GIS2 - K2 - Constipation

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CONSTIPATION

Atan Baas Sinuhaji


Department of ChildHealth
School of Medicine,University Of Sumatera Utara
Medan
CONSTIPATION

FREQ. DEFECATION 

- HARD, DRY STOOLS


- DIFFICULT/PAIN
- INCONTINENCE
= SOILING
= ENCOPRESIS
FREQUENCY OF DEFECATION

NORMAL = 1 X / DAY
ABNORMAL < 1 X / 2 DAYS
SOILING

WITHOUT CONSTIPATION WITH CONSTIPATION

MENTAL RETARDATION
CLASSIFICATION

1. ACUTE / CHRONIC (  3 MONTHS )


2. SEVERITY
3. ORGANIC / FUNCTIONAL
4. PATHOGENESIS
5. ANORECTAL DYSFUNCTION (+)/(-)
RECTAL FILLING

DEFECATION

PROPULTION OF RECTAL CONTENTS

- DISTENTION
- CONSTRICTION

- RECTAL PRESSURE

- URGE TO DEFECATE
- STRAINIG
- RELAXING THE ANAL SPHINCTER
CONSTIPATION

IMPAIRED RECTAL IMPAIRED RECTAL


FILLING PROPULTION
IMPAIRED RECTAL FILLING

IMPAIRED PERISTALSIS OBSTRUCTION

DRUGS HORMONAL

-SPASMOLYTIC MORBUS HIRSCHSPRUNG


HYPOTHYROIDISM
-CODEIN
IMPAIRED RECTAL PROPULTION

1. PERISTALSIS
2. OBSTRUCTION
3. SENSATION
4. ANAL SPHINCTER ANAL FISSURE
5. ABNORMALITY OF ABDOMINAL/ PELVIC
WALL
6. ABNORMALITY OF AUTONOMIC &
CORTICAL CONTROL
CONSEQUENCES

1. VOMITING
2. ABDOMINAL PAIN
3. ABDOMINAL DISTENTION
4. PAIN TO DEFECATE
5. BLOODY STOOLS ANAL FISSURE
6. ANOREXIA
7. ABDOMINAL MASS RETENTION OF URINE
8. CHRONIC - PCM
- MEGACOLON
MEGACOLON

CONGENITAL IDIOPATHIC
= M. HIRSCHSPRUNG = ACQUIRED
= CHRONIC IDIOPATHIC CONSTIPATION

STOOLS MEGACOLON

Ganglion (-)
Peristalsis External Anal
Obstruction Sphincter
BARIUM
PARADOXAL DIARRHOEA IN LOOP INCONTINENTIA
ALVI
MEGACOLON

IDIOPATHIC= SECUNDER CONGENITAL


1. ONSET 2-3 YEARS 1ST DAY
2. SOILING (+) (-)
3. PARADOXAL (-) (+)
DIARRHOEA
4. PCM (-) (+)
5. ABD. DISTENTION (+) (++)
6. ANAL SPHINCTER LOOSE TIGHT
7. RECTAL AMPULLA FULL EMPTY
8. ENTEROCOLITIS (-) (+)
9. TREATMENT MEDICAL SURGERY
M. HIRSCHSPRUNG

DIAGNOSIS

IRRIGATION
OPERATION

FULMINANT
ENTEROCOLITIS
COLOSTOMY

DEATH DEFINITIVE (6-12 MONTHS)


CHRONIC IDIOPHATIC
CONSTIPATION
1. EVACUATION OF FIRM STOOLS (FECAL DISIMPACTION) :
• MgSO4
• IRRIGATION
• etc
2. MAINTENANCE
1. DIETARY MANIPULATION FIBERS >>>
TAP WATER >>>
2. TOILET TRAINING
3. DRUGS : a. SPASMOLYTIC (-)
b. LAXANTIA :
• lactulose
• polyethylene glycol
c. ANAEROB BACTERIAL:
• metronidazole

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