Pemicu 5

Constipation
Michelle Betsy

LO 1
Anatomy of lower GIT

A
n
a
t
o
m
y
3

Colon
Flexura coli dextra

Taenia coli Plica semilunaris

omentalis
Appendix omentalis

Haustra coli
Taenia coli
libera
Taenia coli
mesocolica Taenia coli
libera
Muara
appendix
caecum
mesoappendix
Appendix veriformis

Colon descendens

Mesocolon
sigmoideum
Taenia coli libera
Tunika muscularis longitudinalis

Projection of appendix vermiformis

( McBurney point)

Linea Monro-Ricther

Titik McBurney

Gross Anatomy of Large Intestine

physiology of lower GIT

PHYSIOLOGY

Large intestine
As this residue passes
through the colon, nearly
all of the water is
absorbed,
leaving
a
usually soft but formed
substance called stool.
Muscles in the wall of your
colon separate the waste
into small segments that
are pushed into your
lower colon and rectum.
As the rectal walls are
stretched, they signal the
need
for
a
bowel
movement.
When
the
sphincter
muscles in your anus
relax, the rectal walls
contract
to
increase

PHYSIOLOG
Y
Fluid
loads
along
the
gastrointestinal tract
Each day, close to 10 L of fluid
composed of ingested food and
drink and secretions from the
salivary
glands,
stomach,
pancreas,
bile
duct,
and
duodenum pass the ligament of
Treitz
The
jejunum
absorbs
approximately 6 L and the ileum
2.5 L, leaving about 1.5 L to pass
into the colon each day
The colon absorbs more than 90%
of
this
load,
leaving
approximately 0.1 L in the feces
Therefore, the overall efficiency

Small Intestine
Intestinal mucus is secreted by surface

epithelial cells throughout the GI tract, by

Brunners glands in the duodenum, and by
characteristic goblet cells in the mucosa of the
small and large intestine.
Function: lubricates the food and holds
immunoglobulin in place.

The Jejunum

The Ileum

The Colon

bowel movement
A bowel movement is the last stop in the

movement of food through your digestive tract. It

is made of what is left after your digestive system
(stomach, small intestine, and colon) absorbs
nutrients and fluids from what you eat and drink.
It's also called stool or feces. Stool passes out of
the body through the rectum and anus.
Sometimes a bowel movement isn't normal.
Diarrhea happens when stool passes through the
large intestine too quickly. Constipation occurs
when stool passes through the large intestine too
slowly. Other abnormalities with bowel
movements may be a sign of a digestive problem.

BER (Basic Electrical

Rhythm)

BER is initiated by the interstitial cells of Cajal,

stellate mesenchymal pacemaker cell with smooth

muscle like features that send long multiply branched
processes into the intestinal smooth muscle.
The location of that cells:

In stomach and the small intestinethe outer

circular muscle layer near the myenteric plexus
In the colonthe submucosal border of the circular
muscle layer

Small Intestinal Motility

1. Peristalsis: movement along the tract

2. Segmentation: mix contents to promote digestion &

absorption

LO 2
Constipation

Definition
Constipation is an acute or chronic condition
in which bowel movements occur less often
than usual or consist of hard, dry stools that
are painful or difficult to pass. Bowel habits
vary, but an adult who has not had a bowel
movement in three days or a child who has
not had a bowel movement in four days is
considered constipated.

Description
Constipation is one of the most common medical complaints in the United States.
Constipation can occur at any age, and is more common among individuals who resist the
urge to move their bowels at their body's signal. This often happens when children start
school or enter daycare and feel shy about asking permission to use the bathroom.
Constipation is more common in women than in men and is especially apt to occur during
pregnancy. Age alone does not increase the frequency of constipation, but elderly people
(especially women) are more likely to suffer from constipation.
Although this condition is rarely serious, it can lead to:
bowel obstruction
chronic constipation
hemorrhoids (a mass of dilated veins in swollen tissue around the anus)
hernia (a protrusion of an organ through a tear in the muscle wall)
spastic colitis (irritable bowel syndrome, a condition characterized by alternating periods of
diarrhea and constipation)
laxative dependency
Chronic constipation may be a symptom of colorectal cancer, depression, diabetes,
diverticulosis (small pouches in the muscles of the large intestine), lead poisoning, or
Parkinson's disease.

Cause

Constipation usually results from not getting enough exercise, not drinking enough water, or from a

diet that does not include an adequate amount of fiber-rich foods like beans, bran cereals, fruits, raw
vegetables, rice, and whole-grain breads.
Other causes of constipation include anal fissure (a tear or crack in the lining of the anus);
chronic kidney failure; colon or rectal cancer; depression; hypercalcemia (abnormally high levels of
calcium in the blood); hypothyroidism (underactive thyroid gland); illness requiring complete bed
rest; irritable bowel syndrome; and stress.
Constipation can also be a side effect of:
aluminum salts in antacids
antihistamines
antipsychotic drugs
aspirin
belladonna (Atopa belladonna, source of atropine, a medication used to relieve spasms and dilate the
pupils of the eye)
beta blockers (medications used to stabilize irregular heartbeat, lower high blood pressure, reduce
chest pain)
blood pressure medications
calcium channel blockers (medication prescribed to treat high blood pressure, chest pain, some types
of irregular heartbeat and stroke, and some non-cardiac diseases)
diuretics (drugs that promote the formation and secretion of urine)
iron or calcium supplements
narcotics (potentially addictive drugs that relieve pain and cause mood changes)
tricyclic antidepressants (medications prescribed to treat chronic pain, depression, headaches, and
other illnesses)
An adult who is constipated may feel bloated, have a headache, swollen abdomen, or pass rock-like
feces; or strain, bleed, or feel pain during bowel movements. A constipated baby may strain, cry,

