Constipation and soiling Flashcards
types of constipation in kids 2
idiopathic
functional
important secondary causes of constipation in kids 5
Hirschsprung’s disease
cystic fibrosis
hypothyroidism
spinal cord lesion
sexual abuse
typical features in hisotry that suggest constipation 10
lass than 3 stools a week
hard stools difficult to pass
RABBIT DROPPING stools
straining and painful passage of stools
abdopain
holding an abnormal posture, referred to as retentive posturing
rectal bleeding assocaited with hard stools
faecal impaction casuing overflow soiling- with incontenence of particularly loose smelly stools
hard stools palpable in abdomen
loss of sensation of the need to open bowels
define encopresis
term for feacal incontinence
-not considered pathological until 4 years of age
what is encopresis a sign of
chronic constipation
describe the basic process of how encopresis is a sign of chronic constipation
-where the rectum becomes stretched and looses sensation
-large stools remain in rectum and only loose stools are able to bypass the blockage and leak out-> causing soiling
rarer causes of encopresis 6
spina bifida
hirschprungs disease
cerebral palsy
learning disability
psychosocial stress
abuse
lifestyle facotrs that can contribute to teh development of constipation 5
habitual
low fibre diet
poor fluid intake and dehydratoin
sedentray lifestyle
psychosocial problems- difficult home or school
why can children with constipation develop desensitisation of the rectum
if not in the habit of opening bowels and ignore sensation of fullness-> overtime loose sensation of need and open bowels even less->visous cycle as sensation continues to worsen
->leads to faecal impaction (large hard stool blocks the rectum) adn the cycle continues
longer this is left- harder to treat
red flag constipation syx 8
not passing meconium within first 48hrs of birth
lower limb neuro signs
vomitting
ribbon stool
abnormal anus
abnormal lower back/buttocks
failure to thrive
acute severe abdopain and bloating
regarding red flag syx of constipation what can the following be a sign of :
no meconium in first 48hrs 2
CF
hirschsprungs disease
regarding red flag syx of constipation what can the following be a sign of :
lwoer limb neuo syx 2
CP
spinal cord lesion
regarding red flag syx of constipation what can the following be a sign of :
vomiitng 2
intestinal obstruction
Hirschsprungs disease
regarding red flag syx of constipation what can the following be a sign of :
ribbon stool 1
anal stenosis
regarding red flag syx of constipation what can the following be a sign of :
abnormal anus 3
anal stenosisi
IBD
sexual abuse
regarding red flag syx of constipation what can the following be a sign of :
abnormal lower back or buttocks 3
spina bifida
spinal cord lesion
sacral agenesis
regarding red flag syx of constipation what can the following be a sign of :
failure to thrive 3
coeliac disease
hypothyroidism
safeguarding
regarding red flag syx of constipation what can the following be a sign of :
acute sever abdopain and bloating 2
obstruction
intussusception
complicatinos of constipation 6
pain
reduced sensation
anal fissues
haemorrhoids
overflow and soiling
psychosocial morbidity
management of idiopathic constipation 3
provided red flags considered- no need for investigations
-lifestyle advice
high fibre diet and good hydration
encourage and praise visiting toilet
-scheduling visits
-bowel diary
-star charts
-treating constipation can be a prolonged process potentially lasting months
treatment of more severe constipation 2
start laxatives -movicol
-cointinued long term and slowly weaned off as child develops normal regular bowel habits
faecally impacted-> disimpaction regimen with high dose laxatives first
encourage and praise visiting toilet
-scheduling visits
-bowel diary
-star charts
define Hirschsprung’s disease
aganglionic segment of bowel due to developmental failure of the parasympathetic Auerbach anf Meissner plexuses
-although rare is an important differential in childhood constipation
associations to Hirschsprung’s disease2
downs syndorme
male (3x more common)
neonatal presentation of Hirschsprung’s disease 1
failure or delay to pass meconium
older child presentation of Hirschsprung’s disease 2
constipation
abdominal distention
investigaitons ofor Hirschsprung’s disease 2
abdo xray
rectal biopsy-gold standard
Hirschsprung’s disease management 2
initally- rectal washout/bowel irrigation
definitive management- surgery to affected segment of the colon
main risk with gastroenteritis assocaited diarrhoae in children
severe dehydration
most common organism responsible for gastroenteritis assocaited diarrhoae in children
-what are the associated syx with this presentation 2
rotavirus
fever
vomitting
most common cause of chronic diarrhoea in children
cows milk intolerance
5 causes of acute diarrhose in children
- Infection: rota and enterovirus, E coli, salmonella, campylobacter
- Staphylococcal toxin in food poisoning
- Response to infection e.g. pneumonia
- Starvation stools (watery, green mucous)
- Surgical: intussusception, pelvic appendicitis, Hirschprung’s
5 causes of chronic diarrhoea in children
- Toddler’s diarrhoea
- Constipation with overflow.
- Post infectious food intolerance (e.g. lactose).
- Inflammatory bowel disease.
- Malabsorbtion e.g. CF, coeliac
investigations for chronic diarrhoea in a child
- Stool – culture and sensitivity, c.diff toxin, virology
- Bloods – FBC, CRP, LFTs, ESR
- Serum TTG
- Faecal calprotectin
- Peri anal inspection
managment of toddlers diarrhoea
should outgrow
reduced sugar-sweetened drinks
increase fiber and fat in diet
managemnt of other causes of chronic diarrhoea
either treat cuase (ABx) or avoid triggers (lactose intolerant, coeliac)
