case study qs- lower GI

Question 1

A 6y old boy presents with 12m of abdominal pain. He passes stools 1/week with occasional blood. He is on the 98th weight centile and 50th height centile.
Examination shows small soft masses in the LLQ

diagnosis?
what to examine?

Answer 1

Constipation +/- impaction

examination:
Inspect lower spine and anus
Check lower limb neurology
Measurements and centile
No rectal examination

Question 2

ccx of constipation?

Answer 2

megarectum- enlarged dialled rectum

-soft stools can run over and have ‘diarrhoea’ overflow

Question 3

how to treat constipation?

Answer 3

treat early and effectively

Stool softeners/ stimulants 
Senna, lactulose, movicol
As long and as much as needed 
Increase fluid intake
Fruit, veg and fibre
Reduce milk/ sweets
Toilet routine and comfort
Praise and star charts
Watch for “diarrhoea”

Question 4

2y old boy referred for poor weight gain and loose, pale stools (1 year, 3-4 times/day)+ flatus, miserable. Picky eater, all normal diet, formula fed, tried milk free diet- no benefit.
No significant past illness or family history
Examination; Pale, less sub cutaneous fat, muscle wasting, distended abdomen

Diagnosis?

Investigations?

treatment?

Answer 4

Coeliac

Stool screen (faecal elastase, electrolytes, reducing substances, culture)
FBC, iron status, CRP, Renal, liver, bone profile, Vitamin D status
Coeliac serology
IgA (needs separate biochem sample)
Small bowel biopsy (If screen positive)

Gluten free diet with dietitian input.