00:01
Our topic here is
constipation in the young.
00:05
Infrequent passage.
00:06
Now, here will be
true pathology.
00:10
Earlier when we talked
about diarrhea,
high in the differential in a child
will be infections for obvious reasons.
00:18
Constipation, more systemic issues,
we’ll talk about congenital as well.
00:22
Here, because of constipation,
you can expect the stool obviously not
to be watery but hard and dry.
00:28
It could be functional
and, even with functional,
many of you have probably noticed
or maybe even memorized that,
“Oh, functional type of
constipation, that means
that the intestine isn’t
working properly.”
And many of you would jump
down to an answer choice
and choose
Hirschsprung's disease
Be careful, do not do that.
00:48
Remember as a child, how often
did you like to go poop
or, you know, go the bathroom?
You’re playing
with your friends,
you didn’t want to go to the bathroom.
00:56
so it’s actually voluntary
holding on to the stool.
01:02
So functional,
most common cause will be something
like a voluntary withholding
very much keep that in mind.
01:09
There might be absolutely
nothing wrong with your child.
01:11
Why do investigations
and invade the child
with doing tests
when you know that it could be just the
fact that the child wants to play?
Functional.
01:21
Other causes:
Meconium ileum, once you’ve
ruled out functional type of
constipation and other causes.
01:28
For example, cystic fibrosis, extremely
common in young Caucasian children.
01:34
With cystic fibrosis, you
know what there isn’t enough
chloride channels that
properly lubricate the stool.
01:40
Meconium ileus is when the babys first stool (the meconium) causes the bowel obstruction.
01:47
In addition, anterior displaced anus,
Hirschsprung's disease is here
botulism, and hypothyroidism are possible
differentials for pediatric constipation.
01:58
You go step by step by step
and every time you do so,
you should be able to figure out,
well, what’s causing the vomiting?
What’s causing the diarrhea?
or in this case, what’s
causing the constipation.
02:11
Liquid stool may pass
around the hard stool mass
and give a false
impression of diarrhea,
know as, well, encopresis.
02:17
In other words, encopresis
would be the incontinence
that the child is exhibiting.
02:24
And I’ll walk you through
encopresis in a little bit
where we start talking about
greater than 4 years age
and that might be more of a
psychological issue as well.
02:33
But remember, no matter what,
the body’s trying to
evacuate the toxin, okay?
And even if there is constipation and
there is a hard stool in the intestine,
at some point in time, these
toxins have to get out.
02:49
So therefore, there’s every
possibility that the
loose stool might pass
around the hardened stool
So it’s kind of like
taking a detour
and then out it comes, giving you
the false impression of diarrhea
when your child is actually
suffering from constipation.
03:10
Diagnosis.
03:11
X-ray.
03:12
All right. So we’d take a look at an
abdominal x-ray and you notice here
that we have a few bubbles,
enlargement, unclear at this point.
03:20
All that you know is the fact
that on abdominal x-ray,
there’s going to be constipation,
but what’s the cause?
Well, you’d go through the
different differentials.
03:29
Is it functional?
Is it the lack of your neural
crest cells migrating down
to develop your enteric nervous
system so on and so forth.
03:36
Obviously, I’m referring to Hirschsprung.
03:39
Also, consider, thyroid
function studies.
03:43
Sweat test.
03:44
For what? Cystic fibrosis.
03:47
And electrolytes as indicated.
03:51
Management of functional constipation:
you treat it with diet, stool
softeners and perhaps counselling.
03:58
Remember, if the child
psychologically is fearful
for whatever reason
of going to bathroom.
04:06
Or if it is something like
functional constipation, then
you want to ease the stool to pass,
so therefore, you’re
recommending fiber.
04:18
Our topic now brings us to
pediatric encopresis.
04:22
What is it?
It is fecal incontinence.
04:25
Incontinence is an important
topic on your boards,
either in the young
or in the elderly.
04:34
Fecal incontinence after the
age of four years of age
is the definition of
pediatric encopresis.
04:41
More common in boys, 6:1
ratio or 4 to 6:1 ratio.
04:47
Much more common in
boys than in girls.
04:51
Greater than four years of
age, this is incontinence.
04:56
Leakage of loose stool
around an obstruction
are possible signs and symptoms.
05:02
Address the constipation
in terms of management
or perhaps the child
is seeking attention
and/or there might be something
else going on at home,
just keep that in mind.
05:15
And so therefore, psychotherapy
is also part of your management.
05:21
But most likely,
it might be constipation in which the
stool is passing around the constipation.