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Constipation > Constipation > Flashcards

Constipation Flashcards

1
Q

At what age is adult bowel opening pattern established?

A

At age 4.
Children- 4-9 per week.
Adults- 3 per day to 3 a week

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2
Q

What the 3 common reasons for constipation?

A

Psychobehavioral- following painful evacuation and withholding
Posture- toilet seat/squatting
Colonic transit

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3
Q

What are the downsides of increased fibre intake?

A

Reduced caloric intake
Increased faecal energy loss
Decreased bioavailability of minerals
Increased gas formation

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4
Q

What are the intrinsic colonic factors that cause constipation?

A

Reduced interstitial cells of Cajal. This is the pacemaker of the gut.

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5
Q

What are the 2 types of contractions that occur in the GIT that help in bowel opening?

A
  1. Repeated non-propulsive contractions leading to mixing and absorption
  2. Larger coordinated contractions that move stools forward
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6
Q

What happens to colonic motility during sleep?

A

Colonic motility is strongly inhibited during sleep. If there is nocturnal Incontinence, needs further investigations

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7
Q

What is RAIR?

A

Rectoanal inhibitory Reflex

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8
Q

When do neonates pass meconium?

A

<1500 g- 35% in first 24 hrs
<2500 g- 80% in first 24 hrs
>2500 g- 99%

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9
Q

What is a well known presentation of anal stenosis?

A

Baby strains and passes paste like stools but seems to improve with laxatives.

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10
Q

Does a normal neurological exam exclude spinal dysraphism?

A

No! But cremasteric reflex may be useful

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11
Q

What are the red flags for a sacral dimple?

A

> 0.5 cm in size
2.5 cm cranially from anal margin
Overlying skin showing hemangioma or tuft of hair
Gluteal cleft deviation

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12
Q

What does Picolax contain?

A

Sodium picosulphate and Mg citrate

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13
Q

Does prebiotics help in constipation?

A

May be associated with change in consistency of stools but no change in frequency. Possibly less pain understandably

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14
Q

Does probiotics help in constipation?

A

Possibly increases transit time but not much difference

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15
Q

When is Ba enema indicated in evaluating constipation?

A

To assess extent of anganglionic segment in HD

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16
Q

What % of coeliac children present with constipation as the only presenting symptom?

A

0.2%

17
Q

When is rectal biopsy indicated in constipation?

A

Delayed meconium passage
Constipation since first few weeks of life
Chronic abdominal distension and vomiting
FH of HD
Faltering growth with any of above
Syndromes associated with HD

18
Q

Does low ARM always present with early constipation?

A

No. usually early but can present around the time of weaning.

19
Q

Does surgery cure low ARM?

A

No. Constipation persists but continence is preserved. Surgery allows laxatives to work!!

20
Q

What is the usual surgical pathway for constipation?

A

ACE or stoma. If stoma initially, it is closed after forming an ACE. Then Duhamel and then restorative procto-colectomy

21
Q

What is the sensitivity and specificity of rectal biopsy in HD?

A

93% and 98% respectively

22
Q

What is sensitivity and specificity OD ARM I HD?

A

91% and 94% respectively

23
Q

What are the indications for ARM?

A

To diagnose non-relaxing IAS
Faecal Incontinence
To evaluate effect of botox on IAS
in children operated for HD with Incontinence

24
Q

What is the prognosis of childhood constipation?

A

40% still symptomatic by 5 yrs

20% still symptomatic by 10 yrs

25
Q

What is prucalopride?

A

5-HT4 agonist. Increases Ach and then increases intestinal motility. But not enough evidence.

26
Q

What is lubiprostone?

A

It is a PGE1 derivative and a pro secretory agent.
Well tolerated in children.
MC RCT currently on

27
Q

What is the usual regime for Peristeen?

A

10-20 mls/kg water or saline everyday for the first week followed by 3 per week.

28
Q

What is the risk of perforation with Peristeen?

A

6/million. Increased at the time of initiation and is patients who have undergone pelvic surgery.

Constipation (1 decks)

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