Differential Diagnosis

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Constipation is a disorder and not a disease. It may be secondary to several diseases, including colonic disease (stricture, cancer, anal fissure, proctitis), metabolic and endocrine disturbances (hypercalcemia, hypothyroidism, diabetes mellitus), neurologic disorders (Parkinson's disease, spinal cord lesions), or pharmaco-logic (antidepressive) (Table 5.2). Therefore, exclusion of both intestinal and systemic organic etiologies is an imperative step prior to referring the patient with functional symptoms to the physiology laboratory. Barium enema or colonoscopy is usually indicated and the primary pathology treated. Additional tests, dictated by the history and physical examination, may be necessary to exclude the above-named diseases.

Table 5.2. Etiology of constipation

Poor habits

Morphine

Lead

Low fiber diet

Nonsteroidal antiinflammatories

Mercury

Inadequate fluid intake

Diclofenac

Phosphorus

Inadequate exercise

Indometacin

Miscellaneous agents

Ignoring call to stool

Nabumetone

Barium sulfate

Situational factors (travel, illness)

Naproxen

Thalidomide

Intrinsic bowel disease

Salicylates

Alendronate

Mechanical obstruction

Sulindac

Interferon-alfa-2b

Neoplasm

Muscle relaxants and other analgesics

Leuprolide

Inflammation

Baclofen

Levofloxacin

Volvulus

Carisoprodol

Ondansetron

Infection

Tizanidine

Pamidronate

Incarceration

Tramadol

Neurologic disorders

Intussusception

Calcium channel blockers

Cerebral

Ischemia

Nifedipine

Parkinson's disease

Collagen vascular disease

Verapamil

Stroke

Scleroderma

Antiarrhytmic drugs

Tumor

Amyloidosis

Amiodarone

Spinal

Anorectal disease

Flecainide

Cauda equina tumor

Anal stenosis

Mexiletine

Meningocele

Fissure

Propafenone

Spinal cord injury

Inflammation

Lipid-lowering agents

Tabes dorsalis

Pharmacologic agents

Cholestyramine

Multiple sclerosis

Antidepressants

Colestipol

Paraplegia

Amoxapine

Lovastatin

Peripheral

Bupropion

Provachol

Chagas'disease

Clomipramine

Antihypertensives

Hirschsprung's disease

Fluoxetine

Diuretics

Surgical disruption of nervi

Maprotiline

Acebutolol

erigentes

Mirtazepine

Clonidine

Senna toxicity

Paroxetine

Guanfacine

Von Recklinghausen's disease

Sertraline

Antiplatelet

Autonomic plexus neuropathy

Venlafaxine

Anagrelide

Multiple endocrine neoplasia II-B

Tranquilizers

Hematologic/oncologic drugs

Hypoganglionosis

Alprazolam

Iron therapy

Endocrine causes

Clozapine

Carboplatin

Hypothyroidism

Olanzapine

Erythropoetin

Hypopituitarism

Risperidone

Filgrastim

Diabetes mellitus

Neurologic drugs

Vinblastine

Pheochromocytoma

Bromocriptine

Gastrointestinal drugs

Metabolic causes

Felbamate

Aluminum- and calcium-containing antacids

Dehydration

Pergolide

Mesalamine

Uremia

Valproic acid

Pancreatin

Hypercalcemia

Narcotics

Sandostatin

Porphyria

Burtorphanol

Heavy metal intoxication

Pregnancy

Codeine

Arsenic

Hypokalemia

Fentanyl

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