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A. MLA Map Paediatrics > Constipation > Flashcards

Constipation Flashcards

1
Q

Constipation is a common problem. It means either going to the toilet less often than usual to empty the bowels, or passing hard or painful stools (faeces). How many of the following are required to be diagnosed with constipation in a child according to NICE?

  • <3 complete stools per week (type 3 or 4 on Bristol Stool Form Scale (BSS))
  • hard or large stools
  • rabbit stool (scale 1 on BSS)

1 - 1 or more
2 - 2 or more
3 - all 3

A

2 - 2 or more

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2
Q

How common is constipation in the general population?

1 - 1-2%
2 - 5-10%
3 - 30-40%
4 - >75%

A

1 - 1-2%

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3
Q

Constipation in the general population has an incidence of 1-2%, but what is the incidence in children?

1 - 1-2%
2 - 5-30%
3 - 30-40%
4 - >75%

A

2 - 5-30%

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4
Q

Is constipation more common in men or women?

A
  • 2-3 times more common in women
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5
Q

How long does constipation have to be present for to be diagnosed as chronic constipation?

1 - >2 weeks
2 - >8 weeks
3 - >16 weeks
4 - >32 weeks

A

2 - >8 weeks

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6
Q

Is constipation more common in younger or older ages?

A
  • incidence increases with age
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7
Q

What is the normal stool frequency in the 1st week of life?

1 - 8/day
2 - 4/day
3 - 2/day
4 - 1/day

A

2 - 4/day

After the 1st week, it is typically 1/day

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8
Q

Which 2 of the following are the most common functional/idiopathic (no physical cause) causes of acute constipation?

1 - dehydration
2 - behavioural (nervous at school etc)
3 - hirschsprung’s disease
4 - hypercalcaemia
5 - hypothyroidism

A

1 - dehydration
2 - behavioural (nervous at school etc)

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9
Q

Which 2 of the following medications are more commonly associated with acute constipation?

1 - NSAIDs
2 - opioids (morphine, codeine)
3 - loperamide (imodium)
4 - anti-depressants

A

2 - opioids (morphine, codeine)
3 - loperamide (imodium)

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10
Q

Acute presentations of constipation can begin as an acute pathophysiology, but can also be the begining of a chronic pathology. What is the most common thing that constipation is compared against?

1 - malignancy
2 - bowel obstruction
3 - neurological disorders
4 - idiopathic

A

2 - bowel obstruction

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11
Q

Opiod medication bind to receptors in the brain and GIT. What type of membrane receptors are these?

1 - ion channel receptors
2 - enzyme associated receptors
3 - passive diffusion
4 - G couple protein receptors

A

4 - G couple protein receptors

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12
Q

Endorphones are endogenous opioid neuropeptides and peptide hormones. When they are released they bind to the inhibitory neurons, namely mu, kappa, and delta which allow dopamine, serotonin, and norepinephrine to be released into the CNS. What does the release of dopamine, serotonin, and norepinephrine cause a reduction in?

1 - muscle contractions
2 - pain
3 - abdominal peristalsis
4 - bladder control

A

2 - pain

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13
Q

The GIT walls contain mu opiod receptors. What are the 2 major effects activation of the mu opiod receptors in the GIT can have?

1 - reduced GIT motility
2 - increased GIT motility
3 - increased sphincter tone
4 - increased fluid secretion in bowels

A

1 - reduced GIT motility
3 - increased sphincter tone

Both cause constipation

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14
Q

The GIT walls contain mu opioid receptors. Opioid is able to bind with all opioid receptors inducing reduced GIT motility and increased sphincter tone. What medication, as part of our core drug list is used to treat diarrhoea, but as a consequence can cause constipation?

1 - loperamide (imodium)
2 - NSAIDs
3 - macrogol
4 - Ondansetron

A

1 - loperamide (imodium)
- specifically in the large intestines

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15
Q

When we ask about abdominal pain, we need to ask ourselves, is this a functional or organic cause. Which of the following is NOT a functional cause of abdominal pain?

1 - IBS
2 - abdominal migraine
3 - constipation
4 - functional dyspepsia

A

3 - constipation

Functional = pain is not physical in nature

Organic = pain has a specific physical cause

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16
Q

When we ask about abdominal pain, we need to ask ourselves, is this a functional or organic cause. Which of the following is NOT an organic cause of abdominal pain?

1 - IBS
2 - peptic ulcers
3 - constipation
4 - IBD
5 - pancreatitis

A

1 - IBS

17
Q

What is the most common cause of chronic constipation?

1 - IBD
2 - coeliac disease
3 - irritable bowel syndrome
4 - reflux

A

3- irritable bowel syndrome

18
Q

Can a UTI be an sign of constipation?

A
  • yes

Constipation can lead to bladder/urethral obstruction

19
Q

Pregnancy is a common cause of constipation. What % of women experience constipation?

1 - 4%
2 - 15%
3 - 40%
4 - 90%

A

3 - 40%

20
Q

Is hypo or hyperthyroidism linked with constipation?

A
  • hyperthyroidism = increased metabolic rate and muscle contractions including GIT smooth muscle, causing diarrhoea
  • hypothyroidism = reduced metabolic rate and muscle contractions including GIT smooth muscle, causing constipation
21
Q

Chronic constipation can cause anorectal problems,. Which of the following is NOT one of these?

