7.3. Gastroenterology - Chronic Constipation

Question 1

What are the Clincial Features of Chronic Constipation?

Answer 1

1. Infrequent Passage of Stool - Hard / Painful / Change
2. Poor Appetite
3. Irritable
4. Lack of Energy
5. Abdominal Wall Pain / Distension
6. Withholding / Straining

Question 2

Why do Children become Constipated?

Answer 2

1. Social - Poor Diet (Excessive Milk / Insufficient Fluids) / Potty Training
2. Physical - Intercurrent Illness / Medication
3. Family History
4. Psychological (Secondary)
5. Organic

Question 3

What is the Cycle of Constipation?

Answer 3

1. Withholding of Stool
2. Constipation
3. Large Hard Stool
4. Pain or Anal Fissure
   Repeat

Question 4

What is the Treatment of Constipation, due to Social Causes?

Answer 4

1. Explain Treatments to Parents
2. Dietary:
3. a) Increased In Fibre - Fruit / Vegetables
4. b) Increase in Fluids
5. c) Decrease in Milk

Question 5

What is the Treatment of Constipation, due to Psychosocial Causes?

Answer 5

Reduce Aversive Factors:

1. Soften Stool / Remove Pain
2. Reward “Good” Behaviour - Praise / Star Charts

Question 6

How is Stool Softened / Defecation Stimulated?

Answer 6

1. Osmotic Laxatives - Lactulose
2. Stimulant Laxatives - Senna / Picolax
3. Isotonic Laxatives - Movicol

Question 7

How is Impaction Treated?

Answer 7

1. Emptying Impacted Rectum / Colon
2. Maintain Regular Stool Passage
3. Slow Weaning off Treatment

Question 8

What are the “+”’s in Crohn’s vs U.C. for the Following:

1. Diarrhoea?
2. Rectal Bleeding?
3. Abdominal Pain?
4. Fever?
5. Weight Loss?
6. Growth Failure?
7. Arthritis?
8. Mass?

Answer 8

Crohn’s vs Ulcerative Colitis:

1. Diarrhoea - U.C. More - ++ vs +++++
2. Rectal Bleeding -U.C. More - ++ vs +++++
3. Abdominal Pain -Equal - +++ vs +++
4. Fever - Equal - + vs +
5. Weight Loss - Crohn’s More - ++++ vs +
6. Growth Failure - Crohn’s More - ++++ vs +
7. Arthritis - Equal - ++ vs ++
8. Mass - Crohn’s More - ++ vs -

Question 9

How is a Diagnosis of Inflammatory Bowel Disease made?

Answer 9

1. History / Examination
2. Laboratory Investigations
3. Definitive Investigations

Question 10

What is asked about in an Inflammatory Bowel Disease History?

Answer 10

1. Intestinal Symptoms
2. Extra-Intestinal Manifestations
3. Exclude Infection
4. Family History
5. Growth and Sexual Development
6. Nutritional Status

Question 11

What Laboratory Investigations are looked at in an Inflammatory Bowel Disease?

Answer 11

1. Full Blood Count and ESR - Anaemia / Thrombocytopenia / Raised ESR
2. Biochemistry - Stool Calprotectin / Raised CRP / Low Albumin
3. Microbiology - No Stool Pathogens

Question 12

What Definitive Investigations are looked at in an Inflammatory Bowel Disease?

Answer 12

1. Radiology - MRI / Barium Meal and Follow-Through

2. Endoscopy - Colonoscopy / U.G.I.E / Capsule / Enteroscopy / Mucosal Biopsy

Question 13

What are the Treatments of Inflammatory Bowel Disease?

Answer 13

1. Medical:
2. a) Anti-Inflammatory - NSAID’s
3. b) Immuno-Suppressive - Prednisolone / Azothioprim
4. c) Biologicals - Infliximab
5. Nutritional:
6. a) Immune Modulation
7. b) Nutritional Supplementation
8. Surgical