IBS-C is essential for better diagnosis and treatment. Test your knowledge on this common gastrointestinal issue!