Constipation

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of constipation

Infrequent bowel movements decreased to ‍ times per week, with the last one occurring ‍ days ago

Stools described as ‍hard, ‍lumpy, ‍dry, ‍small in volume, ‍large in diameter, with ‍straining

Alleviating factors: ‍nonedietary modificationslaxatives, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍abdominal discomfort

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍rectal pain or pressure

‍bloating

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍loss of appetite

‍inability to pass gas

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍fever, up to ‍°, over ‍ ‍hoursdays

‍fatigue

‍anal pain

‍rectal bleeding, ‍oncetwice ‍, ‍bright reddark red, ‍withwithout clots

‍dark, tarry stools



Contributing factors:

‍low fiber diet

‍low fluid intake

‍sedentary lifestyle

‍delaying the urge to have a bowel movement

no history of: ‍chronic constipation, ‍irritable bowel syndrome, ‍hypothyroidism, ‍anal fissures, ‍hemorrhoids

no use of: ‍opioids, ‍antidepressants, ‍iron supplements, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍





ASSESSMENT:

‍Functional constipation ‍likelysuspectedpossible

DDx: functional constipation, dehydration, low fiber intake, medication side effect, opioid-induced constipation, irritable bowel syndrome with constipation, hypothyroidism, small bowel obstruction, colorectal cancer, anal fissure, diverticulosis, pelvic floor dysfunction, hypercalcemia, neurological disorders, elderly-related motility decline, celiac disease





PLAN:

Investigations:

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

- Abdominal X-ray

- Abdominal ultrasound

- Colonoscopy

Treatments:

- Increase dietary fiber

- Increase fluid intake

- Regular physical activity

- ‍Laxatives

- ‍Stool softeners

- ‍Polyethylene glycol

- Probiotics

Further care:

- 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