Fecal impaction

A common problem associated with the administration of the bile acid sequestrants is constipation. Constipation may be severe and may occasionally result in fecal impaction. Hemorrhoids may be aggravated. Additional adverse reactions include vitamin A and D deficiencies, bleeding tendencies (including gastrointestinal bleeding) caused by a depletion of vitamin K, nausea, abdominal pain, and distention. 

Laxatives are contraindicated in patients with known hypersensitivity and those with persistent abdominal pain, nausea, or vomiting of unknown cause or signs of acute appendicitis, fecal impaction, intestinal obstruction, or acute hepatitis. These dragp are used only as directed because excessive or prolonged use may cause dependence. Magnesium hydroxide is used cautiously in patients with any degree of renal impairment. Laxatives... 

Fecal impaction, ischemic bowel, pancreatic insufficiency, and intestinal fistulae... 

Gastrointestinal involvement may present initially as small bowel obstruction shortly after birth (known as meconium ileus) due to abnormally thick meconium that cannot be passed. Older CF patients may develop distal intestinal obstruction syndrome (DIOS), formerly called meconium ileus equivalent, which occurs due to fecal impaction in the terminal ileum and cecum. 

Noninfectious causes of acute diarrhea include drugs and toxins (Table 18-3), laxative abuse, food intolerance, irritable bowel syndrome (IBS), inflammatory bowel disease, ischemic bowel disease, lactase deficiency, Whipple s disease, pernicious anemia, diabetes mellitus, malabsorption, fecal impaction, diverticulosis, and celiac sprue. 

Constipation or fecal impaction (see section on pelvic malignancy)... 

Constipation Dehydration Drug induced (anticholinergics) Inactivity Low residue (fiber) content Obstruction/fecal impaction... 

Saline cathartics should not be used on a routine basis to treat constipation. With fecal impactions, the enema formulations of these agents may be helpful. 

Hypersensitivity to any ingredient nausea, vomiting, or other symptoms of appendicitis fecal impaction intestinal obstruction undiagnosed abdominal pain patients who require a low galactose diet (lactulose). 

Sodium Polystyrene Sulfonate (Kayexalate) [Potassium Removing Resin] Uses Rx of T K Action NaVK" ion-exchange resin Dose Adults. 15-60 g PO or 30-60 g PR q6h based on serum Peds. 1 g/kg/dose PO or PR q6h based on serum (given w/ agent, eg, sorbitol, to promote movement through the bowel) Caution [C, M] Contra T Na" Disp Powder, susp SE T Na", -i Na retention, GI upset, fecal impaction Interactions T Risk of systemic alkalosis W/ Ca- or Mg-containing antacids EMS Monitor ECG for h5 pokalemia (flattened T waves) OD Not systemically absorbed but may cause h5 pokalemia and the associated effects (muscle weakness, confusion) and bowel obstruction s5rmpto-matic and supportive... 

PO Mild constipation, fecal impaction, peripheral edema, metabolic alkalosis (muscle pain, restlessness, slow breathing, altered taste)... 

Constipation (may lead to fecal impaction), nausea, vomiting, abdominal pain, indigestion Occasional... 

Contraindications Fecal impaction, GI obstruction, undiagnosed abdominal pain... 

Higfi dosage in elderly-. Fecal impaction characterized by severe stomach pain with nausea or vomiting Occasional... 

Neurotoxicity Fecal impaction Hypercalcemia Osteomalacia and osteoporosis due to phosphate depletion Phosphorous depletion syndrome... 

Patients taking colestyramine often have constipation, abdominal discomfort, and heartburn, but dietary fiber, such as psyllium, can reduce the symptoms (5,6). Other effects are flatulence, nausea, and fecal impaction a mild laxative may be needed, particularly in the elderly. Many other patients complain of anorexia and occasionally there is diarrhea. Doses of colestyramine higher than the 10-16 g normally used can cause steatorrhea (7). 

Finally, gastrointestinal distress in the form of nausea and vomiting is quite common with many of the narcotic analgesics. Because of their antiperistaltic action, these drugs can also cause constipation.48 Because this constipating effect can be quite severe, laxatives and stool softeners (see Chapter 27) can be used to prevent opioid-induced constipation in certain people, such as with patients who are at risk for fecal impaction (e.g., people with spinal cord injuries), or with people who are taking opioids for an extended period of time (e.g., patients receiving opioids for treatment of cancer-related pain).36,70... 

The tendency for these drugs to produce constipation is another side effect that could have important implications for patients receiving physical rehabilitation. Opioid-induced constipation is especially problematic in patients with spinal cord injuries or other conditions that decrease gastrointestinal motility. In such patients, opioids are often administered along with laxatives and GI stimulants (see Chapter 27) to minimize the constipating effects and risk of fecal impaction. Therapists should therefore be aware of these constipating effects and help educate patients and their families so that these effects do not result in serious problems. 

Conjugated bile salts are normally absorbed in the terminal ileum. Disease of the terminal ileum (eg, Crohn s disease) or surgical resection leads to malabsorption of bile salts, which may cause colonic secretory diarrhea. The bile salt binding resins cholestyramine or colestipol may decrease diarrhea caused by excess fecal bile acids (see Chapter 35 Agents Used in Hyperlipidemia). The usual dose is 4-5 g one to three times daily before meals. Side effects include bloating, flatulence, constipation, and fecal impaction. In patients with diminished circulating bile acid pools, further removal of bile acids may lead to an exacerbation of fat malabsorption. These agents bind a number... 

Gastrointestinal Abdominal discomfort, constipation, flatulence, nausea and vomiting, fecal impaction... 

Large doses of aluminium can be associated with fecal impaction and the development of intestinal obstruction in uremic patients (48). Impacted tablets have in some cases caused obstruction (SEDA-16, 417). 

A major complication of constipation in the elderly is fecal impaction, a potentially serious condition that can result from ignoring impulses to defecate. Impaction is the buildup of fecal mass that becomes too large to expel. Increasing dietary fiber is part of the management program for chronic constipation of the elderly. Addition of bran (6-20 g/day) increases fecal weight and increases the frequency of defecation. When wheat bran is not effective, the laxative lactulose is recommended. Lactulose is a disaccharide composed of galactose and fructose connected by a p(l 4) bond. This compound is absorbed poorly in the small intestine because of the absence of enzymes that catalyze its hydrolysis. 

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