Chronic Constipation

Question 1

What is constipation

Answer 1

Infrequent passage of stool

Question 2

Other signs and symptoms with constipation

Answer 2

Poor appetite
Irritable
Lack of energy 
Abdominal pain or distension
Withholding or straining 

Can get overflow diarrhoea

Question 3

Why do children become constipated

Answer 3

Social:

• poor diet (insufficient fluids, excessive milk)
• potty training/ school toilet

Physical:

• intercurrent illness
• medication

Family history:
-slow bowels ?

Psychological

Organic:

• hypothyroidism?
• anal rectal malformation

Question 4

What is the cycle of constipation

Answer 4

Withholding of stool
Constipation
Large hard stool
Pain or anal fissure
Withholding of stool etc

Question 5

Treatment of constipation

Answer 5

1-Social
Diet (increase fibre, fruit, veg, fluids and decrease milk)

2-Psychological
Reduce aversive factors
Reward good behaviour

3-Soften stool and stimulate defecation
Osmotic laxatives (lactulose)
Stimulant laxatives (senna, picolax)
Isotonic laxatives (movicol)

Question 6

How to treat fecal impaction

Answer 6

Empty impacted rectum
Empty colon
Maintain regular stool passage
Slow weaning off treatment

Question 7

Presenting features of crohns in paediatrics (8)

Answer 7

Diarrhoea ++
Rectal bleeding ++
Abdominal pain +++
Fever +
Weight loss ++++
Growth failure ++++
Arthritis ++
Mass ++

Question 8

Presenting features of ulcerative colitis paediatrics (7)

Answer 8

Diarrhoea +++++
Rectal bleeding +++++
Abdominal pain +++
Fever +
Weight loss +
Growth failure +
Arthritis ++

Question 9

How to diagnose IBD in paediatrics

Answer 9

H&E:
Intestinal symptoms
Extra-intestinal manifestations
Exclude infection
FH
Growth and sexual development 
Nutritional status 

Lab:
FBC (anaemia, thrombocytosis)
ESR (raised)
Stool calprotectin (positive)
CRP (raised)
Albumin (low)
Stool sample (no pathogens)

Definitive investigations:
MRI
Barium meal and follow-through 
Colonoscopy
Upper GI endoscopy
Mucosal bleeding
Capsule endoscopy
Enteroscopy (not really done)

Question 10

Crohn’s disease treatment

Answer 10

Induce remission:

1. nutritional therapy
2. steroids

Maintain remission:
1.Thiopurines

Step-up therapy:
1. Anti-TNF

Surgery:

• For complications-
• Not curative-

Question 11

Ulcerative colitis treatment?

Answer 11

Induce remission:

1. 5-ASA
2. Steroids

Maintain remission:

1. 5-ASA
2. Thiopurines

Step-up Therapy:
1. Anti-TNF

Surgery:
Colonectomy Partial/ total
Is curative