Abdominal issues

Question 1

What is the management of idiopathic chronic constipation who is impacted

Answer 1

1. macrogel disimpaction regime starting with low dose and increasing according to response
2. consider stimulant or osmotic laxatives if above doesn’t work

Question 2

What are signs of impaction

Answer 2

overflow diarrhoea

palpable fecal mass

Question 3

Red flag symptoms for childhood constipation

Answer 3

• Timing of onset: from birth/first few weeks of life
• meconium >48hs after birth in term baby
• stool pattern - ribbon stools
• motor problems - leg muscle weakness/gross motor delay
• abdo distention with vomiting

Question 4

What is the management of children with constipation and rd flag symptoms

Answer 4

do not treat

refer to specialist

Question 5

red flag signs on examination for chronic constipation

Answer 5

• abnormal appearance: bruising/fissures/patency/position
• gross abdominal distention
• abnormal asymmetry or flattening of gluteal muscles
• naevi or sinus
• hairy patch
• dimple you can’t see the bottom of
• scoliosis
• lower limb abnormalaties
• abnormal reflexes

Question 6

What may be the cause of not passing meconium in the first 48 hours of life

Answer 6

• Hirshsprung
• meconium ileus - CF
• malrotation/volvulus (billios vomiting)
• anorectal malformation
• vowel atresia/obstruction

Question 7

What is Hirshsprungs disease

Answer 7

• congenital absence of ganglion cells in the submucosal and myenteric plexus
• affected bowel is constantly spasming and unable to relax causing function bowel obstruction

Question 8

What part of the bowel is affected in Hirshsprungs disease

Answer 8

Begins at anus and usuall extends to sigmoig colon but can affect the ascending colon and even the entire bowel.

Question 9

How does Hirshsprungs disease present

Answer 9

• failure/delayed passage of meconium
• chronic constipation
• Faltering growth

Question 10

What will hirshsprungs look like on AXR

Answer 10

gaseous distention

Question 11

What are the investigations of choice to look for Hirshsprungs

Answer 11

• contrast studies: constricted bowel and distended colon proximal to it
• rectal biopsy

Question 12

What will you see on rectal biopsy in a patient with Hirshsprungs

Answer 12

absence of ganglion cells

Question 13

What is the management of Hirshsprungs disease

Answer 13

• decompressing bowel daily with saline enemas

- formation of colostomy and pulling the ganglionic bowel to the anus at a later stage