Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paeds: Gastro and Growth > Constipation > Flashcards

Constipation Flashcards

1
Q

What are 3 things parents may be referring to when they say their child has constipation?

A
  1. Decreased frequency of defecation
  2. Degree of hardness of stool
  3. Painful defecation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the average frequeny of passing stool in the first week of life?

A

4 per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the average frequency of passing stool by the first year of life?

A

2 per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What may the frequency of breastfed infants passing stool be?

A

May not pass for several days and be entirely healthy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the typical frequency of passing stools after 1 year of age?

A

a daily bowel motion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the definition of constipation?

A

Infrequent passage of dry, hardened faeces often accompanied by straining or pain and bleeding associated with hard stools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What may be the character of abdominal pain in constipation?

A

May wax and wane with passage of stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In addition to infrequent passage of stool, what else can happen to passing stools as a result of constipation?

A

overflow soiling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are 6 things that could precipitate constipation?

A
  1. Dehydration
  2. Reduced fluid intake
  3. Anal fissure causing pain
  4. Problem with toilet training
  5. Refusal
  6. Anxiety about opening bowels at school/ in unfamiliar toilets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the usual result of examination in constipation?

A

well child, normal growth, soft abdomen, any abdominal distension normal for age. back and perianal area normal

soft faecal mass may be palpable in lower abdomen but not necessary for diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are 6 underlying conditions that should be considered in constipation?

A
  1. Hirschprung disease
  2. Lower spinal cord problems
  3. Anorectal abnormalities
  4. Hypothyroidism
  5. Coeliac disease
  6. Hypercalcaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Should you perform a digital rectal examination in constipation?

A

No - sometimes considered by paediatric specialist to identify anatomical abnormalities or Hirschprung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are 8 red flags in constipation?

A
  1. Failure to pass meconium within 24 hours of life
  2. Faltering growth/ growth failure
  3. Gross abdominal distension
  4. Abnormal lower limb neurology or deformites e.g. talipes or secondary urinary incontinence
  5. Sacral dimple above natal cleft, over the spine - naevus, hairy patch, central pit, or discoloured skin
  6. Abnormal appearance/ position/ patency of anus
  7. Perianal fistulae, abscesses, or fissures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What would you be worried about with the symptom of failure to pass meconium within 24 hours of life?

A

Hirschprung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What would you be worried about with the symptom of faltering growth/growth failure?

A

Hypothyroidism, coeliac disease, others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What would you be worried about with the symptom of gross abdominal distension?

A

Hirschprung disease or other gastrointestinal dysmotility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What would you be worried about with the symptom of abnormal lower limb neurology or deformity, e.g. talipes or secondary urinary incontinence?

A

lumbosacral pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What would you be worried about with the symptom of sacral dimple above natal cleft, over the spine (e.g. naevus, hairy patch, central pit, discoloured skin)?

A

Spina bifida occulta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What would you be worried about with the symptom of abnormal appearance/ position/ patency of anus?

A

abnormal anorectal anatomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What would you be worried about with the symptom of perianal bruising or multiple fissures?

A

sexual abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What would you be worried about with a symptom of perianal fistulae, abscesses, or fissures?

A

Perianal Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the usual course of constipation arising acutely in young children?

A

may arise after acute febrile illness, usually resolves spontaneously or with use of maintenance laxative therapy and extra fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What happens in longstanding constipation?

A

rectum becomes overdistended with subsequent loss of feeling need to defecate; involuntary soiling may occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why can involuntary soiling occur in long-standing constipation?

A

contractions of the full rectum inhibit the internal sphincter, leading to overflow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What does the management of long-standing constipation rely on?

A

multidisciplinary approach, more protracted management

26
Q

What can occur secondarily to constipation in the school setting?

A

frequently teased at school, secondary behavioural problems common

27
Q

What are the 3 first things to do when diagnosing a child with constipation?

A
  1. Ensure adequate oral fluid intake
  2. Encourage good toileting habits
  3. Coeliac screen and thyroid function tests
28
Q

In the case of mild constipation, if initial measures don’t work what pharmacology therapy can be introduced? 2 aspects

A
  1. Polyethylene glycol 3350 + electrolytes (low dose regimen: e.g. Movicol Paediatric Plain) ±
  2. Stimulant laxative e.g. sodium picosulphate or senna if response inadequate
29
Q

What is an example of polyethyle glycol 3550 + electrolytes?

A

Movicol Paediatric Plain

30
Q

What are 2 examples of stimulant laxatives used in constipation in children?

A
  1. Sodium picosulphate
  2. Senna
31
Q

What is the management of constipation with impaction?

A

Polyethylene glycol 3350 + eletrolytes (e.g. Movical Paediatric Plain) disimpaction regimen, escalating dose over 1-2 weeks

32
Q

What can be done if there is a good response of mild constipation to pharmacological measures (polyethylene glycol 3350 + electrolytes± stimulant laxative)?

A

continue same laxative therapy for maximum of 6 months to ensure regular stooling, titrating the dose

33
Q

What should be done if the is a good response of impaction in constipation to polyethylene 3350 + electrolytes disimpaction regimen?

A

start same regimen as used for mild constipation, i.e. polyethylene glycol 3350 + electrolytes ± stimulant laxative

34
Q

What should be done if there is inadequate response of constipation with impaction to polyethylene glycose 3350 + electrolytes disimpaction regimen?

