Pediatric GI 3: Constipation And Ingestions Flashcards
What is the medical sequelae for caustic ingestion?
Esophagitis -> necrosis -> perforation -> stricture formation
Caustic ingestion facts
70% are accidental ingestion of basic products and produce liquefaction necrosis
- Drain decloggers are most common
Acidic vs basic
- acidic = less common and produce thick eschar with coagulation necrosis
- basic = more common and produce liquefactive necrosis
Symptoms:
- vomiting
- severe gastritis
- drooling
- refusal for food or drinks
- oral burns* (absence of this DOESNT rule out severe injuries)
- dysphagia
- dyspnea
- abdominal pain
- hematemesis
Structure formation increases if circumferential ulcerations are present
absence of symptoms = mild-no lesions
presence of hematemesis, respiratory distress or presence of any of the 3 symptoms or more above = severe injuries/lesions
***use upper endoscopy to identify issues
Treatment of caustic ingestion
1) Dilution by water or milk is acute treatment
2) Call poison control and get ingredients from the ingested material. Go from there
**NEVER DO neutralization, induce emesis or gastric lavage (all are contraindicated)
What is the vomiting center?
Medullary vomiting center (area postrema)
- takes direct afferent innervation and indirectly from the CTZ
Oral rehydration therapy (ORT)
Common therapy first used when vomiting is the prime symptom or complaint
Contains 2% glucose and 50-90 mEq/L of sodium
- also this is the concentration in pedelite
- usually comes in powder formula and mix with water
- can be made manually with 1L of water, 3.5g table salt, 2.9g trisodium citrate
Therapy is given 50mL/kg (mild dehydration) or 100mL/kg (moderate dehydration) over 4 hrs
- for each diarrheal stool present within 4 hrs = add 10mL/kg additionally
- reassess after 4 hrs, if still present keep going
NEVER use sports drinks/sodas/juices
Eosinophilic esophagitis
Chronic esophageal disorder which is characterized by GERD like symptoms with >15 eosinophils per high-power field
Common symptoms:
- following is seen in children usually
- vomiting
- feeding issues and failure to thrive
- Following is only seen in older children
- solid food dysphagia
- chest/epigastric pain
- heart burn
More common males and 7yrs is the mean age
Treatment:
- dietary restrictions With “6 food elimination diet” and allergy testing(remove milk/soy/wheat/egg/peanuts and tree nuts and seafood)
- *this has a very high success rate =91%
Medications if symptoms are present
- fluticasone oral capsules
- good for people who dont want to adhere or have a poor response to dietary restrictions (66-77% of children/adults see remission within 3 months)
Constipation in children
Completely dependent on the defecation reflex with pressure receptors in the rectal muscle
- **a hard stool passed with difficulty every third day should be empirically treated as constipation
Colonic stasis = excessive drying of stool from colon and failure to initiate reflexes from the rectum
Can be very wide ranged in children
- “toilet stuffers” = can clog the toilet when constipation actually resolves
- encoparesis = severe liquid stool with a hard stool in the intestines
Treatment:
-1) bowel clean out = senna laxative in morning and night for 2-3 days and miralax in 4-8oz water every 1-2 hrs for 12 doses
can cause UTIs, anxiety and marked emotional impact
What is functional constipation?
Intentional/subconscious withholding of stool
- usually is causes by a social stressor (abuse/new sibling/starting school/etc/ push toilet training too early/aggressively)
Stool is firm/small and difficult to pass which results in anal irritation and anal fissures
- coercive or inappropriate early toilet training is a serious factor for this
rare but can be caused by dietary changes as well due to allergies
Encoparesis definition
Voluntary or involuntary passage of watery feces in inappropriate places due to fecal impaction for at least once a month for 3 consecutive months once age 4 has been reached
- cant be taking laxative though to diagnosis this
Shows fecal impaction and is mistaken for diarrhea often
- to tell the difference watch for normal poop behaviors (difference is they aren’t straining but rather withholding)
Treatment of encoparesis
Patient education, relief of impaction and softening of the stool
- need to focus on regular postprandial toilet sitting and adaption of a balanced diet
(The regular time of sitting on the toilet is used to try to retrain the child into getting normal sensations of voiding bowels (they have lost this in encoparesis, but can be retrained to get it again)
- *caregivers cant be retaliatory towards soiling episodes = this will just compound it worse)
- instead reward good adherence (positive reinforcement)**
If really bad = stool softener enemas (polyethylene glycol or lactulose)
Umbilical hernias
Common in males and African Americans
- super high rates in premature infants and congenital hypothyroid deficiencies regardless of race
- *must rule out difference between omphalocele and benign fascial defects**
- push on it gently, if it goes back down = hernia. Also omphalocele can often show intestines ands easily discerned
Most require no therapy and spontaneously resolve in first few years of life
What medical condition is heavily tied with rectal prolapse in children?
Cystic fibrosis and excessive constipation
