constipation in children

Question 1

define

also may be overflow diarrhoea

Answer 1

Constipation is generally defined as a child that defaecates less than 3 times per week or has significant difficulty passing stool. Chronic constipation in children is associated with hard pellet like stool that is difficult to pass. There may also be overflow diarrhoea from fluid moving past the hard stool in the rectum.

Question 2

cx

Answer 2

Low fibre diet
Dislike of using toilet
Pain on passing stool e.g., secondary to an anal fissure or very hard stool
Not recognising sensation of needing to pass stool

Question 3

cx

Answer 3

Low fibre diet
Dislike of using toilet
Pain on passing stool e.g., secondary to an anal fissure or very hard stool
Not recognising sensation of needing to pass stool

Question 4

mx

Answer 4

Initial treatment of chronic constipation is with a movicol disimpaction regimen

This is followed by maintenance movicol, alongside a high fibre diet and advice about encouraging good toileting habits

2nd line is senna

Question 5

what is hirschsprung

Answer 5

As the baby develops in utero, the distal colon is not innervated correctly. The resulting aganglionic colon is shrunken and not able to distend properly. This causes a back pressure of stool trapped in the more proximal colon.

absesnse og ganglion cells in myenteric and submucosal plexuses
occurs in rectosigmoid

Question 6

features of hirschsprung

Answer 6

a delay in passing meconium (>48 hours)
a distended abdomen
forceful evacuation of meconium after digital rectal examination - like gush woosh
poor response to movicol
poor weight gain

Question 7

DX and tx of hirshsprung

Answer 7

rectal suction biopsy
removal of the section of aganglionic colon and the healthy bowel is pulled through.

Question 8

wheere does hirschsprung typically occur

Answer 8

rectosigmoid

Question 9

anal fissure painful on rectum exam and kid cries when going to the toilet what do you do

Answer 9

dis-impaction regime of laxatives - lactulose

Question 10

necrotising entercolitis

Answer 10

abdo distention
blood stools
prematurity is a risk factor

Question 11

foecal loading seen in

Answer 11

chronic constipation

Question 12

when taking a rectal biopsy in hirschsprung disease where are you taking it from

Answer 12

1.5cm above the pectinate lin e