Child with elimination problem Flashcards

Question

Red flags for constipation

Answer 1

Not passing meconium within 48h (CF or Hirschprungs) Onset from birth to few weeks of life - Hirschsprungs Distension and vomiting FHx of Hirschsprungs Ribbon stool pattern - anal stenosis Leg weakness or motor delay Abnormal appearance of anus Abnormal lumbosacral and gluteal region

Answer 2

FTT Developmental delay Coeliac HYpothyroidism CMPA Safeguarding

Answer 3

Correct any reversible factors e.g high fibre diet and good hydration Start laxatives - 1st line = movicol Faecal impaction disimpaction regimen with high dose laxatives at first Encourage and praise visiting toiler - bowel diary, scheduling visits and star charts Foot stool - for positioning

Answer 4

Manual evacuation Polyethylene glycols via NG for whole gut lavage ACE - anterograde colonic enema - enema through appendix or coecal junction Psychosocial + behavioural therapies

Answer 5

Escalating dose of macgrocols (movicol/laxido) If fails add stimulant (Senna) If macrogol not tolerated use stimulant with lactulose/docusate Avoid suppositories/enema in primary care

Answer 6

Lack of bladder control during the day in a child who is old enough to be continent (over age of 3-5) Nocturnal enuresis is normally present

Answer 7

Lack of attention to bladder sensation - may be a developmental, psychogenic problem, may occur in otherwise normal children who are too preoccupied Detrusor muscle instability: sudden, urgent urge to void which is induced by sudden bladder contractions Bladder neck weakness Neuropathic bladder - enlarged and fails to empty properly, assoicated w/ spina bifida UTI Ectopic ureter - constant dripping and child is always damp

Answer 8

FHx Males Obesity Developmental delay Constipation Faecal impaction Psychological or behavioural disorders Sleep apnoea and upper airway obstruction symptoms

Answer 9

MCS urine sample USS may show bladder pathology XR of spine may show vertebral anomaly MRI spine - tethering of cord

Answer 10

Affected children with no neuro cause - star charts, bladder training and pelvic floor exercises Treat any constipation first , then daytime, then nighttime enuresis Small portable alarm with pad in pants - activated by urine - can be used for lack of attention to bladder sensation Anticholinergic drugs - oxybutynin - may be helpful if other measures fail, decrease bladder contractions

Answer 11

Emotional upset UTI Polyuria from osmotic diuresis in DM or renal contracting disorder (e.g sickle cell disorder or CKD) Faecal retention severe enough to reduce bladder volume and can cause bladder neck dysfunction

Answer 12

Genetically determined delay in sphincter competence Small children need to be stress free and have a measure of parental approval in order to learn night-time incontinence Emotional stress can interfere and cause secondary enuresis Underlying stress

Answer 13

Explain problem is common and beyond control - parents should stop punitive procedures Star chart - wet beds treated as matter of fact and not punished >5y - alarm - rings when start weeing so get up and go toilet - reward system Desmopressin - rapid/short term solution e.g camp Recurs - restart desmopressin plus alarm

Answer 14

3 or more partially formed or watery stools per day foe less than 14 days

Answer 15

loose stool with blood and mucus, pyrexia and abdo cramps

Answer 16

Organisms or toxin related Rotavirus - 60% Campylobacter - severe abdo pain Shigella/Salmonella produce dysenteric type of infection with blood and pus in stool, pain and tenesmus Cholera and enterotoxigenic E. Coli infection - profuse, rapidly deteriorating diarrhoea

Answer 17

Usually none Stool culture - if septic, blood or mucus, I.C child, recent travel not improved in 7 days U&Es - creatinine, glucose if IV fluid needed or signs of hypernatraemia Blood culture for abx

Answer 18

Antidiarrhoeals not used - ineffective, may prolong bacteria can be S/E Abx rarely needed - sepsis, extra-intestinal spread, malnourished or I.C Abx for: C. diff associated w/ pseudomembranous colitis Cholera Shigella Giardiasis

