Pediatric emergency medicine trisk 116
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (106.06 KB, 4 trang )
TABLE 18.1
ETIOLOGY OF CONSTIPATION
I. Functional
A. Fecal retention
B. Depression
C. Harsh toilet training
D. Toilet phobia
E. Avoidance of school bathrooms
F. Fecal soiling
G. Anorexia nervosa
II. Pain on defecation
A. Anal fissure
B. Foreign body
C. Sexual abuse
D. Laxative overuse
E. Proctitis
F. Rectal prolapse
G. Rectal polyps
H. Perianal streptococcal infection
III. Mechanical obstruction
A. Hirschsprung disease
B. Imperforate anus
C. Abdominal/pelvic mass
D. Upper bowel obstruction
E. Anal/rectal stenosis
F. Anal atresia (newborn)
G. Meconium ileus (newborn)
H. Pregnancy
IV. Decreased sensation/motility
A. Drug induced
B. Viral “ileus”
C. Neuromuscular disease
1. Hypotonia
2. Werdnig–Hoffmann disease
3. Cerebral palsy
4. Down syndrome
5. Chronic intestinal pseudo-obstruction
D. Metabolic abnormalities
1. Hypothyroidism
2. Hyperparathyroidism
3. Hypercalcemia
4. Hypokalemia
5. Diabetes mellitus
6. Diabetes insipidus
7. Renal tubular acidosis
8. Heavy metal poisoning
E. Infant botulism
F. Spinal cord abnormality (tumor, tethered cord)
G. “Prune belly” syndrome
V. Stool abnormalities
A. Dietary
B. Dehydration
C. Malnutrition
D. Celiac disease
E. Cystic fibrosis
VI. Pseudoconstipation
A. Breastfed infant
B. Normal variation in stool frequency
TABLE 18.2
COMMON CAUSES OF CONSTIPATION
Functional
Anal fissure
Viral illness with ileus
Dietary
Inadequate fluid intake and malnutrition should be uncovered by dietary
history. Specific recent medications may cause constipation ( Table 18.5 ).
Ingestion of lead is also a potential and serious reason for constipation. Infant
botulism typically presents with acute constipation, weak cry, poor feeding, and
decreasing muscle tone (see Chapter 97 Neurologic Emergencies ). Acute
constipation can also be a symptom of a bowel obstruction but is usually a less
prominent feature than other symptoms (see Chapter 116 Abdominal
Emergencies ).
Acute constipation in the child ≥6 months of age occurs for many of the same
reasons as in the young infant. History may reveal dietary factors such as
introduction of solid foods or excessive intake of cow’s milk, recent viral illness
or use of medication, as well as the presence of underlying illness, such as
neuromuscular disease. Physical examination will rule out anal malformations
and other physical problems that could result in trouble defecating.
Chronic Constipation
Constipation of more than 1 month’s duration in a young infant <6 months of age,
although likely to be a functional problem, is especially concerning and should
prompt evaluation for an underlying illness. Spinal muscular atrophy, amyotonia,
congenital absence of abdominal muscles, dystonic states, and spinal dysraphism
can cause problems with defecation and can be readily diagnosed with history and
physical examination.
Anorectal anomalies occur in approximately 1 in 2,500 live births. Imperforate
anus presents at birth with absence of any anal opening. Anal stenosis causes the
passage of ribbon-like stools with intense effort and is diagnosed by rectal
examination demonstrating a tight, constricted canal. In “covered anus,” the anus
can be covered by a flap of skin, leaving only a small opening for passage of
stool. Anterior displacement of the anus may cause constipation by creating a
pouch at the posterior portion of the distal rectum that catches the stool and
allows only overflow to be expelled after great straining. The treatment may be
medical or surgical.
TABLE 18.3
SOME ATYPICAL PRESENTATIONS OF CONSTIPATION
Anorexia
Headaches
Lethargy
Limp
Refusal to walk
Seizure-like activity (shaking, staring spells)
Urinary retention
Urinary tract infection
