Constipation Flashcards Preview

Pediatrics > Constipation > Flashcards

Flashcards in Constipation Deck (20):
1

Causes of acute constipation

1. Fluid depletion->fever, hot weather
2. Bowel obstruction->congenital, adhesions

2

Signs a child may be constipated

Infrequent stools
Pain and straining on defecation
Abdominal pain
Passsing small hard stools
Avoiding the toilet
Not having an urge to defecate
Difficulty finishing defecation
Painful bottom
Dribbling urine
Fecal smell
Leaking liquid stools into underwear

3

Chronic causes of constipation

1. Functional->common, disabled children, witholding from painful, +risk megacolon. Use laxatives, bowel training and diet.
2. Hirschsprung's->newborn, FTT, abdominal distension. Requires rectal biopsy.

4

Important history

Infrequent but normal stools not indicator of constipation
Hardness
Pain
Abdominal pain
Blood, anal fissure
Onset- ?infancy
Precipitating events-> mismanaged toilet training, fluid depletion, febrile illness, vomiting
Hiding while defecating, withholding behaviour
Diet
Consider maltreatment
Time of meconium passage

5

Examination

Growth ht/wt/HC->Hirchsprungs and FTT
Abdominal examination->hard stool in LLQ
Anorectal examination->rectal not usually indicated. ?Anal fissure.
Spine->deep sacral cleft or tuft of hair
Neurology->assessment of lower limb

6

Investigations

AXR not generally indicated
Rectal biopsy->hirschsprungs
Growth faltering->check celiac screen and hypothyroidism

7

What is fecal impaction

When no adequate bowel movement for days/weeks->a large fecal mass becomes compacted in the rectum

8

If Hirschsprung's disease more common in boys or girls

More common in boys

9

Risk factors for constipation

Diet->low fluid, low fibre
Holding of stools
Change in routine
Lack of exercise
Genetics
Medication->codeine, cough, anticonvulsants, antihistamines

10

Management of constipation: overview

Stage 1: Dietary management and behaviour modifications
Stage 2: Disimpaction
Stage 3: Maintenance
Stage 4: Vigilance

11

How frequently do children pass stools

May pass every 2-3 days, breast fed may be less frequently

12

When is constipation particularly common

When transitioning to solids, toilet training,

13

Most common cause of constipation in childhood

Functional
Pain->apprehension->retention->passage of hard stools->cycle of withholding

14

Less common Medical causes

Cow milk allergy
Celiac disease
Hypercalcemia
Hypothyroidism

15

Less common surgical causes

Hirschsprung
Meconium ileus
Anatomic malformations of anus
Spinal nord abnormalities

16

Behaviour modifications

Position- foot stool, knees higher than hips. Lean forward, elbows on knees
Toilet sits->5 minutes three times a day, after meals. Time. Encourage child to bulge abdomen/ Praise child for sitting on the toilet.
Chart or diary
Avoid toilet training until child is passing soft, painless stools

17

Dietary management

Fibre->wholewheat bread and cereals
Fluids
Stool softeners->fruit (with peel), vegetables, beans, nuts, prune juice

18

Disimpaction (1-2 weeks or until symptoms resolve)

1) Laxatives
Iso-osmotic->Movicol= +fluid, softens
Stimulant laxative->sodium picosulfate, bisacodyl, senna if Movicol ineffective
Osmotic laxatives->lactulose
Bulking agent->Fybogel
2)Glycerin suppositories
3)Enemas may rarely be used in severe
4)Manual evacuation under general anaesthesia in extreme cases

19

Maintenance therapy

Stools should be kept soft with softener and stimulant for 6 months.
Continue with dietary and behaviour modifications

20

Vigilance

Start or escalate treatment at first indication of recurrence of hard stools

Decks in Pediatrics Class (58):