EMQs for Medical Students - PasTest

G A S T R O E N T E R O L O G Y
4. THEME: CONSTIPATION
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B
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I
J
Carcinoma of the colon/rectum
Chronic idiopathic constipation
Depression
Diabetes mellitus
Diverticular disease
Hypercalcaemia
Hypothyroidism
Iatrogenic (drug therapy)
Pelvic nerve or spinal cord injury
Simple constipation
The patients below have all presented with constipation. Please select the most appropriate
diagnosis from the above list. Each cause may be used once, more than once or not at all.
1. A 66-year-old man presents with a 3-month history of difficulty passing stool.
On direct questioning, his bowels had previously been open daily with the
passage of normal, formed stool. He now complains of straining to pass small,
worm-like stools with mucus. He also has a sensation of needing to pass stool
but being unable to do so.
2. A 28-year-old woman with a history of chronic schizophrenia is referred by the
psychiatric team after complaining of abdominal pain, bloating and
constipation. She opens her bowels approximately twice a week with the
passage of hard stool. She also complains of a dry mouth.
3. A 92-year-old woman falls and fractures her right neck of femur. She has been
admitted to hospital by the orthopaedic team under whom she has a dynamic
hip screw. Six days post-operatively she is complaining of colicky lower
abdominal pain and the nurses tell you that she has not opened her bowels
since the operation. Faeces are palpable in the left colon and on rectal
examination. A plain abdominal radiograph confirms the presence of faecal
loading.
4. A 24-year-old girl gives a lifelong history of constipation from early childhood.
She opens her bowels every 2 weeks and has little or no urge to pass faeces
between these times. She complains of chronic lower abdominal discomfort,
nausea and bloating.
5. A 56-year-old man is admitted to hospital with a short history of lower
abdominal pain and difficulty opening his bowels. At the time of admission he
has not passed faeces for 6 days and is now experiencing difficulties passing
urine (hesitancy, poor stream). Direct questioning reveals that he has a
6-month history of chronic cough with occasional hemoptysis, which he puts
down to his being a smoker. His wife thinks that he might also have lost some
weight recently.
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