Constipation Flashcards
At what age is adult bowel opening pattern established?
At age 4.
Children- 4-9 per week.
Adults- 3 per day to 3 a week
What the 3 common reasons for constipation?
Psychobehavioral- following painful evacuation and withholding
Posture- toilet seat/squatting
Colonic transit
What are the downsides of increased fibre intake?
Reduced caloric intake
Increased faecal energy loss
Decreased bioavailability of minerals
Increased gas formation
What are the intrinsic colonic factors that cause constipation?
Reduced interstitial cells of Cajal. This is the pacemaker of the gut.
What are the 2 types of contractions that occur in the GIT that help in bowel opening?
- Repeated non-propulsive contractions leading to mixing and absorption
- Larger coordinated contractions that move stools forward
What happens to colonic motility during sleep?
Colonic motility is strongly inhibited during sleep. If there is nocturnal Incontinence, needs further investigations
What is RAIR?
Rectoanal inhibitory Reflex
When do neonates pass meconium?
<1500 g- 35% in first 24 hrs
<2500 g- 80% in first 24 hrs
>2500 g- 99%
What is a well known presentation of anal stenosis?
Baby strains and passes paste like stools but seems to improve with laxatives.
Does a normal neurological exam exclude spinal dysraphism?
No! But cremasteric reflex may be useful
What are the red flags for a sacral dimple?
> 0.5 cm in size
2.5 cm cranially from anal margin
Overlying skin showing hemangioma or tuft of hair
Gluteal cleft deviation
What does Picolax contain?
Sodium picosulphate and Mg citrate
Does prebiotics help in constipation?
May be associated with change in consistency of stools but no change in frequency. Possibly less pain understandably
Does probiotics help in constipation?
Possibly increases transit time but not much difference
When is Ba enema indicated in evaluating constipation?
To assess extent of anganglionic segment in HD
What % of coeliac children present with constipation as the only presenting symptom?
0.2%
When is rectal biopsy indicated in constipation?
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
Does low ARM always present with early constipation?
No. usually early but can present around the time of weaning.
Does surgery cure low ARM?
No. Constipation persists but continence is preserved. Surgery allows laxatives to work!!
What is the usual surgical pathway for constipation?
ACE or stoma. If stoma initially, it is closed after forming an ACE. Then Duhamel and then restorative procto-colectomy
What is the sensitivity and specificity of rectal biopsy in HD?
93% and 98% respectively
What is sensitivity and specificity OD ARM I HD?
91% and 94% respectively
What are the indications for ARM?
To diagnose non-relaxing IAS
Faecal Incontinence
To evaluate effect of botox on IAS
in children operated for HD with Incontinence
What is the prognosis of childhood constipation?
40% still symptomatic by 5 yrs
20% still symptomatic by 10 yrs
What is prucalopride?
5-HT4 agonist. Increases Ach and then increases intestinal motility. But not enough evidence.
What is lubiprostone?
It is a PGE1 derivative and a pro secretory agent.
Well tolerated in children.
MC RCT currently on
What is the usual regime for Peristeen?
10-20 mls/kg water or saline everyday for the first week followed by 3 per week.
What is the risk of perforation with Peristeen?
6/million. Increased at the time of initiation and is patients who have undergone pelvic surgery.
