{"id":849,"date":"2017-05-23T06:51:41","date_gmt":"2017-05-23T06:51:41","guid":{"rendered":"http:\/\/papergp.com\/index.php\/gi-and-renal\/constipation\/"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"constipation","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/gi\/constipation\/","title":{"rendered":"Constipation"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4><strong>Differential diagnosis<\/strong><\/h4>\n<ul>\n<li>Obstruction &#8211; abdo pain, distension, vomiting, prev abdo surgery<\/li>\n<li>Bowel Ca &#8211; weight loss, PR bleeding, FH<\/li>\n<li>Medications &#8211; opiates, PPIs, iron\/calcium supplements, calcium channel blockers<\/li>\n<li>UTI<\/li>\n<li>Dietary &#8211; low fluid\/fibre<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;\n<\/p><div class=\"content-box-blue\">\n<h4><strong>Data gathering<\/strong><\/h4>\n<ul>\n<li>History &#8211; as above<\/li>\n<li>Examine &#8211; abdominal, PR<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;\n<\/p><div class=\"content-box-blue\">\n<h4><strong>Clinical management<\/strong><\/h4>\n<ul>\n<li>Investigations\n<ul>\n<li>Bloods &#8211; FBC, U+E, LFTs, Calcium, TFTs<\/li>\n<\/ul>\n<\/li>\n<li>Explanation<\/li>\n<li>Treatment\n<ul>\n<li>Lifestyle\n<ul>\n<li>Fibre, fluids (2L water), keep active, toileting routines<\/li>\n<\/ul>\n<\/li>\n<li>Medications\n<ul>\n<li>1st line: Fybogel (bulk forming laxative &#8211; avoid if opiate induced constipation)<\/li>\n<li>2nd line: Macrogol (osmotic laxative)<\/li>\n<li>3rd line: Bisacodyl (stimulant laxative)\n<ul>\n<li><em>nb: stimulants should ideally be given at night as it takes 8-10 hours to reach the colon after administration<\/em><\/li>\n<\/ul>\n<\/li>\n<li>Impacted faeces\n<ul>\n<li>Arachis oil enemas<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Followup \/ Safety-net\n<ul>\n<li>continue medication at maintenance dose for several weeks after regular bowel habit is established &#8211; this may take several months<\/li>\n<li>if no improvement despite the above, consider referral<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n\n\n<h4 class=\"wp-block-heading\">Reference<\/h4>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"https:\/\/gps.camdenccg.nhs.uk\/pathways\/constipation\">https:\/\/gps.camdenccg.nhs.uk\/pathways\/constipation<\/a><\/li><li>http:\/\/gp.barnetccg.nhs.uk\/downloads\/services\/pathways\/Gastroenterology\/Adult-constipation-July-018-v7-3.pdf<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Differential diagnosis Obstruction &#8211; abdo pain, distension, vomiting, prev abdo surgery Bowel Ca &#8211; weight loss, PR bleeding, FH Medications &#8211; opiates, PPIs, iron\/calcium supplements, calcium channel blockers UTI Dietary &#8211; low fluid\/fibre &nbsp; Data gathering History &#8211; as above Examine &#8211; abdominal, PR &nbsp; Clinical management Investigations Bloods &#8211; FBC, U+E, LFTs, Calcium, TFTs &hellip; <a href=\"https:\/\/papergp.com\/index.php\/gi\/constipation\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Constipation<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":315,"menu_order":67,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-849","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/849","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=849"}],"version-history":[{"count":7,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/849\/revisions"}],"predecessor-version":[{"id":2407,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/849\/revisions\/2407"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/315"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=849"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}