PEDS Elimination

Constipation is the infrequent and difficult passage of stools.

• Encopresis is fecal incontinence, can develop secondary to constipation
• -Abd is distended and can lose muscle function causing encopresis

change in diet, dehydration, lack of exercise, stress, pain from fissures, excessive milk intake

Bowel habits: hx of soiling events: frequency, duration, intensity, poor bladder control

Stool habits: frequency, consistency, methods used to stool (meds)

Diet: fiber, veggies, fruits, juices, water

Other symptoms: bloating, pain or cramping, abd distention, palpable fecal mass, decreased bowel sounds, anal fissures, rubbing at butt, odor

Disempaction first: can be traumatic for child. Make dx by xray

• NS enemas, stool softeners, laxatives
• If use of fleet laxatives watch for hypernatremia and hyperpoisphatemia

• Need to retrain rectal tone
• Want to keep stools soft when retraining
• 6-12 months approx to retrain
• Stressful on family

• Older than 1- Mineral oil: cold, mix with ice cream/choc milk
• 6-12 months- lactulose, milk of magnesia
• Infants- barely cereal, prune juice, sometimes lactulose

• Increase fiber
• Limit milk
• Increase water

• -Help parents get good habits
• -Need to change retention habit (sit on toilet after meals for 10 mins but no longer)
• -Keep behavioral chart
• -Positive rewards
• -No negative reinforcement
• -Allow discussion of feelings: encourage self care, extra clothes in case of habits

• 2-3 soft stools per day without pain
• Medications slowly withdrawn over 3-6 months

Inflammation and infection in the vermiform appendix

Most common in children but can happen at any age

Healthy child could be in the hospital for possibly the first time

Fever and chills, progressively getting higher

• Pain: progresses in intensity and becomes localized to lower right quadrant, Mc Burney's point.
• If appendix perforates, child will feel relief, but other symptoms will increase
• Abdominal tenderness; gaurding

GI symptoms: N/V, anorexia, diarrhea, rigid abd after perforation

Lab results: 15-20 WBC

Radiographic results: abd ultrasound shows enlarged appendix. CT with contrast not usually done but can show fluid filled and inflammation

Pre-Op: NPO, pain meds, cold packs, NO HEAT, IV fluids, teaching

Post-Op: plain, early ambulation, resume regular diet after bowel sounds heard, D/C in 24-48 hours

Pre-Op: NPO, NG tube, pain meds, cold packs, NO HEAT, IV fluids, IV antibiotics, teaching, anxiety

Post-Op: NG tube, slowly advance diet, IV abx 5-14 days (pic line normally used), care for JP or penrose drains (monitor color, decreases after 24-48 hours), watch for abd abscess formation (about 72 hours after): fever, pain, increased abd girth, N/V

• Teens, early 20s
• Entire intestinal tract
• Transmural involvement
• Fistulas common
• Remissions and exacerbations

• Abd pain
• non bloody diarrhea
• fever
• Palpable abd mass
• Anorexia
• Severe weight loss
• Significant growth impairement

• 15-40 yr olds
• Colon, rectum upward
• Mucosa and submucosa
• fistulas rare
• remissions rare

• Usually no abd pain
• Blood diarrhea
• No masses
• Moderate weight loss
• mild growth impairment

Diarrhea acct, dehydration, growth failure, vitamin deficiencies, anemia

Psychosocial: anxiety, depression, fears about being social, low self esteem

Steroids: long term consquences (affects growth)

Immunosuppressives: methotrexate, cyclosporine, 6-MP

Antibiotics: falgyl, ciproflaxacin

• -Avoid mill products, hypoallergenic, low fiber, low fat, low residue, high protein

• -May need NG or G-tube
•         elemental diets: peptamen, vivonex

• -May need TPN: nutritional support is important, usually have protein, fat, carb, vitamin deficits

• -Will probably be doing initial teaching.
• -Home management
• -Self care management as a major goal
• -Support groups help with education and emotional support

CAMP MAGIC for emotional support

• IN=Into
• Part of a section of the intestine gets sucked into the distal bowel

• Pediatric emergency!
• Can cause necrosis and sepsis

Sudden onset, crying, pulling legs up, severe pain... paroxysms of pain initially then moves to constant pain

Classic Signs: currant jelly stool (bloody mucus), sausage shaped abd mass

Air insufflation: hydration, NPO, NG tube if distended, passage of normal stool, resume reg diet, go home

Barium enema: same as above + watch for passage of barium

Surgical Intervention: NPO, NG tube, feed when bowel sounds return, pain meds

• AKA: aganglionic megacolon
• -Absence of ganglion cells in the rectum/colon
• -Ganglion are nerve cells that form from top to bottom of the rectum/colon
• -Can be short or entire bowel
• - Will never have nerve cells in that section

Newborn: failure to pass meconium

Infancy: ribbon stools

Older child: ribbon stools, constipation