management of constipation

Question 1

What is the definition of constipation?

Answer 1

passage of dry, hardened faeces often accompanied by straining or pain

Question 2

Name 3 potential causes of constipation in babies

Answer 2

1. Hypothyroidism
2. Hypercalcaemia
3. Hirschsprung disease
4. Anorectal abnormalities

Question 3

Examination of constipation

Answer 3

1. Palpable abdominal mass in well looking child

2. Digital rectal examination

Question 4

Mx of constipation - if the distended abdomen is palpable

Answer 4

1. Movicol - paediatric plain (Macrogol and electrolytes) are given for 2 weeks fo disimpaction
   ( use stimulant laxative 2nd line if ineffective)
2. Polyethene glycol maintainence regime to ensure consistent evacuation of faeces
3. Still not successful - enema or manual evacuation under anaesthetics

Question 5

What is the pathophysiology of ‘Hirschsprung disease’?

Answer 5

• absence of ganglion cells
• from myenteric and submucosal plexus
• results in narrow, contracted segment of large bowel

Question 6

Where is the Hirschsprung disease commonly confined to?

Answer 6

• rectosigmoid colon

Question 7

How do newborns present with Hirschsprung’s disease?

Answer 7

1. Failure to pass meconium in the first 24 hours of life

abdo distention/bile stained vomiting may develop

Question 8

How do children later in childhood present?

Answer 8

1. Chronic constipation associated with abdominal distention

2. Growth failure

Question 9

How is Hirschsprung diagnosed?

Answer 9

via Rectal suction biopsy to demonstrate the absence of ganglion cells

Question 10

Mx of Hirschsprung disease

Answer 10

1. Colostomy

2. Anastomosing normally inverted bowel to the anus