Ch 332.3 - Encopresis and Functional Constipation

Question 1

Constipation is defined as delay or difficulty in defecation present for ___ or longer and significant enough to cause distress to the patient

Answer 1

2 weeks

Question 2

Based on the Rome III criteria, chronic constipation in infants and toddlers must include 1 month of at least how many of the 6 criteria

Answer 2

2

Question 3

Criteria for chronic constipation in infants and toddlers based on Rome III

Answer 3

1) ≤2 defecations per week 2) ≥1 episode of incontinence after acquisition of toilet training skills 3) History of excessive stool retention 4) History of painful or hard bowel movements 5) Presence of large fecal mass in the rectum 6) History of large-diameter stool that might obstruct the toilet

Question 4

Criteria for chronic constipation in children aged 4 to 18 yrs based on Rome III

Answer 4

At least 2 of 6: 1) ≤2 defecations per week 2) ≥1 episode of incontinence per week 3) History of retentive posturing or excessive volitional stool retention 4) History of painful or hard bowel movements 5) Presence of large fecal mass in the rectum 6) History of large-diameter stool that might obstruct the toilet

Question 5

Functional constipation can usually be differentiated from that caused by organic causes on the basis of

Answer 5

History and PE

Question 6

Unlike anorectal malformations and Hirschprung disease, functional constipation ___

Answer 6

Typically starts after the neonatal period

Question 7

Findings associated with constipation that are suggestive of underlying pathology

Answer 7

1) Failure to thrive 2) Weight loss 3) Abdominal pain 4) Vomiting 5) Persistent anal fissure or fistula

Question 8

Voluntary or involuntary passage of feces into inappropriate places at least once a month for 3 consecutive months once 4 y/o has been reached

Answer 8

Encopresis

Question 9

Other considerations for patients with intractable constipation

Answer 9

1) Hypothyroidism 2) Hypocalcemia 3) Lead toxicity 4) Celiac disease 5) Allergy testing

Question 10

What condition presents with megarectosigmoid in water-soluble contrast enema

Answer 10

Severe functional constipation

Question 11

Therapy for functional constiaption and encopresis

Answer 11

1) Patient education 2) Relief of impaction 3) Softening of the stool

Question 12

Maintenance therapy for functional constipation is generally continued until

Answer 12

A regular bowel pattern has been established

Question 13

Options for rapid fecal disimpaction

Answer 13

1) Glycerin supposed in infants and toddlers 2) Phosphate enema, 60ml in <1yo, 6ml/kg in >1yo

Question 14

Options for slow oral disimpaction

Answer 14

1) PEG with electrolytes 25cc/kg over 2-3 days or until clear fluid comes from anus (2-3 days) 2) PEG without elec 1.5g/kg x 3 days 3) Mineral oil 3cc/kg BID x 7 days 4) Lactulose 2cc/kg BID x 7 days

Question 15

Options for maintenance therapy

Answer 15

1) YEARS: Mineral oil, lactulose, PEG 2) MONTHS: Senna, glycerin enemas, bisacodyl suppositories