Constipation differential diagnosis: Difference between revisions

	Constipation Microchapters
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Revision as of 15:27, 20 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	Diagnostic study of choice
	History and Symptoms							Physical Examination				Electrolyte tests			Biochemical tests
	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	-	-	+/-	++	-	-	-	-	-	Empty rectum	Normal	Normal	Normal	↓↑	Normal	Normal	Acute change in bowel habits Rectal bleeding Anemia	Rectosigmoidoscopy with biopsy
Diabetic autonomic neuropathy	-	-	-	+	++	+/-	-	+/-	-	Normal	↓	Normal	Normal	Normal	↑↑	Normal	Distal neuropathy Gastroparesis Nausea and vomiting	FBS and HbA1C
Irritable bowel syndrome (IBS)	-	+	+/-	-	-	-	-	-	-	Normal	Normal	Normal	Normal	Normal	Normal	Normal	Frequent change in bowel habit Abdominal pain alleviating with bowel movement	Rolling out other pathophysiologies
Rectocele	-	-	-	-	-	-	-	-	+	Bulging rectum	Normal	Normal	Normal	Normal	Normal	Normal	Obstruction Absence of defecation and gas passing	Anoscopy
Anal fissure	-	-	+++	-	-	-	-	-	-	Increased sphincter tone Anal lesion	Normal	Normal	Normal	Normal	Normal	Normal	Rectal bleeding after defecation	DRE
Anismus	-	-	+	-	-	-	-	-	-	Increased sphincter tone	Normal	Normal	Normal	Normal	Normal	Normal	Absence of defecation and gas passing	DRE
Systemic sclerosis	+	-	-	-	-	+	-	-	-	Normal	Normal	Normal	Normal	Normal	Normal	Normal	Raynaud phenomenon Fingertip ulcer	Clinical characteristics Anti-centromere and anti-Scl-70 antibodies
Hypothyroidism	-	-	-	-	-	+	-	-	-	Normal	↓↓	Normal	Normal	Normal	Normal	↑↑	Weakness and fatigue Dysmenorrhea	Thyroid function tests (TFT)
Parkinson's disease	+/-	-	-	-	-	-	++	+	-	Normal	↑↑	Normal	Normal	Normal	Normal	Normal	Muscle stiffness Drooling	Brain MRI
Multiple sclerosis	+	-	-	-	-	-	+	+	-	Normal	↓↑	Normal	Normal	Normal	Normal	Normal	Blurred vision Erectile dysfunction	Brain MRI CSF biochemical profile
Hypomagnesemia	-	+	-	-	-	-	+	-	-	Normal	↓	↓↓	Normal	Normal	Normal	Normal	Nystagmus Seizure	Plasma Mg level
Hypocalcemia	-	+	-	-	-	-	-	-	-	Normal	↓	Normal	Normal	↓↓	Normal	Normal	Muscle weakness Dysesthesia	Plasma Ca level
Depression	-	-	-	+	-	-	-	-	-	Normal	Normal	Normal	Normal	Normal	Normal	Normal	Hopelessness Weakness and fatigue Depressed mood	Psychological examination
Pregnancy	-	-	-	-	-	-	-	-	-	Normal	Normal	Normal	Normal	Normal	Normal	Normal	Lower extremities edema Dyspnea Nausea and vomiting	Plasma βhCG Ultrasonography

References

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 {{family tree| | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | Y01 | | Y02 | | Y03 | | Y04 | | Y05 | |Y01=YES|Y02=NO|Y03=YES|Y04=YES|Y05=NO}}
 {{family tree| | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
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+{{family tree|boxstyle=background: #FA8072; color: #000000;| | Z01 | | Z02 | | Z03 | | Z04 | | Z05 | | Z06 | | Z07 | | Z08 | | Z09 | | Z10 | | Z11 | | Z12 | | Z13 | |Z01=[[Malignancy]]|Z02=[[Diabetic neuropathy|Diabetic autonomic neuropathy]]|Z03=[[Irritable bowel syndrome]]|Z04=[[Rectocele]]|Z05=[[Fissure]]|Z06=[[Anismus]]|Z07=[[Systemic sclerosis]]|Z08=[[Hypothyroidism]]|Z09=[[Parkinson's disease]]|Z10=[[Multiple sclerosis]]|Z11=[[Hypomagnesemia]]|Z12=[[Hypocalcemia]]|Z13=[[Depression]]}}
 {{family tree/end}}
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 ===Differentiating Diseases that Cause Constipation===
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 * [[Ultrasonography]]
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 ==References==
 {{Reflist|2}}