Chapter 113: Constipation Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient diagnosed with chronic constipation uses polyethylene glycol and reports increased abdominal discomfort with nausea and vomiting. What is the initial action by the provider?

a. Increase the dose of polyethylene glycol b. Obtain radiographic abdominal studies c. Perform a stool culture and occult blood d. Refer to a specialist for colonoscopy

ANS: B a. Bisacodyl b. Docusate sodium c. Methylcellulose d. Mineral oil

Patients with abdominal pain, nausea, and vomiting should have radiologic studies to exclude obstruction, ileus, megacolon, or volvulus. If those are ruled out, increasing the laxative may be warranted. Stool culture is indicated if the parasite ascariasis is suspected. Referral for colonoscopy is needed if alarm symptoms for neoplasm are present.

2. A patient has recurrent constipation which improves with laxative use but returns when laxatives are discontinued. Which pharmacologic treatment will the provider recommend for long-term management?

ANS: C

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Methylcellulose is a bulk-forming product and is used initially. The other medications are used for more severe constipation and not recommended for long-term use. Mineral oil, an emollient, will soften stool, but it has been associated with aspiration and lipoid pneumonia, prevents absorption of fat-soluble vitamins, and can cause fecal incontinence; it is not generally recommended.

Multiple Response

1. A patient reports a decrease in the frequency of stools and asks about treatment for constipation. Which findings are part of the Rome IV criteria for diagnosing constipation? (Select all that apply.)

a. Feeling of incomplete evacuation b. Fewer than 5 stools per week c. Hard or lumpy stools d. Presence of irritable bowel syndrome e. Symptoms present for 3 months

ANS: A, C, E

According to the Rome III criteria, symptoms must have begun 6 months prior and persisted for at least 3 months and include a feeling of incomplete evacuation, lumpy or hard stools, fewer than 3 stools per week, and not meeting criteria for irritable bowel syndrome.