Constipation chez l'enfant

Question 1

Dx prob?
premiers jours de vie: délai méconium (> 24h)
scybalous
pebble-like, hard stool for at least 2 weeks
anal canal devoid of stool on examination
and sudden evacuation of stool on digital exam.

Answer 1

Hirschsprung dz

Question 2

dx?
developmental disorder characterized by absence of ganglia in the distal colon, resulting in a functional obstruction
(absence de plexus myentérique)

Answer 2

Hirschsprung dz

Question 3

test dx, gold-standard pour Hirschsprung dz?

Answer 3

Contrast enema is useful but

full-thickness rectal BX remains the criterion standard

Question 4

Tx Hirschsprung dz?

Answer 4

remove aganglionic bowel and restore continuity of the healthy bowel with the distal rectum, with or without an initial intestinal diversion

Question 5

grandes catégories ddx constipation kid?

Answer 5

fonctionnelle
oragnique:
GI
neuro
msucu
mx mét
collagénose

Question 6

vrai ou faux:

99% of healthy term newborns pass meconium before 48h of life.

Answer 6

vrai

Question 7

vrai ou faux:

50% of children with Hirschsprung dz will also pass meconium within 48h

Answer 7

vrai

Question 8

red falgs constipation kid?

Answer 8

severe abdo distension
abnormal abdo musculature
abnormal anal position
perianal fistula
anal scars, hematomas, or extreme fear during anal inspection
tight empty rectum with palpable fecal mass
explosive stool and air from rectum after withdrawal of axamining finger (blast sign)
midline pigmentary abnormalities of the lower spine
sacral dimple and or overlying tuft of hair
glutealt cleft deviation, flat buttocks
absent anal reflex (anal wink) or cremasteric reflex
Decreased strength/tone/deep tendon reflexes in lower extremities