Upgrade to remove ads
GI Block - Pediatric Constipation / Encopresis
Module 2 - Diarrhea and Constipation
Terms in this set (29)
Definition of constipation
A delay or difficulty in defecation that has been present for more than 2 weeks and is causing distress.
Failure to pass three stools per week
Pain with passage.
How does constipation end up worsening and becoming more painful for the kid? What is encopresis?
They associate pain with the pooping, so they do everything they can to hold it in. The impaction gets bigger and harder, and rectum gets distended and painful.
ENCOPRESIS: Mom may think the kid's pooping just fine because of underwear stains, but that might just be from some more fluid poop getting around the impaction.
Kid might not know they're even doing it. And got used to the stink
A kid older than 3 years should be having bowel movements how frequently?
At least once every 48 hours.
Chronic constipation will lead to... (other than encopresis)
After puberty, which sex is more likely to be constipated?
What other disease do you have to always have to consider when it looks like constipation?
Two other major ones.
Hypothyroidism and anal stenosis
How does functional constipation typically arise in an INFANT? How can you fix it?
Parents start their kid out feeding on solids that are bananas, vegetables, and rice. Fruits and carbs can be constipating.
Take those out, add oatmeal and vegetables, barley, etc.
How does functional constipation typically arise in a TODDLER?
Toddler gets rebellious and doesn't want to poop.
How does functional constipation typically arise in an OLDER CHILD? What can you do about it?
Embarrassed by the smell of their poop and think classmates will make fun of them, so they hold it.
You can remind them that they're not paying for the water, so keep flushing it so there's no smell. Otherwise, sometimes kid is taken to teacher's bathroom to poop.
What's a way to "retrain" the kid's bowel to poop in the morning?
Feed them hot breakfast and tell them to go play a video game or read for 10 or 20 minutes, then they should have to go. Instead of rushing them out the door after breakfast.
What kind of historical information do you want to get to be able to diagnose and treat the kid's constipation?
Onset, duration, painful, bleeding with defecation.
Parents think their kid is having pain from excessive straining when actually it's from withholding.
Can get to the bottom of a precipitating EVENT that lead to this, like an illness or something emotional.
What kind of physical findings are you looking for with constipation?
Size of anal canal and the rectum. Is rectum empty or full?
Can feel poop in colon on abdominal exam (?)
Look for "sacral dimples" (seen on the OUTSIDE) --> Can indicate spina bifida or tethered cord.
Location of the anus on the perineum. Can be more anterior, making defecation difficult. Is the anus even perforated?
Fissures, fistulae (needs surgery), or hemorroids.
Confirm the presence of an ANAL WINK.
Hirschprung's disease (congenital megacolon) vs. Functional constipation (acquired megacolon)
Age at onset:
Incidence: 1:5000-1:10000 vs 1:5-1:10
Sex M:F = 4:1 vs. 1:1
Infancy vs. variable (wean from breast, toilet training, school entry, post-enteritis)
Soiling rare vs. common
PHYSICAL: small, empty rectum vs. large rectum full of stool.
Radiologic findings in Hirschprung's disease
No gas in the colon. Large, dilated colon. Small caliber rectum.
What two neurological defects do we know that can cause colonic dysmotility?
Lipoma pressing on sacral spinal nerves.
What are some behavioral signs that a child might be constipated?
Squatting (to help hold it)
Holding onto furniture or mother
Flushing, sweating, crying
What is a psychosocial consideration you would keep in dealing with a constipated child?
Sexual abuse - constipation and problems with going into a bathroom.
Mainstay of treatment for constipation (not clinical)
Parent education - including, get fiber into the kid's diet. Tell them to watch frequently to make sure the kid's getting the stool out.
What clinical treatment measures do you use for constipation?
Must evacuate the colon: Enemas and oral cathartics (laxatives & stool softener)
For anal fissures - xylocaine ointment or hydrocortisone suppositories
Must establish regular bowel habits
When should you use a consult?
When a parent is taken aback by the laxative regimen. Get a second opinion.
History suggests underlying organic cause.
Child isn't getting anywhere because the parent doesn't understand you need to stay on a strict regimen. Keeps relapsing.
Dietary changes that fix constipation.
Increase fluids. Balance fruit, whole grains, vegetables. Don't need 3 glasses of milk a day for calcium and vitamin D. Can get those from other sources.
Medications used to fix constipation
Lactulose & sorbitol (nonabsorbable sugars)
Magnesium hydroxide (Milk of Mag)
Sodium phosphate (fleet enema)
What is encopresis (physiologically)?
Insensitivity of internal anal sphincter. Stool builds up and they don't get a sensation that they need to go until there's a bunch in there. Chronic overflow, and the child doesn't know that they're leaking.
How does encopresis usually arise? How does it end up in your doctor's office?
The child is holding their stool for whatever reason, leading to insensitivity of the sphincter. Goes on for 3-6 months before the parent can't take it because of the smell and finally goes to the doctor. Child might even be hiding their stained underwear.
Encopresis gender preference. Time of day.
More often in boys. While awake and active
Encopresis differential diagnosis
Spinal cord injury
Congenital megacolon (Hirschprung's)
Encopresis physical exam findings
Huge (softball) stool ball in rectal exam.
Sphincter may be soft and let you in easily.
Stool smeared around anus.
Stool palpated throughout colon on abd. exam.
Goal of therapy. How to treat.
Re-establish continence. Return of normal rectal muscular tone.
Evacuate massive impaction. Several days of enemas followed by lax.
Reduce rectal vault size
Lots of laxatives to maintain clean colon (for life)
Reward trips to the bathroom.
What's a smart way to get a lot of fiber into a kid's diet for encopresis, since kids are generally picky eaters?
Sneak it into a smoothie.
THIS SET IS OFTEN IN FOLDERS WITH...
Exam 3: Pediatric Gastroenteritis
FNP Board Review: Pediatrics, Respiratory Issues
YOU MIGHT ALSO LIKE...
Peds Chapter 20 PrepU
Exam 4 Key Points
OTHER SETS BY THIS CREATOR
Immunosuppressants - Monoclonal Antibodies
DIT - Drug Side Effects List (pg 132)
Pediatric Milestones and Immunizations
OTHER QUIZLET SETS
GI Exam 2 Pediatrics
A&P p. 11-19