1 - haemorrhoids
2 - anal fissures (tears of rectum)
3 - painful defaecation
4 - rectal prolapse (bottom end of rectum falls out)
5 - rectal obstruction

A

5 - rectal obstruction

22
Q

Which congenital condition causing an absence of ganglia in the bowel resulting in a lack of peristalsis can cause constipation and is often diagnosed in infancy?
- 90% diagnosed in infancy
- 1% diagnosed in adults

1 - Coeliac disease
2 - Hirschsprung’s disease
3 - Coeliac disease
4 - Rotavirus disease

A

2 - Hirschsprung’s disease
- THIS IS A RED FLAG!!!

Can often be difficult to meconium, which can be very dangerous, but means patients can be diagnosed very early

Patients can also have abdominal distension with vomiting as food comes back up the wrong way

23
Q

Hirschsprung’s disease is a congenital condition causing an absence of ganglia in the bowel resulting in a lack of peristalsis can cause constipation and is often diagnosed in infancy. What investigation is required to aid with the diagnosis of Hirschsprung’s disease?

1 - X-ray
2 - CT scan
3 - digital rectal exam
4 - rectal biopsy

A

4 - rectal biopsy

24
Q

All of the following can cause constipation. Which 2 of the following are most common?

1 - Coeliac disease
2 - Hirschsprung’s disease
3 - IBD disease
4 - Hypothyroidism

A

1 - Coeliac disease
4 - Hypothyroidism

25
Q

If a child presents with constipation in the 1st week of life, is this more likely to be idiopathic or non-idiopathic?

A
  • non-idiopathic

Likely to be congenital, like Hirschsprung’s disease

26
Q

If a child failed top pass meconium, is this more likely to be idiopathic or non-idiopathic?

A
  • non-idiopathic

An idiopathic cause of constipation would typically pass in the 1st 2 weeks

Idiopathic causes of failure to pass meconium is a RED FLAGS

27
Q

If a child has poor growth and general well being this is an amber flag. Is this more likely to be idiopathic or non-idiopathic?

A
  • non-idiopathic
28
Q

Which of the following is the least likely symptom to present with in a child with constipation?

1 - Hard stools
2 - Straining or pain and bleeding
3 - Abdominal pain
4 - Increased appetite
5 - Faecal impaction-severe symptoms, overflow soiling and a faecal mass on abdominal examination.

A

4 - Increased appetite

Typically reduced appetite as eating can worsen symptoms

Eating does improve with passage of stool.

29
Q

All of the following can occur in chronic constipation, which 2 are the most common symptom?

1 - abdominal pain
2 - bloating
3 - overactive bladder
4 - urine urgency

A

1 - abdominal pain
2 - bloating

30
Q

Patients with chronic constipation can have faecal impactio, what is this faecal impaction?

1 - stool becomes very thin to pass stool causing diarrhoea
2 - stool causing bowel infection
3 - stool becomes so hard it cannot be passed
4 - all of the above

A

3 - stool becomes so hard it cannot be passed

Can also lead to overflow diarrhoea as solid cannot move, but fluid around it does

31
Q

In patients with chronic constipation, all of the following should be performed, but which is least important initially?

1 - FBC
2 - ESR and CRP
3 - TFTs
4 - LFTs

A

4 - LFTs

  • hypothyroidism can cause constipation
32
Q

In patients with chronic constipation, which 2 of the following stool tests that should be performed?

1 - inflammatory marker faecal calprotectin
2 - amylase
3 - qFIT for blood caused by cancer
4 - bile acids

A

1 - inflammatory marker faecal calprotectin
3 - qFIT for blood caused by cancer

33
Q

In an acute setting with someone with constipation, which imaging techniques is best to rule out a bowel obstruction?

1 - MRI
2 - ultrasound
3 - CT scan
4 - X-ray

A

3 - CT scan

X-ray can also be used

34
Q

In someone with constipation, what invasive techniques could be used to identify the cause?

1 - blood samples
2 - colonoscopy
3 - CT scan
4 - rectal biopsy

A

2 - colonoscopy
- virtual colonoscopy is also possible

Bowel transit time tests and pelvic floor tests can also be performed.

35
Q

Which 2 of the following are important to help manage constipation?

1 - balanced diet, fluid intake and increased fibre intake
2 - ensure children are potty trained by 2 years old
3 - allow nappies to be worn for as long as possible to reduce anxiety
4 - support good toileting habits

A

1 - balanced diet, fluid intake and increased fibre intake
4 - support good toileting habits

36
Q

Which of the following is the most common laxative used in the treatment of constipation?

1 - Ispaghula husk
2 - Senna
3 - Docusate sodium
4 - Macrogol

A

4 - Macrogol

This is polyethylene glycol, but the brand name is macrogel, also known as Laxido, CosmoCol, Molaxole and Molative

37
Q

What class of laxatives does Macrogol, the most commonly used laxative come under?

1 - osmotic
2 - bilk forming
3 - stimulant
4 - stool softener

A

1 - osmotic

These are not well absorbed so fluid is pumped into the bowel in an osmotic gradient

Often used in combination with stimulant laxatives such as Senna or glycerol suppositories which irritate the GIT walls, drawing in electrolytes from the enterocytes, which subsequently draws water into the lumen

38
Q

Should children be started on a set dose based on weight, or always started on the lowest doses?

A
  • always put on lowest dose

Children remain on the laxatives until they have 1-2 soft stools formed

39
Q

What is the definition of chronic diarrhoea?

1 - >24 weeks
2 - >12 weeks
3 - >6 weeks
4 - >2 weeks

A

2 - >12 weeks

A. MLA Map Paediatrics (61 decks)

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