Constipation differential diagnosis: Difference between revisions

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Revision as of 21:16, 19 December 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Diseases that cause constipation should differentiate from each others, such as malignancy, diabetic autonomic neuropathy, irritable bowel syndrome, rectocele, fissure, anismus, systemic sclerosis, hypothyroidism, Parkinson's disease, multiple sclerosis, hypomagnesemia, hypocalcemia, and depression.

Differentiating Constipation from Other Diseases

Diseases that cause constipation should differentiate from each others, such as malignancy, diabetic autonomic neuropathy, irritable bowel syndrome, rectocele, fissure, anismus, systemic sclerosis, hypothyroidism, Parkinson's disease, multiple sclerosis, hypomagnesemia, hypocalcemia, and depression.

•Weight loss>10 lb
•FHx of CRC
•Acute onset in elderly
•Hematoschezia
•Iron deficiency anemia
•Positive OB

•Analgesic
•Anticholinergic
••Antihistamines
••Antispasmodics
••Antidepressants
••Antipsychotics
•Cation-Containing agent
••Iron supplements
••Aluminum (antacids, sucralfate)
••Barium
•Neuron targeting agents
••Opiates
••Antihypertensive
••Ganglion blockers
••Calcium channel blockers
••5HT3 antagonists

Alarm signs

Drugs

Constipation

Abdominal pain

YES

NO

Irritable bowel syndrome
Malignancy
Diabetic autonomic neuropathy

Hypothyroidism
Hypomagnesemia
Hypocalcemia
Systemic sclerosis
Multiple sclerosis
Parkinson disease
Depression
Fissure
Anismus
Rectocele

Weight loss

Anal pain

YES

NO

YES

NO

Irritable bowel syndrome
Diabetic autonomic neuropathy

Fissure
Anismus
Rectocele

Hypothyroidism
Hypomagnesemia
Hypocalcemia
Systemic sclerosis
Multiple sclerosis
Parkinson disease
Depression

Polyuria
Polydipsia
Polyphagia

Mass protrusion

Dry skin

YES

NO

YES

NO

YES

NO

Fissure
Anismus

Hypothyroidism
Systemic sclerosis

Hypomagnesemia
Hypocalcemia
Multiple sclerosis
Parkinson's disease
Depression

Rectal bleeding

Dysphagia

Neurologic symptoms
(tremor, abnormal gait)

YES

NO

YES

NO

YES

NO

Multiple sclerosis
Parkinson disease

Hypomagnesemia
Hypocalcemia
Depression

Basal ganglia atrophy in MRI

Electrolyte disturbance

YES

NO

YES

NO

Malignancy

Diabetic autonomic neuropathy

Irritable bowel syndrome

Differentiating Diseases that Cause Constipation

Diseases	History and Symptoms							Physical Examination				Laboratory Findings					Other Findings
Diseases	Weight loss	Abdominal pain	Anal pain	Dysphagia	Polyphagia, Polyuria, Polydipsia	Dry skin	Tremor	Abnormal gait	Protruding mass	Sphincter manometry	Deep tendon reflex	Mg	K	Ca	FBS	TSH	Other Findings
Malignancy			+
Diabetic autonomic neuropathy	↑			-
Irritable bowel syndrome (IBS)		↓
Rectocele
Anal fissure
Anismus
Systemic sclerosis
Hypothyroidism
Parkinson's disease
Multiple sclerosis
Hypomagnesemia
Hypocalcemia
Depression
Pregnancy

References

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 {{family tree| | |!| | | | | S01 | | | | | | | S02 | | | | | | | | | | | | | | | S03 | | | | | | | | | | | | | | | | | |S01=[[Irritable bowel syndrome]]<br>[[Diabetic]] [[autonomic]] [[neuropathy]]|S02=[[Fissure]]<br>[[Anismus]]<br>[[Rectocele]]|S03=[[Hypothyroidism]]<br>[[Hypomagnesemia]]<br>[[Hypocalcemia]]<br>[[Systemic sclerosis]]<br>[[Multiple sclerosis]]<br>[[Parkinson disease]]<br>[[Depression]]}}
 {{family tree| | |!| | | | | |!| | | | | | | | |!| | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | |}}
-{{family tree|boxstyle=background: #00FF00; color: #000000;| | |!| | | | | S01 | | | | | | | S02 | | | | | | | | | | | | | | | S03 | | | | | | | | | | | | | | | | | |S01='''''[[Polyuria]]'''''<br>'''''[[Polydypsia]]'''''<br>'''''[[Polyphagia]]'''''|S02='''''[[Mass]] protrusion'''''|S03= '''''[[Dry skin]]'''''}}
+{{family tree|boxstyle=background: #00FF00; color: #000000;| | |!| | | | | S01 | | | | | | | S02 | | | | | | | | | | | | | | | S03 | | | | | | | | | | | | | | | | | |S01='''''[[Polyuria]]'''''<br>'''''[[Polydipsia]]'''''<br>'''''[[Polyphagia]]'''''|S02='''''[[Mass]] protrusion'''''|S03= '''''[[Dry skin]]'''''}}
 {{family tree| | |!| | | |,|-|^|-|.| | | |,|-|-|^|-|-|.| | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | | | | | | | | |}}
 {{family tree| | |!| | | T01 | | T02 | | T03 | | | | T04 | | | | | | T05 | | | | | | | | | | | T06 | | | | | | | | | | |T01=YES|T02=NO|T03=YES|T04=NO|T05=YES|T06=NO}}
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 |-
-|'''[[Anismus]]'''
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Anismus]]'''
-|
+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
 |-
-|'''[[Systemic sclerosis]]'''
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Systemic sclerosis]]'''
-|
+| style="background: #F5F5F5; padding: 5px;" |
-|
+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
 |-
-|'''[[Hypothyroidism]]'''
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hypothyroidism]]'''
-|
+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
 |-
-|'''[[Parkinson's disease]]'''
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Parkinson's disease]]'''
-|
+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
 |-
-|'''[[Multiple sclerosis]]'''
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Multiple sclerosis]]'''
-|
+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
 |-
-|'''[[Hypomagnesemia]]'''
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hypomagnesemia]]'''
-|
+| style="background: #F5F5F5; padding: 5px;" |
-|
+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
 |-
-|'''[[Hypocalcemia]]'''
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hypocalcemia]]'''
-|
+| style="background: #F5F5F5; padding: 5px;" |
-|
+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
 |-
-|'''[[Depression]]'''
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Depression]]'''
-|
+| style="background: #F5F5F5; padding: 5px;" |
-|
+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
-|
+| style="background: #F5F5F5; padding: 5px;" |
-|
+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
-|
+| style="background: #F5F5F5; padding: 5px;" |
 |-
-|'''[[Pregnancy]]'''
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Pregnancy]]'''
-|
+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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+| style="background: #F5F5F5; padding: 5px;" |
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 |}