ManagementofConstipationinAdults便秘的人管理ManagementofConstipationinAdults便秘的人管理ManagementofConstipationinAdults便秘的人管理ManagementofConstipationinAdultsStephenAglubat,MDMay2012ObjectivesDefineConstipationTreatmentoptionsforconstipationManagementofConstipationin1ManagementofConstipationinAdultsStephenAglubat,MDMay2012ManagementofConstipationin2ObjectivesDefineConstipationTreatmentoptionsforconstipationObjectivesDefineConstipation3Case76yearoldfemalewithPMHxofHTN,DMII,HLD,presentstotheclinic.She’scomplainingofhavingstoolsonlytwiceaweek,andfeeling“full.”She’seatingmorevegetables,starteddrinkingmorewater,andsherecentlyincludedMetamuciltoherdiet.Herlastcolonoscopyoneyearagowasclean.Shecomestoyourofficetobeevaluatedforherconstipation.Whatwouldyouofferherfortheconstipation?A.LactuloseB.SennaC.DocusateD.WeeklytapwaterenemasCase76yearoldfemalewithPM4DefinitionRomeIIIcriteria:2ofthebelowdefinesconstipationStrainingLumpyHardStoolsIncompleteEvacuationUseofDigitalRectalManeuversSensationofAnorectalBlockage<3BowelMovementsperweekDefinitionRomeIIIcriteria:25PathophysiologyIConstipationiscausedby:PrimaryColorectaldysfunctionSlowTransitDyssnerygicDefacationIrritableBowelSyndromePathophysiologyIConstipation6PathophysiologyIIConstipationiscausedby:SecondaryCausesEndocrine/MetabolicNeurologicMyogenicDisordersMedicationsObstructionChronicIdiopathicConstipation(CIC)PathophysiologyIIConstipation7Management-of-Constipation-in-Adults便秘的人管理22張課件8ManagementInitialtreatmentofChronicFunctionalConstipationLifestylemodificationDietandfiberManagementInitialtreatmentof9LifestyleModificationsIncreasedfluidintakeExerciseEstablishregularbowelregimenpatternLifestyleModificationsIncreas10DietandfiberFiberincreasesbulk/distensionDistentioncausesstoolpropulsion.>25goffiber/dayEffectmaytakeweeks.Adverseeffects:Bloating,flatulenceDietandfiberFiberincreases11LaxativesIStimulantLaxativesSennaBisacodylLaxativesIStimulantLaxatives12LaxativesIIBulkforminglaxativesPsyllium(Metamucil)Methylcellulose(Citrucel)Polycarbophil(FiberCon)Dextran(Benefiber)LaxativesIIBulkforminglaxat13LaxativesIIIOsmoticLaxativesPolyethyleneglycolLactuloseSorbitolMagnesiumHydroxideLaxativesIIIOsmoticLaxatives14OthertherapiesColonicsecretagoguesLubipristoneOthertherapiesColonicsecreta15Management-of-Constipation-in-Adults便秘的人管理22張課件16SummaryConstipationintheolderadultmaybeduetochronicconstipation,secondaryetiologicfactorsAthoroughhistorymustbeobtainedtoruleoutsecondarycauses.Therapyincludes:Diet/lifestyleStimulantLaxativesOsmoticLaxativesSummaryConstipationintheold17Case76yearoldfemalewithPMHxofHTN,DMII,HLD,presentstotheclinic.She’scomplainingofhavingstoolsonlytwiceaweek,andfeeling“full.”She’seatingmorevegetables,starteddrinkingmorewater,andsherecentlyincludedMetamuciltoherdiet.Herlastcolonoscopyoneyearagowasclean.Shecomestoyourofficetobeevaluatedforherconstipation.Whatwouldyouofferherfortheconstipation?A.LactuloseB.SennaC.DocusateD.WeeklytapwaterenemasCase76yearoldfemalewithPM18Case76yearoldfemalewithPMHxofHTN,DMII,HLD,presentstotheclinic.She’scomplainingofhavingstoolsonlytwiceaweek,andfeeling“full.”She’seatingmorevegetables,starteddrinkingmorewater,andsherecentlyincludedMetamuciltoherdiet.Herlastcolonoscopyoneyearagowasclean.Shecomestoyourofficetobeevaluatedforherconstipation.Whatwouldyouofferherfortheconstipation?A.LactuloseB.SennaC.DocusateD.WeeklytapwaterenemasCase76yearoldfemalewithPM19References1.Managementofchronicconstipationinolderadults.Wald,Arthur.Uptodate.March2012References1.Managementofchr20謝謝你的閱讀知識就是財富豐富你的人生謝謝你的閱讀知識就是財富21

