Paediatric Gastroenterology Flashcards
1
Q
Most cases of constipation can be described as.. or..
A
idiopathic constipation or functional constipation, no significant underlying cause other than simple lifestyle factors
2
Q
Secondary causes of constipation
A
- Hirschsprung’s disease
- Cystic fibrosis (particularly meconium ileus)
- Hypothyroidism
- Spinal cord lesions
- Sexual abuse
- Intestinal obstruction
- Anal stenosis
- Cows milk intolerance
- Medication e.g. opiates
- Learning disability
- Hypercalcemia
- Anal fissures
3
Q
Presentation/typical features in history and examination that suggest constipation
A
- Less than 3 stools a week
- Hard stools that are difficult to pass
- Rabbit dropping stools
- Straining and painful passages of stools
- Abdominal pain
- Holding an abnormal posture, referred to as retentive posturing
- Rectal bleeding associated with hard stools
- Faecal impaction causing overflow soiling, with incontinence of particularly loose smelly stools
- Hard stools may be palpable in abdomen
- Loss of the sensation of the need to open the bowels
4
Q
- What is encopresis?
A
faecal incontinence
5
Q
- Encopresis is not considered pathological until the age of..
A
4
6
Q
- Encopresis is usually a sign of..
A
chronic constipation where the rectum becomes stretched and looses sensation.
Large hard stools remain in the rectum and only loose stools are able to bypass the blockage and leak out, causing soiling.
7
Q
- Other rarer causes of encopresis include:
A
- Spina bifida
- Hirschprung’s disease
- Cerebral palsy
- Learning disability
- Psychosocial stress
- Abuse
8
Q
- lifestyle factors that can contribute to the development and continuation of constipation:
A
- Habitually not opening the bowels
- Low fibre diet
- Poor fluid intake and dehydration
- Sedentary lifestyle
- Psychosocial problems such as a difficult home or school environment (always keep safeguarding in mind)
9
Q
- What is desensitisation of the rectum and how does it happen?
A
- Often patients develop a habit of not opening their bowels when they need to and ignoring the sensation of a full rectum.
- Over time they loose the sensation of needing to open their bowels, and they open their bowels even less frequently.
- They start to retain faeces in their rectum.
- This leads to faecal impaction, which is where a large, hard stool blocks the rectum.
- Over time the rectum stretches as it fills with more and more faeces.
- This leads to further desensitisation of the rectum.
10
Q
- Desensitisation of the rectum can lead to…
A
faecal impaction, which is where a large, hard stool blocks the rectum
11
Q
- Red flags in the history or examination that should make you think about serious underlying conditions that may be causing the constipation. These should prompt further investigations and referral to a specialist:
A
- Not passing meconium within 48 hours of birth (cystic fibrosis or Hirschsprung’s disease)
- Neurological signs or symptoms, particularly in the lower limbs (cerebral palsy or spinal cord lesion)
- Vomiting (intestinal obstruction or Hirschsprung’s disease)
- Ribbon stool (anal stenosis)
- Abnormal anus (anal stenosis, inflammatory bowel disease or sexual abuse)
- Abnormal lower back or buttocks (spina bifida, spinal cord lesion or sacral agenesis)
- Failure to thrive (coeliac disease, hypothyroidism or safeguarding)
- Acute severe abdominal pain and bloating (obstruction or intussusception)
12
Q
- Complications of constipation
A
- Pain
- Reduced sensation
- Anal fissures
- Haemorrhoids
- Overflow and soiling
- Psychosocial morbidity
*
13
Q
Management of constipation
A
- Correct any reversible contributing factors, recommend a high fibre diet and good hydration
- Start laxatives (movicol is first line)
- Faecal impaction may require a disimpaction regimen with high doses of laxatives at first
- Encourage and praise visiting the toilet. This could involve scheduling visits, a bowel diary and star charts.
Laxatives should be continued long term and slowly weaned off as the child develops a normal, regular bowel habit.
14
Q
Presentation and examination findings of pyloric stenosis
A
2nd to 4th weeks of life , rarely up to 4 months
- projectile’ vomiting, typically 30 minutes after a feed
- hungry baby that is thin, pale and generally failing to thrive.
- constipation and dehydration may also be present
- a palpable mass may be present in the upper abdomen:”like a large olive”
15
Q
- How is pyloric stenosis diagnosed?
A
abdominal ultrasound
