Chronic Megacolon

CHRONIC MEGACOLON 1.

CHIEF COMPLAINT •Chronic megacolon

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HPI

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ROS

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SYMPTOMS •Constipation

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HISTORY

a. FAMILY HISTORY •Diabetes

•Thyroid disorders •Hypertension •Parkinson disease b. SOCIAL HISTORY c. PAST MEDICAL HISTORY •Diabetes •Hypothyroidism •Hypokalemia •Parkinson disease d. SURGICAL HISTORY e. CHRONIC CONDITIONS  Chagas disease  Parkinson disease  Myotonic dystrophy  Diabetic neuropathy  Spinal cord injury  Paraneoplastic neuropathy  Amyloidosis  Scleroderma  Dermatomyositis/polymyositis  Systemic lupus erythematosus  Mixed connective tissue disease  Hypothyroidism

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Hypokalemia Porphyria Pheochromocytoma Nonfamilial visceral neuropathy

ALLERGIES PHYSICAL EXAMINATION Physical examination generally reveals a distended abdomen, which may or may not be tense. Tympany is invariably present. Digital rectal examination may demonstrate a hard mass of stool just above the anorectal ring. Digital rectal examination in a patient with Hirschsprung disease may bring about a large gush of retained fecal material. SPECIFIC DATA LIKE GRADING TESTS TO BE ORDERED • CBP • Serum electrolyte • Thyroid function test • X-ray Abdomen • USG Abdomen • CT scan Abdomen • MRI Abdomen • colonic marker transit study • Anorectal manometry • Pudendal nerve latency test • Colonoscopy

10. ASSESSMENT/PLAN Medical Care •Do fecal evacuation by enemas and suppositories •Empty the bowel (eg, osmotic laxatives, enemas, suppositories, cathartics, digital disimpaction). Surgical Care •Total abdominal colectomy with ileorectal anastomosis •Total proctocolectomy with ileostomy •Total proctocolectomy with ileoanal anastomosis

11. EDUCATION •Take high-fiber diet •High-fluid intake diet •Practice a bowel habit retraining program (eg, scheduled times for defecation, increased physical activity if possible). •Consume bulking agents/bowel agents. •Slowly alter/individualize the regimen. 12. MEDICATION •Psyllium •Sorbitol •Lactulose •Senna •Bisacodyl •Cascara sagrada •Polyethylene glycol (PEG) solution •Tegaserod 13. FOLLOW UP