1、最靈繁的人也看不見自己的背脊。——非洲

2、最困難的事情就是認識自己。——希臘

3、有勇氣承擔命運這才是英雄好漢。——黑塞

4、與肝膽人共事，無字句處讀書。——周恩來

5、閱讀使人充實，會談使人敏捷，寫作使人精確。——培根

1、最靈繁的人也看不見自己的背脊。——非洲

2、最困22ManagementofConstipationinAdults便秘的人管理ManagementofConstipationinAdults便秘的人管理ManagementofConstipationinAdults便秘的人管理ManagementofConstipationinAdultsStephenAglubat,MDMay2012ObjectivesDefineConstipationTreatmentoptionsforconstipationManagementofConstipationin23ManagementofConstipationinAdultsStephenAglubat,MDMay2012ManagementofConstipationin24ObjectivesDefineConstipationTreatmentoptionsforconstipationObjectivesDefineConstipation25Case76yearoldfemalewithPMHxofHTN,DMII,HLD,presentstotheclinic.She’scomplainingofhavingstoolsonlytwiceaweek,andfeeling“full.”She’seatingmorevegetables,starteddrinkingmorewater,andsherecentlyincludedMetamuciltoherdiet.Herlastcolonoscopyoneyearagowasclean.Shecomestoyourofficetobeevaluatedforherconstipation.Whatwouldyouofferherfortheconstipation?A.LactuloseB.SennaC.DocusateD.WeeklytapwaterenemasCase76yearoldfemalewithPM26DefinitionRomeIIIcriteria:2ofthebelowdefinesconstipationStrainingLumpyHardStoolsIncompleteEvacuationUseofDigitalRectalManeuversSensationofAnorectalBlockage<3BowelMovementsperweekDefinitionRomeIIIcriteria:227PathophysiologyIConstipationiscausedby:PrimaryColorectaldysfunctionSlowTransitDyssnerygicDefacationIrritableBowelSyndromePathophysiologyIConstipation28PathophysiologyIIConstipationiscausedby:SecondaryCausesEndocrine/MetabolicNeurologicMyogenicDisordersMedicationsObstructionChronicIdiopathicConstipation(CIC)PathophysiologyIIConstipation29Management-of-Constipation-in-Adults便秘的人管理22張課件30ManagementInitialtreatmentofChronicFunctionalConstipationLifestylemodificationDietandfiberManagementInitialtreatmentof31LifestyleModificationsIncreasedfluidintakeExerciseEstablishregularbowelregimenpatternLifestyleModificationsIncreas32DietandfiberFiberincreasesbulk/distensionDistentioncausesstoolpropulsion.>25goffiber/dayEffectmaytakeweeks.Adverseeffects:Bloating,flatulenceDietandfiberFiberincreases33LaxativesIStimulantLaxativesSennaBisacodylLaxativesIStimulantLaxatives34LaxativesIIBulkforminglaxativesPsyllium(Metamucil)Methylcellulose(Citrucel)Polycarbophil(FiberCon)Dextran(Benefiber)LaxativesIIBulkforminglaxat35LaxativesIIIOsmoticLaxativesPolyethyleneglycolLactuloseSorbitolMagnesiumHydroxideLaxativesIIIOsmoticLaxatives36OthertherapiesColonicsecretagoguesLubipristoneOthertherapiesColonicsecreta37Management-of-Constipation-in-Adults便秘的人管理22張課件38SummaryConstipationintheolderadultmaybeduetochronicconstipation,secondaryetiologicfactorsAthoroughhistorymustbeobtainedtoruleoutsecondarycauses.Therapyincludes:Diet/lifestyleStimulantLaxativesOsmoticLaxativesSummaryConstipationintheold39Case76yearoldfemalewithPMHxofHTN,DMII,HLD,presentstotheclinic.She’scomplainingofhavingstoolsonlytwiceaweek,andfeeling“full.”She’seatingmorevegetables,starteddrinkingmorewater,andsherecentlyincludedMetamuciltoherdiet.Herlastcolonoscopyoneyearagowasclean.Shecomestoyourofficetobeevaluatedforherconstipation.Whatwouldyouofferherfortheconstipation?A.LactuloseB.SennaC.DocusateD.WeeklytapwaterenemasCase76yearoldfemalewithPM40Case