Constipation - Primary, Hirschsprungs disease, Meckels diverticulum Flashcards
Normal frequency for opening bowels
-U6 months
-3years
Roughly
U6 months - 3x a day
3years - once a day
Constipation diagnosis features in U1 year
Stool pattern
-fewer than 3 complete stools a week (T3, 4 Bristol stool chart)
-hard, large stool
-rabbit droppings (T1)
Associated symptoms on passing stool
-distress
-bleeding
-straining
Hx
-past episode of constipation
-past/current anal fissure
Constipation diagnosis features in 1 year+
Stool pattern
-fewer than 3 complete stools a week (T3, 4)
-overflow soiling (v loose, smelly, passed without sensation)
-rabbit droppings (T1)
-large infrequent stools
Associated symptoms on passing stool
-appetite improves afterwards
-waxing/waning of abdo pain with passage of stool
-retentive posturing (straight legged, tiptoed, back arching)
-straining
-anal pain
Hx
-past episode of constipation
-past/current anal fissure
-painful bowel movements and bleeding associated with hard stool
Causes of constipation
MAJORITY IDIOPATHIC
Dehydration
Low fibre diet
Medication - opiates
Anal fissure
Hypothyroidism
Hirschsprungs’ disease
Hypercalcemia
Learning difficulties
Features that suggest idiopathic constipation
Timing
-After a few weeks of life
Coinciding with symptoms and medical changes
-fissures
-taking medications
-acute infections
Coinciding with life events
-change in diet
-potty/toilet training
-moving house
-starting school/nursery
-major changes in family
Passing meconium U48hrs
No issues with
-growth
-neuro developments
Red flags that suggest underlying cause for constipation
Reported from birth, first few weeks of life
Meconium passage taking 48hrs+
Faltering growth
Previously unknown/undiagnosed weakness in legs
Locomotion delay
Distention
Fecal impaction
-what is it
-presentation
Large dry hard stool that stays in the rectum
-severe constipation
-overflow soiling
-palpable mass in abdomen
Management of fecal impaction
Polyethylene glycol 3350 + electrolytes (Movicol)
-escalating dose regime
If no disimpaction after 2wks => add stimulant laxative
Treatment may initially increase soiling and abdo pain
Maintenance therapy for constipation
1st line - movicol paeds palin
2nd - add stimulant laxative (senna, bisacodyl)
Continue for several weeks after regular bowel habit established, then reduce dose gradually
Management of infants not yet weaned
Bottle fed - extra water between feeds
-gentle abdo massage, bicycling legs
Breastfed - consider organic causes
-breastmilk normally makes stool soft
Management of contipation in infants being/have been weaned
Extra water, diluted fruit juice, fruit
Add lactulose if needed
Hirschsprungs disease
-what is it
-risk factors
-presentations
-investigations
-management
Developmental failure of PNS Auerback and Meissner’s plexuses in rectum => uncoordinated peristalsis and functional obstruction
PRESENTS FROM BIRTH
Downs
Neonatal - failure/delay to pass meconium
Older children - constipation, abdo distention
AXR
Gold standard - rectal biopsy
Initial - rectal washout/bowel irrigation
Definitive - surgery
Meckels diverticulum
-what is it
-presentation
-investigations
-management
Congenital diverticulum of small intestine containing
-ectopic ileal, gastric, pancreatic mucosa
2 feet from ICV
2 inches long
CAN PRESENT AS INTUSSUSCEPTION, VALVULUS
Abdo pain - appendicitis mimic
Rectal bleeding - most common cause of painless massive GI bleeding needing transfusion in children
GI obstruction
Vomiting, constipation - if obstructed
Hemodynamically stable, less severe - Meckel’s scan (Tc99 has affinity for gastric mucosa)
Severe - mesenteric arteriography
Remove if narrow neck/symptomatic
