Constipation and Gastroenteritis Flashcards
How often should infants, 1 yo’s and 4yo’s poo?
Infant’s is four times a day,
1 yo’s two times a day
4 and above should have an adult pattern
Define constipation?
Infrequent passing of dry, hardened faeces often accompanied by straining or pain.
What is the most common causes of simple constipation?
Reduce fluid intake in infants and toddlers.
Anal fissure causing pain.
In older children it may relate to problems with toilet training, unpleasant toilets or stress. (stool withholding)
What might be found on examination of a child with constipation?
Palpable abdominal mass.
DRE’s should only be done by a paediatric specialist and if it is absolutely necessary.
What are the red flags symptoms in children with constipation? (6)
Failure to pass meconium in first 24hrs: Hirschsprungs or other dismotility disorders
Failure to thrive: Hypothyroidism, coeliac disease
Gross abdominal distension – Hirschprung’s or other GI dysmotility
Abnormal lower limb neurology – lumbosacral pathology
Sacral dimple – spinal bifida occulta
Bruising and fissures – sexual abuse
How should you manage simple constipation/stool withholding?
Stool withholding:
Encouragement and close supervision of the child. Psychological support can be given if indicated.
Constipation:
If faeces are not palpable (abdominally) then give a balanced diet and sufficient fluids.
If faeces are palpable (abdominally) can give a mild osmotic laxative (movicol) alongside good hydration and a balanced diet.
If not effective consider a stimulant laxative and consider a more significant cause.
What is Hirschsprung’s disease and how common is it?
An absence of ganglion cells from the myenteric and submucosal plexuses of part of the large bowel which results in a narrow and contracted segment.
The disease starts in the rectum and extends proximally until there is an area of normally innervated bowel.
Occurs in 1 in 5000 live births (usually male)
How does Hirschsprung’s present?
It presents with bowel obstruction usually with failure to pass meconium.
How is Hirschsprung’s diagnosed?
Colonoscopy with biopsy showing absence of ganglionic cells.
What is the treatment of Hirschsprung’s?
Surgical treatment.
Colonoscopy of affected bowel followed by an anastomosis of the unaffected bowel with the anus.
How common is gastroenteritis in children and what is the most common cause?
It is very common.
10% of under 5’s suffer from gastroenteritis annually
It is usually viral with the most common pathogen being rotavirus.
What are the symptoms of gastroenteritis?
Sudden onset of loose watery stools or onset of vomiting.
Which signs and symptoms should make you rule out a diagnosis of gastroenteritis?
Temp: (Infection)
38 or more (if under 3 months)
39 or more(over 3 months)
Respiratory: (Lower lobe pneumonia?)
SOB
Tachypnoea
Meningitis/raised ICP: Altered state of consciousness Neck stiffness Bulging fontanelle Non-blanching rash (sepsis)
Blood and/or mucus in stools Severe abdominal pain Abdominal distension/rebound tenderness. Bilious vomit (malrotation volvulus)
When should a stool sample be sent?
If the child is immunocompromised If there is blood or mucous in the stool If there has been recent foreign travel If the diagnosis is uncertain If the diahorrea is not improving after 7 days
What should you look for in a dehydration assessment?
Dry mucosal membranes Sunken fontanelle Sunken eyes Skin tugor (late sign) Reduced UO (no. of wet nappies)
Severe dehydration: (shocked) Reduced consciousness Skin colour mottled or pale Cold peripheries Prolonged capillary refill
