Ch 332.3 - Encopresis and Functional Constipation Flashcards Preview

Nelson - The Digestive System > Ch 332.3 - Encopresis and Functional Constipation > Flashcards

Flashcards in Ch 332.3 - Encopresis and Functional Constipation Deck (15):
1

Constipation is defined as delay or difficulty in defecation present for ___ or longer and significant enough to cause distress to the patient

2 weeks

2

Based on the Rome III criteria, chronic constipation in infants and toddlers must include 1 month of at least how many of the 6 criteria

2

3

Criteria for chronic constipation in infants and toddlers based on Rome III

1) ≤2 defecations per week 2) ≥1 episode of incontinence after acquisition of toilet training skills 3) History of excessive stool retention 4) History of painful or hard bowel movements 5) Presence of large fecal mass in the rectum 6) History of large-diameter stool that might obstruct the toilet

4

Criteria for chronic constipation in children aged 4 to 18 yrs based on Rome III

At least 2 of 6: 1) ≤2 defecations per week 2) ≥1 episode of incontinence per week 3) History of retentive posturing or excessive volitional stool retention 4) History of painful or hard bowel movements 5) Presence of large fecal mass in the rectum 6) History of large-diameter stool that might obstruct the toilet

5

Functional constipation can usually be differentiated from that caused by organic causes on the basis of

History and PE

6

Unlike anorectal malformations and Hirschprung disease, functional constipation ___

Typically starts after the neonatal period

7

Findings associated with constipation that are suggestive of underlying pathology

1) Failure to thrive 2) Weight loss 3) Abdominal pain 4) Vomiting 5) Persistent anal fissure or fistula

8

Voluntary or involuntary passage of feces into inappropriate places at least once a month for 3 consecutive months once 4 y/o has been reached

Encopresis

9

Other considerations for patients with intractable constipation

1) Hypothyroidism 2) Hypocalcemia 3) Lead toxicity 4) Celiac disease 5) Allergy testing

10

What condition presents with megarectosigmoid in water-soluble contrast enema

Severe functional constipation

11

Therapy for functional constiaption and encopresis

1) Patient education 2) Relief of impaction 3) Softening of the stool

12

Maintenance therapy for functional constipation is generally continued until

A regular bowel pattern has been established

13

Options for rapid fecal disimpaction

1) Glycerin supposed in infants and toddlers 2) Phosphate enema, 60ml in <1yo, 6ml/kg in >1yo

14

Options for slow oral disimpaction

1) PEG with electrolytes 25cc/kg over 2-3 days or until clear fluid comes from anus (2-3 days) 2) PEG without elec 1.5g/kg x 3 days 3) Mineral oil 3cc/kg BID x 7 days 4) Lactulose 2cc/kg BID x 7 days

15

Options for maintenance therapy

1) YEARS: Mineral oil, lactulose, PEG 2) MONTHS: Senna, glycerin enemas, bisacodyl suppositories