Constipation

HISTORY:

Constipation for ‍ ‍hoursdays

Frequency: ‍ times per week, with the last one ‍ days ago

Stools type: ‍hardlumpydrysmall in volumelarge in diameter, with ‍straining

Treatments tried: ‍nonedietary modificationslaxatives, ‍effectiveineffective

‍abdominal discomfort

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍rectal pressure

‍bloating

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍

‍loss of appetite

‍inability to pass gas

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍fever, up to ‍°, over ‍ ‍hoursdays

‍rectal bleeding, ‍oncetwice ‍, ‍bright reddark red, ‍withwithout clots

‍dark, tarry stools



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍



ASSESSMENT:

‍Functional constipation ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍TSH, ‍electrolytes, ‍calcium, ‍glucose

- Abdominal X-ray

- Abdominal ultrasound

- Colonoscopy

- Increase dietary fiber

- Increase fluid intake

- Regular physical activity

- ‍Laxatives

- ‍Stool softeners

- ‍Polyethylene glycol

- Probiotics

- Referral to gastroenterologist

- Referral to dietitian

- Follow-up in ‍ ‍weeksmonths

- Return if constipation worsens, if new symptoms develop such as abdominal pain or blood in stools, or if symptoms do not improve with treatment