Answer 19

Difficult to manage ORS If IV fluids too quick - rapid reduction in plasma sodium conc. and osmolarity will lead to a shift in water = cerebral oedema - give fluid over 48h Nutrition - developing countries can lead to malnutrition, may be zinc deficiency and supplementation may be helpful

Answer 20

Most managed at home Contact HCP if dehydration sx develop Child is not clinically dehydrated - drink plenty of fluids Don't drink fruit juices and carbonated drinks Give ORS to increased risk Advise that usual diarrhoea is 5-7d Usual vomiting is 1-2d Doesn't resolve within time period contact HCP

Answer 21

Up to 50% have structurally abnormality in UT Pyelonephritis may damage growing kidney by forming a scar, predisposing to HTN and CKD if scarring is bilateral

Answer 22

classic tria: dysuria, frequency + loin pain in older children fever vomiting lethargy irritability poor feeding FTT abdo pain jaundice haematuria offensive urine

Answer 23

Clean catch urine is recommended Not available: urine collection pads or invasive: catheter samples or suprapubic aspiration Infants <3m referred to specialist + MCS sample Use dipstick testing in children >3m + <3y

Answer 24

Suspect acute pyelonephritis High to intermediate risk of serious illness Infants under 3m Positive for leukocyte esterase or nitrite Infants + children with recurrent UTI Infection doesn't respond to treatment within 24-48h Clinical sx + dipstick tests don't correlate

Answer 25

referral to paeds, treat with parenteral abx use cephalosporin - cefotaxime or ceftriaxone + abx against listeria (amoxicllin)

Answer 26

Start abx if leukocyte esterase, nitrates or both are positive Lower: 1. Trimethoprim/Nitrofurantoin 2. Nitrofurantoin/amoxicillin/cefalexin Upper: 1. Oral: cefalexin/co-amoxiclav 1. IV: co-amoxiclav/cefuroxime/ceftraixone

Answer 27

1. Nitrofurantoin 2. Amoxicillin/cefalexin 3. Consult microbiologist

Answer 28

Unwell Irritable/lethargic Reduced U/O Pale or mottled skin cold extremities sunken eyes dry mucous membranes/skin turgor tachycardia/tachypnoea low BP Slow crt

Answer 29

Children with diarrhoea drink large quanities of water = greater net loss of sodium than water, leading to fall in plasma sodium Leads to a shift of water from extracellular to intracellular compartements Increase in intracellular volume leads to a greater degree of shock per unit water loss

Answer 30

total body deficit of sodium + water losses of sodium + water are proportional and plasma sodium remains within normal range (isonatraemic)

Answer 31

More water loss than to sodium relatively and plasma sodium concentration increases Occurs from high water losses ECF becomes hypertonic with respect to ICF Water shifts into ECF Harder to spot as signs of ECF depletion are less per unit of loss Dangerous as fluid is drawn out of brain and cerebral shrinkage within a rigid skull - jittery movements, increased muscle tone with hyperreflexia, altered consciousness, seizures and multiple, small cerebral haemorrhages

Answer 32

ORS mainstay - correction of deficit, maintenance and ongoing losses No dehydration - usual feeds/bottle, ORS supplement (if refuse/don't like taste aren't too dehydrated) no fruit juices or carbonated drinks With signs but at home: <5y 50ml/kg for deficit over 4h + maintenance ORS >5y 200ml ORS after each loose stool plus normal fluid intake Shock: IV therapy, rapid infusion of 0.9% sodium chloride solution

Answer 33

Toddler diarrhoea - commonest cause of persistent loose stools per day for 4+ weeks Coeliac disease Lactose intolerance - primary (rare) and secondary (after acute gastroenteritis) Functional GI disorders - toddler diarrhoea and IBS IBD Food allergy and intolerances CF Small intestinal bacterial overgrowth Malignancy

Answer 34

Stools are varying consistency Sometimes well formed and sometimes explosive and loose Presence of undigested vegetables - "peas and carrots diarrhoea" Affected children are gen. well Underlying maturational delay in intestinal motility which leads to intestinal hurry Usually grow out of it by 5, achieving foecal continence Relieve symptoms can be achieved by making sure child's diet has fat and fibre (slows gut transit) Excessive consumption of fresh fruit juice can exacerbate