Lower GI conditions Flashcards
What is the definition of constipation generally?
Difficulty passing stool and it is hard and painful
What are the signs and symptoms of constipation?
Poor appetite
Irritable
Lack of energy
Abdo pain or distension
Withholding or straining
Diarrhoea-liquid overflow incontinence
Why do children become constipated?
Social = poor diet (insufficient fluids, excessive milk), potty training/school toilet
Physical=intercurrent illness, medication (Gaviscon, opiates etc)
Psychological (secondary)
Organic (pass meconium at a normal time-Hirschsprung’s disease, Hypothyroidism)
What are the treatments of constipation?
- Explain Tx to patients
- Dietary (increase fibre, fruit & veg and fluids and decrease milk)
- Psychology-reduce aversive factors (soften stool and remove pain) and reward ‘good’ behaviour
- Soften stool and stimulate defecation
What is available to soften stool and stimulate defecation?
Isotonic laxatives (Movicol/Laxido)
Osmotic laxatives (Lactulose)
Stimulant laxatives (Sienna, picosulphate)
Advantages=non invasive, given by parents
Disadvantages=non compliance, side effects (windy pain, tummy ache)
What are the problems associated with a megarectum?
- Incomplete bladder emptying
- UTI
- Soiling
Give adequate treatment for constipation! How much? How long?
- Enough to make them go and to make sure stool always soft & never painful
- Until no longer required, related to duration of problem
What is the treatment for severe constipation?
- Empty impacted rectum
- Empty colon
- Maintain regular stool passage
- Slowly weaning off treatment
- Ensure compliance
What are some extra-intestinal manifestations seen in crohns disease?
- Erythema nodosum
- Oral changes (angular cheilitis, ulcers)
- Peri-anal tags and fissures
Rolled edge ulcer-Crohn’s disease
What Lab investigations are done for IBD?
- FBC & ESR (anaemia, thrombocytosis, raised ESR)
- Biochem=STOOL CALPROTECTIN, raised CRP, low albumin
- Microbio=NO stool pathogens
What are the differences between adult and paediatric IBD?
Children tend to ger more Crohn’s disease and the disease tends to be more severe and extensive
More IBDU in children
Slight female predominance in adults and a slight male predominance in children
What do most children with UC present with in terms of inflam?
PANCOLITIS
What pattern of inflam is seen in children that you don’t see very much in adults?
Upper GI/panenteric
What are the definitive investigations done for IBD?
- Radiology (especially for crohn’s disease) = MRI , Barium meal & follow through (younger kids)
- ENDOSCOPY-colonoscopy & upper GI endoscopy - biopsy, Capsule or balloon enteroscopy
What are the aims of treatment for IBD?
- Induce & maintain remission
- Correct nutritional deficiencies
- Maintain normal growth & development (ongoing inflam and steroid use can slow down growth)