Symtomps
As well as less frequent, hard (and perhaps painful) stools,
constipation can cause:
Tummy ache (abdominal pain).
Poor appetite.
General malaise (feeling 'off colour').
Behavioural changes, such as being more irritable or unhappy.
Fidgeting, restlessness and other signs that the child needs to go to
the toilet.
Feeling sick (nausea).
Severe constipation can cause impaction (where a very large stool is
stuck in the rectum). This can cause further symptoms. In particular,
this can cause a child to soil their pants regularly with very soft
faeces, or with faecal-stained mucus. This is often mistaken by
parents as diarrhoea. Impaction is discussed in detail later.

Types on constipation in children

and babies
Idiopathic constipation. This is common. The word idiopathic means of

unknown cause. Various factors may be involved (discussed later), but many
children become constipated for no known reason.
Short bouts of constipation. It is common for children and babies to have a bout of

mild constipation for a day or so. This may settle quickly, often without the need for
medical treatment.
Long-term constipation. In about 1 in 3 children who become constipated, the problem
becomes more long-term (persistent). This is also called chronic idiopathic
constipation.

Constipation due to an underlying disease or condition. This is uncommon.

The constipation is said to be secondary to this other problem. Some examples of

conditions and problems that can cause constipation are:
Some neurological conditions.
Hypothyroidism (an underactive thyroid gland).
Cystic fibrosis.
Rare diseases with abnormal development of the bowel, such as Hirschsprung's

disease.
As a side-effect of certain medications that a child has to take for another condition.

Diagnosis
The patient's observations and medical history help a
primary care physician diagnose constipation.
The doctor uses his fingers to see if there is a hardened
mass in the abdomen, and may perform a
rectal examination. Other diagnostic procedures include a
barium enema, which reveals blockage inside the intestine;
laboratory analysis of blood and stool samples for internal
bleeding or other symptoms of systemic disease; and a
sigmoidoscopy (examination of the sigmoid area of the
colon with a flexible tube equipped with a magnifying lens).
Physical and psychological assessments and a detailed
history of bowel habits are especially important when an
elderly person complains of constipation.

Complication
Hemorrhoids
Hemorrhoids are the most common yet one of the most feared
complications of constipation.
Hemorrhoids are swollen and inflamed vascular structures of the
anus. We are using the term "vascular structures" and not simply
"veins" here. As we will see in a separate article, they differ slightly
in nature and have a very specific role in the anus function.
Hemorrhoids can be internal to the anus, or external (in which case
they can be seen and touched). They can sometimes develop
unnoticed. They almost always become painful, swollen, throbbing,
irritated, itchy and bleeding.
In the remedies section, we will present some very good herbs that
can reduce swelling, calm the burning and itch, and strengthen the
constitution of those vascular structures.

Fecal impaction

Fecal impaction (also spelled faecal impaction) is a real problem in

constipated children. See "psychological blockage" section below. It is
not very common in the young adult sufferer, but increases significantly
with age and greatly hinders the quality of life of the older population. If
and when it happens to you, you should be prepared to deal with this
situation.
Let us not forget one of the key roles of the colon: to dehydrate food
residues in order to reclaim precious water and minerals. If this stool
matter is not evacuated, it will become drier and drier. At some point, a
hard, immovable plug may form in the colon. This is faecal (or fecal)
impaction.
As we will see on the page dedicated to fecal impaction, this condition
brings its own sets of symptoms, some unexpected (liquid stool
evacuation we will explain why).

Fecal incontinence
It happens when we lose the ability to control our bowel

muscles. The last part of the colon, the anus in particular, is

not tonic enough to keep the stools and gases inside.
This leads to involuntary passage of fecal material. This can
range from sporadic leakage of a small amount of feces or
gas, to the passage of a complete bowel movement.
The main cause is of course chronic constipation, and the
continuous stretching of the anal muscles, leading to a loss
of tension and tonicity. We will dedicate a separate page to
this trying situation.

Bleeding
rectal bleeding is one of the innocuous complications
of constipation. Hard and dry feces have a tendency
to cut into our colon and anal mucosa, creating small
tears that can bleed on and off. This can be
accompanied by throbbing pain (the tear being
tender and inflamed).
Rectal bleeding can also hide a more serious
condition. Do not worry yourself too much at this
stage if you see occasional bleeding on your toilet
paper. For us chronically constipated, it is part of our
condition.

Prevent constipation
Food and fibre
This advice applies to babies who are weaned, and children. Foods which are
high in fibre are: fruit, vegetables, cereals, wholemeal bread. A change to a
high-fibre diet is often 'easier said then done', as many children are fussy
eaters. However, any change is better than none. Listed below are some ideas
to try and increase your child's fibre intake:
A meal of jacket potatoes with baked beans, or vegetable soup with bread.
Dried (or semi-dried) apricots or raisins for snacks.
Porridge or other high-fibre cereals (such as Weetabix, Shredded Wheat or
All Bran) for breakfast.
Offering fruit with every meal - perhaps cut up into little chunks to make it look
more appealing.
Perhaps do not allow sweets or desserts until your child has eaten a piece of
fruit.
Another tip for when children are reluctant to eat high-fibre foods is to add
powdered bran to yoghurt. The yoghurt will feel grainy, but powdered bran is
tasteless.