Constipation Flashcards
How is constipation defined in the pediatric population?
Constipation is defined as abnormally delayed or infrequent passage of stool.
What are the two main types of constipation in children?
- Functional (idiopathic) constipation - No underlying medical or anatomical problem.
- Organic constipation - Secondary to an underlying medical or anatomical issue.
What criteria are used to diagnose functional constipation?
The Rome Criteria are used to diagnose functional constipation.
How long must symptoms be present to meet the Rome Criteria for functional constipation in children?
1 month in children under 4 years.
• 2 months in children over 4 years.
What are the diagnostic criteria for functional constipation according to the Rome Criteria? (Name at least 4)
At least 2 or more of the following:
1. 2 or fewer stools per week.
2. 1 or more episodes of incontinence per week (after toilet training).
3. History of excessive stool retention.
4. History of hard or painful bowel movements.
5. Presence of large faeculoma in the rectum (clinically or on X-ray).
6. History of passing large diameter stools (that may even obstruct the toilet).
What is necessary to determine the presence of a predisposing condition for constipation?
A combination of history, clinical examination, and special investigations.
How do breastfed babies’ stooling patterns typically vary?
Breastfed babies have highly variable stooling patterns. They may stool several times a day or as seldom as once a week.
What should be observed in neonates who appear to be “grunting” or “squirming”?
This behavior is often normal and does not necessarily indicate pathology. It is common for small babies to make faces, squirm, or grunt when asleep or awake. As long as the baby is growing well and otherwise healthy, no intervention is needed.
What should be checked when assessing a neonate for constipation?
- Confirm the anus is normal size and in the center of the pigmented area, indicating the muscle complex.
- Check for signs of Hirschsprung’s disease.
- Look for evidence of occult spinal dysraphism.
What are the indications for referral to work-up for possible Hirschsprung’s disease in neonates and young infants? (List at least 3)
- Delayed passage of meconium (greater than 48 hours in term infants).
- Constipation from the first few weeks of life.
- Chronic abdominal distension plus vomiting.
- Family history of Hirschsprung’s disease.
- Faltering growth in addition to any of the above.
How can spinal defects lead to constipation?
Spinal defects, such as Myeomeningocele, tethered cord, fatty filum, sacral agenesis, and other overt, occult, or acquired defects, can cause significant constipation due to impaired nerve function affecting bowel motility.
What is essential for managing constipation in patients with spinal defects?
Patients with spinal defects require active, lifelong management of their constipation and should be referred to a relevant specialty for long-term management and follow-up.
What is African degenerative leiomyopathy, and where is it most commonly seen?
African degenerative leiomyopathy is a condition commonly seen in children from South, East, and Central Africa, especially in the Eastern Cape of South Africa.
What is the typical presentation of African degenerative leiomyopathy?
The typical presentation includes:
1. Long history of abdominal distension, cramps, and vomiting.
2. Constipation.
3. Faltering growth.
4. Malabsorption.
What radiological findings are seen in African degenerative leiomyopathy?
X-rays show marked gaseous distension, particularly of the colon (megacolon).
What histological findings are associated with African degenerative leiomyopathy?
Histology of the bowel shows:
1. Smooth muscle degeneration.
2. Vacuolated cytoplasm.
3. Increased fibrosis of muscular layers.
4. Normal innervation, but in some cases, hyperplasia of the myenteric plexus.
What is the prognosis for African degenerative leiomyopathy?
It is a progressive, life-limiting condition, requiring specialist management.
What are common symptoms of peri-anal fissures in children?
Common symptoms include severe pain on defecation and bloody streaks on stool and on wiping.
When should a child with peri-anal fissures be referred for further investigation?
Referral is necessary if the fissures are non-healing, recurrent, or associated with peri-anal sepsis and ulceration.
How should most peri-anal fissures be managed in children?
Most peri-anal fissures can be managed with:
1. Stool softeners.
2. Isosorbide mononitrate paste applied to the anus.
3. Anaesthetic cream.
What is the purpose of taking a detailed history in a child with constipation?
The purpose is to:
1. Identify any underlying conditions predisposing to constipation.
2. Determine if the child meets the criteria for functional constipation.
3. Assess if the child’s diet could be contributing to constipation.
What underlying conditions should be considered when taking the history of a child with constipation?
Conditions to consider include:
1. Cerebral palsy or other central nervous system abnormalities.
2. Inherited and genetic abnormalities (e.g., Trisomy 21, cystic fibrosis).
3. Spinal defects (e.g., myelomeningocele, tethered cord, sacral agenesis, previous pelvic or spinal surgery, traumatic spinal cord injury).
4. Autism.
5. Hypothyroidism.
6. Any anorectal disorders (e.g., imperforate anus, Hirschsprung’s disease).
How can a patient’s diet contribute to constipation?
A poor diet frequently plays a significant role in functional constipation. Taking a detailed account of the patient’s diet can help identify problem areas.
What psychosocial stressors could contribute to constipation in children?
Psychosocial stressors such as new school, bullying, family conflict, lack of clean and safe toilets at school, or medication usage (e.g., opiates, antidepressants) can contribute to constipation.
