Constipation / Diarrhoea / IBD Flashcards

Question

What are complications

Answer 1

``` Dehydration = common Electrolyte imbalance - Hypokalaemia Paralytic ileus Transient lactose intolerance IBS Ketoacdisois if persistent ```

Answer 2

Unwell / lethargic Decreased urine Pale Cold

Answer 3

``` Decreased consciousness Sunken eyes Dry membrane Decreased fontanelle Decreased turgur Tachycardia Weak pulses Prolonged CRT Hypotension ```

Answer 4

Fluid replacement Oral if no dehydration ORS (diorite) - 50ml /kg 4 hourly IV if shock - 4,2,1

Answer 5

ORS every watery stool

Answer 6

``` Increase tone Hyper-reflexia Convulsion Drowsy Coma ```

Answer 7

Isotonic to rehydrate over 48 hours | Decrease Na <0.5mol / l /hour

Answer 8

CMPI GORD Intolerance Iron deficiency anaemia

Answer 9

``` <3 stools per week Hard and large or Rabbit dropping Large stool in rectum or palpable per abdomen Overflow soil >1 episode ``` ``` Other Sx Distress on passing = constipation or ano-rectal Rectal bleeding Poor appetite / pain - improves when pass Abdo distension Irritable Lack of energy Withholding behaviour ``` Can present like appendicitis

Answer 10

Idiopathic = most common Low fibre Dehydration Excessive milk ``` RF Diet Withholding stool Change to daily routine Not enough exercise FH ```

Answer 11

``` Intercurrent illness Spinal cord lesion = always do LL neurology Opiates Hypothyroid Hypercalcaemia Hirschprung Meconium ileus Imperforate anus Obstruction Anal stenosis Gut atresia CMPI Coaliec IBD Sexual abuse ```

Answer 12

``` Constipation Hard / large stool Followed by pain when passing Avoidance / fear Child withholds Leads to fissure Megarectum -> soiling as sphincter open UTI ```

Answer 13

``` From birth - no stool >48 hours Occur in first few weeks after birth Ribbon stool - anal stenosis Faltering growth / FTT Neuro signs e.g. leg weakness Motor delay Acute, severe abdominal pain + vomting Distension No associated with diet change ```

Answer 14

Severe constipation Mass Overflow

Answer 15

Abdominal exam + anus Weight + height LL neurology / spine for dimples - spina bifida X-Ray

Answer 16

``` How often How hard Previous episode Fissure / painful movement PR bleed Soiling? Withholding behaviour Toilet training Diet / appetite Daily activity Any worries Medication Rx tried Development ```

Answer 17

``` Increased fluid and fibre Decrease milk Toilet = pleasant Regular toilet Reward good behaviour Pharmacologicla = 2nd line ```

Answer 18

Movicol (isotonic) = 1st line Senna (stimulant) = after 2 weeks if stool now soft Lactulose (osmotic) = if stool hard - Not useful as need to drink loads and children don't

Answer 19

Continue laxatives for several weeks then decrease dose

Answer 20

Breast feeding

Answer 21

Haemorrhoids

Answer 22

More severe | More extensive

Answer 23

Maintaining growth

Answer 24

Proctitis rare | Pancolitis common

Answer 25

Malabsorption - b12 may be only Sx | Upper GI / pan enteric more common

Answer 26

``` Raised ESR / CRP Anaemia Thrombocytosis Leucocytosis Low albumin ```

Answer 27

``` Exclude infection FBC, U+E, CRP, LFT Blood and stool culture Coeliac -ve Thyroid -ve Raised calprotectin Endoscopy MRI / barium meal if inconclusive ```

Answer 28

``` Nutrition - supplement FODMAP Elemental feeding = 85% remission and healing Anti-inflammatory Immune suppression Biologics Steroids = last ditch ```

Answer 29

Azathioprine - not in UC Methotrexate Cyclosporin

Answer 30

Infliximab (anti-TNFa)

Answer 31

Maintain growth and development

Answer 32

Poor growth No puberty Unresponsive to medical Rx

Answer 33

``` Poor growth / puberty Colon cancer Haemorrhage Electrolyte Toxic dilatation and megacolon Obstruction Perforation ```

Answer 34

``` Infection Weight gain Appetite Moon face Adrenal gland failure Poor growth ```

Answer 35

Hirshprung CF - meconium ileus Imperforate anus

Answer 36

Coeliac IBD CF Hypothyroid