Constipation differential diagnosis: Difference between revisions

	Constipation Microchapters
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Revision as of 21:40, 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
	GI symptoms			Extra GI symptoms				Abnormal gait	Anal protruding mass	DRE	Deep tendon reflex	Mg	K	Ca	FBS	TSH
	Dysphagia	Abdominal pain	Anal pain	Weight loss	Polyphagia, Polyuria, Polydipsia	Dry skin	Tremor	Abnormal gait	Anal protruding mass	DRE	Deep tendon reflex	Mg	K	Ca	FBS	TSH
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

Template:WH Template:WS

@@ Line 51: / Line 51: @@
 {|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! rowspan="2" |Diseases
+! rowspan="3" |Diseases
 ! colspan="7" |History and Symptoms
 ! colspan="4" |Physical Examination
 ! colspan="5" |Laboratory Findings
-! rowspan="2" |Other Findings
+! rowspan="3" |Other Findings
+! rowspan="3" |Diagnostic study of choice
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-!Weight loss
+! colspan="3" |GI symptoms
+! colspan="4" |Extra GI symptoms
+! rowspan="2" |Abnormal gait
+! rowspan="2" |Anal protruding mass
+! rowspan="2" |DRE
+! rowspan="2" |Deep tendon reflex
+! rowspan="2" |Mg
+! rowspan="2" |K
+! rowspan="2" |Ca
+! rowspan="2" |FBS
+! rowspan="2" |TSH
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+!Dysphagia
 !Abdominal pain
 !Anal pain
-!Dysphagia
+!Weight loss
 !Polyphagia, Polyuria, Polydipsia
 !Dry skin
 !Tremor
-!Abnormal gait
-!Protruding mass
-!Sphincter manometry
-!Deep tendon reflex
-!Mg
-!K
-!Ca
-!FBS
-!TSH
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Malignancy]]'''
@@ Line 78: / Line 82: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 98: / Line 103: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 115: / Line 121: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |↓
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 132: / Line 139: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Rectocele]]'''
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 151: / Line 159: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Anal fissure]]'''
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 170: / Line 179: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Anismus]]'''
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 189: / Line 199: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Systemic sclerosis]]'''
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 208: / Line 219: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hypothyroidism]]'''
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 227: / Line 239: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Parkinson's disease]]'''
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 246: / Line 259: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Multiple sclerosis]]'''
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 265: / Line 279: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hypomagnesemia]]'''
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 284: / Line 299: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hypocalcemia]]'''
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 303: / Line 319: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Depression]]'''
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 322: / Line 339: @@
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Pregnancy]]'''
+| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 340: / Line 358: @@
 | style="background: #F5F5F5; padding: 5px;" |
 |}
 ==References==