Encopresis - ANSWER constipation with fecal soiling, partial stool incontinence Constipation etiologies - ANSWER NB: iron in formula overzealous toilet training fear of using bathroom 2nd to lack... of privacy or cleanliness personality/emotion diet Constipation 2nd to disorders of GI tract - ANSWER Structural (Hirschsprung's) Systemic (hypothyroidism) 2nd to meds (narcs, antihistamines) neurogenic (spinal cord lesions) Constipation tx - ANSWER NB: water with prune juice, glycerin suppository Older: stool softeners, miralax, lactulose Encopresis criteria - ANSWER must occur once a month for at least 3 months chronological or developmental age of child must be at least 4 years fecal incontinence must not be due to physiologic effects of meds or medical condition Encopresis male vs female - ANSWER occurs more commonly in MALES than females primary encopresis - ANSWER child who has never achieved fecal continence by 4 years of age 2ndary encopresis - ANSWER fecal incontinence occurring in a child over 4 years following a period of established fecal continence most common cause of encopresis - ANSWER CONSTIPATION encopresis tx - ANSWER aggressive bowel cleansing daily stool softeners bathroom times/star chart hirschsprung's disease - ANSWER congenital aganglionic megacolon congenital anomaly resulting in mechanical obstruction from inadequate motility in 1 part of the intestine incidence 1:1000 live births 4x more common in MALES associated with downs hirsch s/sx - ANSWER NB: failure to pass meconium stool within 24-48 hours after birth poor feeding, vomiting, abd distention infancy: sx as above as well as poor weight gain, constipation ominous signs: fever, lethargy, bloody diarrhea childhood: chronic constipation hirsch. typical stool - ANSWER FOUL SMELLING RIBBON LIKE STOOLS hirsch diagnosis - ANSWER gastro graphin enema- shows transition zone bt megacolon and aganglionic distal segment dx confirmation= RECTAL BIOPSY daily maintenance fluid requirements - ANSWER 100ml/kg for first 10kg 50 ml/kg for second 10mg 20ml/kg for remaining body wt isotonic - ANSWER equal amounts of h2o and na are lost hypotonic - ANSWER electrolyte loss is >fluid loss hypertonic - ANSWER water loss > electrolyte loss dehydration levels - ANSWER mild- weight loss 5% moderate: wt loss 10% infants, 6-8% children severe: 15% infants 10% children toddler's diarrhea (chronic non-specific diarrhea) - ANSWER diarrhea >2 weeks common in infants/children 6-54 months stools are loose with undigested food children are healthy and normal growth juice, dietary fat restriction, carb map-absorption tx: limit all orbitol/fructose foods/liquids, increase fiber/fat GERD - ANSWER peaks at 4 months, sharply declines at 6 months appendicitis peak - ANSWER preschool to young adult- peaks at 10 years most common cause of emergency abdominal surgery in childhood - ANSWER appendicitis diagnostic test of choice for appy - ANSWER ct hypertrophic pyloric stenosis - ANSWER most common in WHITE FIRST BORN MALES hypertrophic pyloric stenosis - ANSWER non bilious vomiting becoming more forceful- projectile 4-12 weeks olive shaped abd mall with visible peristalsis in ULQ Intussusception - ANSWER collapse of telescoping of a section of the intestine into a distal portion of intestine more common in males, rare after 4 CURRANT JELLY STOOL (bowel obstruction) sausage shaped mass in URQ intussusception dx and tx - ANSWER and us to r/o perf (no barium enema) tx of choice: hydrostatic reduction via water soluble contrast and air pressure (75% success rate) [Show More]
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