Constipation

Question 1

< […] times per week or has significant difficulty passing stool
Chronic: hard […] like stool that is difficult to pass

Answer 1

3
pellet/rabbit

Question 2

overflow diarrhoea

Answer 2

fluid moving past the hard stool in the rectum.

Question 3

Cause:
MC: […]
- Low […]
- Dislike of using toilet
- Pain on passing stool e.g., secondary to an anal […] or very hard stool
- Not recognising sensation of needing to pass stool

Answer 3

diet
fibre
fissure

Question 4

Diagnosis

Answer 4

history and palpation of impacted faeces (hard, depressible masses) on abdominal examination.

Question 5

Managament
- […] disimpaction regimen, followed by maintenance […]
- high […] diet
- advice about encouraging good […] habits

Answer 5

movicol, movicol
fibre
toileting

Question 6

Good toileting habits advice

Answer 6

Go when you feel like you need to poo
Sit down on toilet, elbows on knees and lean forward

Question 7

What differential must be excluded
1. When to suspect

Answer 7

Hirschprung’s disease
1. Chronic constipation that does not respond to movicol regimen

Question 8

Hirchsprung’s disease
[…] distal colon is shrunken and not able to […] properly. This causes a back pressure of stool

Answer 8

Aganglionic, distend

Question 9

Hirchsprung’s disease: FEATURES at birth
- a delay in passing […] (>48 hours)
- a […] abdomen
- forceful evacuation of meconium after […]

Answer 9

meconium
distended
DRE - digital rectal examination

Question 10

Hirchsprung’s disease - DIAGNOSIS

Answer 10

rectal biopsy

Question 11

Hirchsprung’s disease - Mx
- initially: […] washout/bowel irrigation
- definitive: resection of […] portion

Answer 11

anganglionic