Abdominal pain: Hirschsprung's disease and constipation Flashcards
What does blood in stools indicate?
Intussusception, inflammatory bowel disease, Henoch Schonlein purpura and gestroenteritis
What is the vomiting of bile highly suggestive of?
Small Bowel obstruction, necrotising enterocolitis, Hirschsprung’s disease
Horseshoe kidney is associated with which condition?
Turner’s syndrome
What is vesicoureteric reflux?
vesico-ureteric reflux is the retrograde flow of urine from the bladder up into the ureters, renal pelvis or pelvicalyceal system
What does vesicoureteric reflux predispose patients to?
UTI, pyelonephritis, hydronephrosis, hypertension or end-stage renal failure
What are the common presentations of UTI in infants < 3 months of age?
Fever, vomiting, poor feeding, Failure to thrive, Irritability
What was the diagnostic criteria used to define constipation?
Rome IV diagnostic criteria is used to define constipation as having spontaneous bowel movements for <3 times per week.
When will it be known as chronic constipation?
There is chronic constipation if symptoms last for 12 weeks or more in 6 months.
Constipation is more common in?
Constipation is more common in females, the elderly and during pregnancy
What are the red flag symptoms in someone (of any age) presenting with constipation? What will you be suspicious of?
Red flags:
- Aged 40 and above
- Unexplained rectal bleeding
- Unexplained abdominal pain
- Unexplained or sudden weight loss
- Changes in bowel habits
- Iron deficiency anaemia
Suspicious of colorectal cancer.
What is the normal stool frequency in children according to their age?
Average of 4 per day in the 1st week of life
2 per day at 1 year of age
3 per week is usually attained at 4 years of age
Define “overflow soiling” in children
There is overflow soiling if there are very loose smelly stools passed without sensation or awareness/involuntary passage of fluid or semi-solid stools.
Why does overflow soiling occur in constipated children?
Overflow results from an overloaded bowel
What are the red flags of constipation in children? What could each red flag indicated?
Symptoms of constipation appearing from birth or during the first few weeks of life –> indicates Hirschsprung’s disease
Delay in passing meconium for >48 hours (2 days) after birth in a full-term infant –> Hirschsprung’s disease or Cystic Fibrosis
Abdominal distension with vomiting –> Hirschsprung’s disease or intestinal obstruction
Ribbon stool pattern - may indicate anal stenosis
What is the medication given for disimpaction? How old must the child be?
Macrogol (Movicol-Paediatric)
Child must be >5 years old.
Initially give 4 sachets per day on 1st day, then increase by 2 sachets daily, up to a max of 12 sachets per day. Switch to maintenance laxative therapy after disimpaction.
What is Hirschsprung’s disease?
Hirschsprung disease is a birth defect in which there are missing nerve cells at the end of the child’s bowel, resulting in bowel obstruction and blockages as the stools cannot move through the bowel normally.
Which areas in the bowel are commonly affected in Hirschsprung’s disease?
Most commonly affected areas are the sigmoid colon and rectum.
When is Hirschsprung’s disease suspected in a child?
When there is failure to pass meconium in the first 48 hours after birth.
When there is abdominal distention with vomiting (bilious vomit).
What investigations are done to diagnose Hirschsprung’s disease?
Anorectal Manometry: use of pressure sensors and balloons to measure the rectal muscles. Balloon inserted into the child’s rectum in inflated. Normal response would be relaxation of rectal muscles.
Abdominal X-ray: to look for intestinal obstruction
What are the management options of Hirschsprung’s disease?
Pull-through procedure: Where the defective part of large colon is removed, and the healthy part connected to the healthy anus
Ostomy surgery: Either Ileostomy or Colostomy
The treatment of faecal impaction can initially lead to?
Treatment of faecal impaction can initially increase soiling and abdominal pain.
Which medication is safe for use in babies?
What are its side effects?
Lactulose.
SE: Stomach cramps and wind
