Constipation and IBD Flashcards
1
Q
What is constipation?
A
Infrequent passage of stool
2
Q
What do you want to know about the child presenting with constipation?
A
- How often?
- How hard?
- Is it painful?
- Has there been a change?
3
Q
What is normal stool frequency?
A
4 per day to 1 per week
4
Q
What does stool frequency depend on?
A
- Age
- Diet
5
Q
What are the components of the Bristol stool chart?
A
- Type 1 = separate hard lumps
- Type 2 = lumpy and sausage like
- Type 3 = sausage shape with cracks in the surface
- Type 4 = like a smooth sausage or snake
- Type 5 = soft blobs with clear cut edges
- Type 6 = mushy consistency with ragged edges
- Type 7 = entirely liquid
6
Q
What are some signs and symptoms of constipation?
A
- Poor appetite
- Irritable
- Lack of energy
- Abdominal pain or distension
- Withholding or straining
- Diarrhoea
7
Q
Why do children become constipated?
A
- Social
- Poor diet (insufficient fluids, excess milk)
- Potty training or school toilets issue
- Physical
- Intercurrent illness
- Medications (opiates and Gaviscon)
- Family history
- Psychological (secondary)
- Organic
8
Q
What is the vicious cycle of constipation?
A
- Large hard stool
- Leads to pain or anal fissure
- Child withholds stool
- Becomes constipated
9
Q
How does overflow diarrhoea develop?
A
- Rectum tells them they need to go but the child clenches the external sphincter
- Stool continues to be dehydrated by bowel becoming harder
- Back passage begins to stretch and creates a mega rectum
- Soiling occurs when the mega rectum holds the internal sphincter open
10
Q
Social treatment of constipation
A
- Explain treatment to parents
- Dietary
- Increase fibre
- Increase fruit
- Increase vegetables
- Increase fluids
- Decrease milk
11
Q
Psychological treatment of constipation
A
- Reduce the aversive factors by making going to the toilet a pleasant experience
- Correct height
- Not cold
- School toilets
- Avoid punitive behaviour from parents
- Reward good behaviour
- General praise and star charts
- Encourage child to try going to the bathroom after every meal
12
Q
Medical treatment for constipation
A
- Soften stool and stimulate defecation
- Osmotic laxatives (lactulose)
- Stimulant laxatives (senna, picolax)
- Isotonic laxatives (movicol)
13
Q
How is impaction treated?
A
- Empty impacted rectum
- Empty colon
- Maintain regular stool passage
- Slow weaning off treatment
14
Q
How can constipation be confirmed on imaging?
A
- Colonic marker study
- When x-rayed at the end of the week the markers should have already be excreted.
- In constipation the markers can be seen in the rectum and distal colon
15
Q
How has the incidence of Crohn’s disease changed in Scottish children?
A
Dramatic increase