A

add stimulant laxative e.g. sodium picosulphate or senna

35
Q

How can the management of constipation be summarised in a flow diagram?

A
36
Q

What should be explained to parent and child about soiling?

A

it is involuntary, recovery of normal rectal size and sensation can be achieved by may take a long time

37
Q

What is the initial aim for impacted constipation? How can this be achieved?

A

evacuate overloaded rectum completely; can be achieved using disimpaction regimen of stool softeners, initially with a macrogol laxative e.g. polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain)

escalating dose regimen over 1-2 weeks or until impaction resolves

if unsuccessful, add stimulant laxative e.g. senna or sodium picosulphate

38
Q

What kind of laxative is polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain)?

A

Macrogol laxative - stool softeners i.e. osmotic laxative

39
Q

What can be substituted for a macrogol laxative e.g. polyethylene 3350 + electrolytes is not tolerated?

A

osmotic laxative e.g. lactulose can be substituted

40
Q

What should always follow disimpaction treatment and why?

A

Maintenance treatment, to ensure ongoing regular, pain-free defecation - generally polyethyelene glycol (with or without stimulant laxative) = treatment of choice, gradually reducing dose over period of months in response to improvement in stool consistency and frequency

41
Q

How should maintenance therapy following a good response to initial disimpaction treatment/ treatment for mild constipation be stopped?

A

dose reduced over 1-2 months based on improvement in stool consistency and frequency

42
Q

What is the role for dietary interventions in managing constipation with impaction?

A

little or no beenfit, although should receive sufficient fluid and balanced diet.

addition of fibre can make it worse

43
Q

What is the effect of adding dietary fibre in impaction/constipation?

A

not helpful, may make stools larger and more difficult to pass

44
Q

What physiological reflex should children be encouraged to make use of in constipation?

A

encourage to sit on toilet after mealtimes to utilise physiological gastrocolic reflex

45
Q

How can engaging the child in the treatment process for constipation be achieved?

A

explore concerns and motivation to change; sometimes use of behavioural interventions e.g. star chart can record and reward progress and motivate child

46
Q

Why is it important that lots of encouragement by family and health professionals is part of the management of constipation?

A

Relapse common, psychological support sometimes required

47
Q

What must you reassure parents about the use of laxatives?

A

it is safe, even long term, as underuse is commonest reason for treatment failure

48
Q

What are 2 things that sometimes must be resorted to in the case of extremely severe faecal retention?

A
  1. evacuation with enemas
  2. manual evacuation under anaesthetic

both under specialist supervision, paying attention to avoiding distress and embarrassment for child

49
Q

What is Hirschprung disease?

A

Absence of ganglion cells from the myenteric and submucosal plexuses of part of the large bowel, resulting in narrow, contracted segment

50
Q

Where is the bowel affected by Hirschprung disease located?

A

extends from rectum for variable distance proximally, ending in normally innervated, dilated colon

51
Q

Where is the lesion confined to in 75% of cases of Hirschprung disease?

A

Rectosigmoid

52
Q

In what proportion of Hirschprung disease is the entire colon affected?

A

10%

53
Q

When does presentation of Hirschprung disease usually occur?

A

Neonatal period

54
Q

How does Hirschprung disease usually present?

A

In neonatal period, intestinal obstruction heralded by failure to pass meconium in first 24 hours of life

Abdominal distension, later bile-stained vomiting develop

55
Q

What are 3 ways that Hirschprung disease can present?

A
  1. Neonatally, failure to pass meconium, distension, bilious vomiting
  2. Infants - severe Hirschprung enterocolitis in first few weeks of life
  3. Later childhood - chronic constipation, abdominal distension, no soiling
56
Q

What are 6 possible features of the presentation of Hirschprung disease?

A
  1. Failure to pass meconium in first 24 hours of life
  2. Abdominal distension
  3. Bilious vomiting
  4. Life-threatening Hirschprung enterocolitis (infancy)
  5. Chronic profound constipation (childhood)
  6. Growth failure
57
Q

How can constipation from Hirschprung disease be differentiated from less severe forms of constipation in childhood (when it presents later)?

A

no soiling in Hirschprung disease (+growth failure with Hirschprung)

58
Q

What may examination reveal in Hirschprung disease in a newborn?

A

rectal examination may reveal narrowed segment and withdrawal of examining finger often releases gush of liquid stool and flatus

59
Q

What can lead to a delay in diagnosis of Hirschprung disease in a newborn?

A

Temporary improvement in obstruction following dilatation caused by rectal examination

60
Q

What is the test to diagnose Hirschprung disease?

A

Demonstrating absence of ganglion cells and large, acetylcholinesterase-positive nerve trunks on a suction rectal biopsy

61
Q

In addition to suction rectal biopsy for diagnosis of Hirschprung disease, what are 2 other investigations that may be used in Hirschprung disease and why?

A

Anorectal manometry (pressure of anal sphincter muscles) or barium studies - give surgeon idea of length of aganglionic segment (unreliable for diagnostic purposes)

62
Q

What is the management of Hirschprung disease?

A

surgical, usually involves initial colostomy followed by anastomosing normally innervated bowel to the anus

Paeds: Gastro and Growth (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions