3 - Paeds - Gastro - Constipation

Question 1

Causes - infants
- (2 that come with pain?)

-older kids?

Answer 1

hirschsprung
anorectal abnormality
hypothyroidism
hypercalcaemia
dehydration/red fluid intake > pain
Anal fissure > pain

toilet training problems, unpleasant toilets, stress

Question 2

Examination - what might you find? when do DRE + who? When to Ix?

Answer 2

palpable abdo mass
DRE only by paeds specialist if pathological cause suspected/red flag Sx
Ix only if indicated by Hx/Ex

Question 3

When can acute constipation occur? treatment for this?

if long standing - what can happen to rectum?

Answer 3

after febrile illness, usually spont resolution or mild laxative/extra fluid

rectum over distended (megarectum) > lose defecation reflex > involuntary soiling

Question 4

Simple constipation VS dysmotility - differences? dysmotility generally….

Answer 4

onset, age, freq, explanation

dysmotility generally chronic and some seen from birth

Question 5

Red flag Sx for these conditions….

• Hirschsprung’s
• Hypothyroid, coeliac
• Hirschsprung’s/other GI dysmotility
• Lumbosacral pathology
• Spina bifida occulta
• Sexual abuse
• perianal crohn’s disease

Answer 5

• failure to pass meconium in first 24h
• FTT
• gross abdo distension
• Abnormal lower limb neuro
• sacral dimple
• bruising/fissures
• perianal fistula/abscess/fissure

Question 6

MGMT - what to do if faeces NOT palpable per abdomen? What if this fails (relapse of rectal loading)?

Answer 6

balanced diet and sufficient fluids + maintenance laxatives

stimulant laxative (senna) +/- osmotic laxative (lactulose)

Question 7

MGMT - what if faeces ARE palpable? Next question to ask after this treatment? what if yes?

Answer 7

macrogol laxative (polyethylene glycol + electrolytes) for 2 weeks

—- pass stool spontaneously???—-

yes > balanced diet and fluids + maintenance laxatives

Question 8

MGMT - what if macrogol laxative (polyethylene glycol + electrolytes) DONT WORK? (cant pass stool spontaneously?)

what if this mgmt works?

Answer 8

stimulant laxative (senna) +/- osmotic laxative (lactulose)

works? - balanced diet + fluids + maintenance laxatives

Question 9

MGMT - what if stimulant +/- osmotic laxatives DONT work

Answer 9

consider enema (+/- sedation) or manual evacuation under GA by paeds specialist