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Paediatrics cabinetchip > Constipation and soiling > Flashcards

Constipation and soiling Flashcards

1
Q

types of constipation in kids 2

A

idiopathic

functional

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2
Q

important secondary causes of constipation in kids 5

A

Hirschsprung’s disease

cystic fibrosis

hypothyroidism

spinal cord lesion

sexual abuse

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3
Q

typical features in hisotry that suggest constipation 10

A

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

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4
Q

define encopresis

A

term for feacal incontinence
-not considered pathological until 4 years of age

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5
Q

what is encopresis a sign of

A

chronic constipation

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6
Q

describe the basic process of how encopresis is a sign of chronic constipation

A

-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

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7
Q

rarer causes of encopresis 6

A

spina bifida
hirschprungs disease
cerebral palsy
learning disability
psychosocial stress
abuse

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8
Q

lifestyle facotrs that can contribute to teh development of constipation 5

A

habitual
low fibre diet
poor fluid intake and dehydratoin
sedentray lifestyle
psychosocial problems- difficult home or school

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9
Q

why can children with constipation develop desensitisation of the rectum

A

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

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10
Q

red flag constipation syx 8

A

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

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11
Q

regarding red flag syx of constipation what can the following be a sign of :
no meconium in first 48hrs 2

A

CF

hirschsprungs disease

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12
Q

regarding red flag syx of constipation what can the following be a sign of :
lwoer limb neuo syx 2

A

CP

spinal cord lesion

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13
Q

regarding red flag syx of constipation what can the following be a sign of :
vomiitng 2

A

intestinal obstruction

Hirschsprungs disease

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14
Q

regarding red flag syx of constipation what can the following be a sign of :
ribbon stool 1

A

anal stenosis

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15
Q

regarding red flag syx of constipation what can the following be a sign of :
abnormal anus 3

A

anal stenosisi
IBD
sexual abuse

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16
Q

regarding red flag syx of constipation what can the following be a sign of :
abnormal lower back or buttocks 3

A

spina bifida

spinal cord lesion

sacral agenesis

17
Q

regarding red flag syx of constipation what can the following be a sign of :
failure to thrive 3

A

coeliac disease

hypothyroidism

safeguarding

18
Q

regarding red flag syx of constipation what can the following be a sign of :
acute sever abdopain and bloating 2

A

obstruction

intussusception

19
Q

complicatinos of constipation 6

A

pain

reduced sensation

anal fissues

haemorrhoids

overflow and soiling

psychosocial morbidity

20
Q

management of idiopathic constipation 3

A

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

21
Q

treatment of more severe constipation 2

A

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

22
Q

define Hirschsprung’s disease

A

aganglionic segment of bowel due to developmental failure of the parasympathetic Auerbach anf Meissner plexuses

-although rare is an important differential in childhood constipation

23
Q

associations to Hirschsprung’s disease2

A

downs syndorme

male (3x more common)

24
Q

neonatal presentation of Hirschsprung’s disease 1

A

failure or delay to pass meconium

25
Q

older child presentation of Hirschsprung’s disease 2

A

constipation

abdominal distention

26
Q

investigaitons ofor Hirschsprung’s disease 2

A

abdo xray

rectal biopsy-gold standard

27
Q

Hirschsprung’s disease management 2

A

initally- rectal washout/bowel irrigation

definitive management- surgery to affected segment of the colon

28
Q

main risk with gastroenteritis assocaited diarrhoae in children

A

severe dehydration

29
Q

most common organism responsible for gastroenteritis assocaited diarrhoae in children

-what are the associated syx with this presentation 2

A

rotavirus

fever
vomitting

30
Q

most common cause of chronic diarrhoea in children

A

cows milk intolerance

31
Q

5 causes of acute diarrhose in children

A
  1. Infection: rota and enterovirus, E coli, salmonella, campylobacter
  2. Staphylococcal toxin in food poisoning
  3. Response to infection e.g. pneumonia
  4. Starvation stools (watery, green mucous)
  5. Surgical: intussusception, pelvic appendicitis, Hirschprung’s
32
Q

5 causes of chronic diarrhoea in children

A
  1. Toddler’s diarrhoea
  2. Constipation with overflow.
  3. Post infectious food intolerance (e.g. lactose).
  4. Inflammatory bowel disease.
  5. Malabsorbtion e.g. CF, coeliac
33
Q

investigations for chronic diarrhoea in a child

A
  1. Stool – culture and sensitivity, c.diff toxin, virology
  2. Bloods – FBC, CRP, LFTs, ESR
  3. Serum TTG
  4. Faecal calprotectin
  5. Peri anal inspection
34
Q

managment of toddlers diarrhoea

A

should outgrow

reduced sugar-sweetened drinks

increase fiber and fat in diet

35
Q

managemnt of other causes of chronic diarrhoea

A

either treat cuase (ABx) or avoid triggers (lactose intolerant, coeliac)

Paediatrics cabinetchip (80 decks)

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