Constipation and Gastroenteritis Flashcards

1
Q

How often should infants, 1 yo’s and 4yo’s poo?

A

Infant’s is four times a day,
1 yo’s two times a day
4 and above should have an adult pattern

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2
Q

Define constipation?

A

Infrequent passing of dry, hardened faeces often accompanied by straining or pain.

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3
Q

What is the most common causes of simple constipation?

A

Reduce fluid intake in infants and toddlers.

Anal fissure causing pain.

In older children it may relate to problems with toilet training, unpleasant toilets or stress. (stool withholding)

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4
Q

What might be found on examination of a child with constipation?

A

Palpable abdominal mass.

DRE’s should only be done by a paediatric specialist and if it is absolutely necessary.

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5
Q

What are the red flags symptoms in children with constipation? (6)

A

Failure to pass meconium in first 24hrs: Hirschsprungs or other dismotility disorders

Failure to thrive: Hypothyroidism, coeliac disease

Gross abdominal distension – Hirschprung’s or other GI dysmotility

Abnormal lower limb neurology – lumbosacral pathology

Sacral dimple – spinal bifida occulta

Bruising and fissures – sexual abuse

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6
Q

How should you manage simple constipation/stool withholding?

A

Stool withholding:
Encouragement and close supervision of the child. Psychological support can be given if indicated.

Constipation:
If faeces are not palpable (abdominally) then give a balanced diet and sufficient fluids.

If faeces are palpable (abdominally) can give a mild osmotic laxative (movicol) alongside good hydration and a balanced diet.

If not effective consider a stimulant laxative and consider a more significant cause.

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7
Q

What is Hirschsprung’s disease and how common is it?

A

An absence of ganglion cells from the myenteric and submucosal plexuses of part of the large bowel which results in a narrow and contracted segment.

The disease starts in the rectum and extends proximally until there is an area of normally innervated bowel.

Occurs in 1 in 5000 live births (usually male)

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8
Q

How does Hirschsprung’s present?

A

It presents with bowel obstruction usually with failure to pass meconium.

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9
Q

How is Hirschsprung’s diagnosed?

A

Colonoscopy with biopsy showing absence of ganglionic cells.

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10
Q

What is the treatment of Hirschsprung’s?

A

Surgical treatment.

Colonoscopy of affected bowel followed by an anastomosis of the unaffected bowel with the anus.

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11
Q

How common is gastroenteritis in children and what is the most common cause?

A

It is very common.

10% of under 5’s suffer from gastroenteritis annually

It is usually viral with the most common pathogen being rotavirus.

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12
Q

What are the symptoms of gastroenteritis?

A

Sudden onset of loose watery stools or onset of vomiting.

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13
Q

Which signs and symptoms should make you rule out a diagnosis of gastroenteritis?

A

Temp: (Infection)
38 or more (if under 3 months)
39 or more(over 3 months)

Respiratory: (Lower lobe pneumonia?)
SOB
Tachypnoea

Meningitis/raised ICP:
Altered state of consciousness
Neck stiffness
Bulging fontanelle
Non-blanching rash (sepsis)
Blood and/or mucus in stools
Severe abdominal pain 
Abdominal distension/rebound tenderness.
Bilious vomit (malrotation volvulus)
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14
Q

When should a stool sample be sent?

A
If the child is immunocompromised
If there is blood or mucous in the stool
If there has been recent foreign travel
If the diagnosis is uncertain 
If the diahorrea is not improving after 7 days
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15
Q

What should you look for in a dehydration assessment?

A
Dry mucosal membranes
Sunken fontanelle
Sunken eyes
Skin tugor (late sign)
Reduced UO (no. of wet nappies)
Severe dehydration: (shocked)
Reduced consciousness
Skin colour mottled or pale
Cold peripheries
Prolonged capillary refill
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16
Q

Which children are at particular increase of dehydration?

A

Children less than 1 (increased risk if less than 6 months)
Infants with a low birth weight
Those who are unable to feed due to illness
Diahorrea (6x in 24hrs)
Vomitting 3 or more x in 24hrs

17
Q

How should you manage fluid replacement therapy?

A

Replace deficit:
50ml/kg if clinically dehydrated or 100ml if shocked give over 4hrs.

Give maintenance fluids:
4ml/kg for 1st 10kg
2ml/kg for 2nd 10kg
1ml/kg thereafter

To be given each hour.

Replace loss:
Whatever is lost replace In=out

18
Q

How should you manage gastroenteritis?

A

Antibiotics not indicated unless specified by microbiology from stool sample.

Oral rehydration therapy.

19
Q

If following an episode of gastroenteritis diahorrea returns once starting normal diahorrea what may be the problem?

A

Infrequently following gastroenteritis there may be temporary lactose intolerance.

This can be confirmed by the presence of non-absorbed sugar in the stools giving a positive ‘Clinitest’ result.