Gastrointestinal Disorders, Essay Example

Case study – Differential and most likely diagnosis

Significant features outlined in this case study relates to a seven year old pediatric patient with frequent stool soiling and chronic constipation from birth. There is a subsequent enlarged rectal valve containing hard stool. The typical presentation from a provisional diagnostic perspective is one ofdescending perineum syndrome with functional constipation as the most likely diagnosis(Blackmer & Farrington, 2010).

Descending perineum syndromeis characterized by ballooning of the perineum along with constipation or degrees of fecal incontinence. Except that it occurs mostly in women and adults it can be mis diagnosed for functional constipation.Functional constipation is also known as chronic idiopathic constipation (CIC). It is very difficult to diagnose since there may be many other associating psychological factors predisposing to the condition, especially, in children(Halachmi & Farhat, 2010).

The diagnosis is, however, made when children present with two or more features that occur at least once a week during a minimum of 2 months prior to the diagnosis. They include two or less stools weekly, which could be either hard or painful accompanied by passage of very large stool; stool retention happening “once a week” or more frequently. In combination there is  a history of large fecal mass found in the rectum, accompanied by soiling, once a weekly or more frequently. These characteristics are classified as Rome 111 (Tabbers, Boluyt, Berger & Benninga, 2011).

Treatment Management Plan

Researchers Hee Chang, Park& Kil Kang (2013) using Rome 111 criteria developed a treatment/management plan after studying children affected by the dysfunction in Korean hospital settings. First line management included digital examination. Incidences of masses in the lower rectum usually occur at a rate of 50% occasionally; 31% always, 31%; 13% mostly and 6% never. Further intervention consists of disimpaction(Hee Chang, Park & Kil Kang, 2013).

Medical management requires osmotic laxatives lactulose. Ninety four percent of cases respond to this treatment. Next treatment plan involves administration of polyethylene glycol (PEG) to which 64% of patients respond successfully. Patients are also referred to a dietician for management. It was discovered that after a 4 week treatment regime 95% of the constipation was resolved, but recurredlater (Hee Chang et.al, 2013).

Strategies for educating patient/family

Since this is a 7 year old child patient teaching and education is aimed at facilitating parents/caregivers in managing the condition at home to prevent constipation and soiling. A dietician will advise on the appropriate portions of food for the child’s weight; activity level and height. Next, an evaluation is recommended to assess what foods rich in fibers the child loves to eat. Many children if not socialized into eating vegetables seldom take enough roughage into their diet to offset constipation issues (Halachmi1 & Farhat, 2010).

Exercise is known to help activate the bowel along with adequate quantities of water taken in daily. Eating a high fiber diet cannot be overstated. Functional constipation is also associated with the fear of defecation or other phobias. Consequently, it would be recommended that this child receives a thorough psychological evaluating regarding the predisposing fear linking the bowel dysfunction (Tabbers et.al, 2010).

References

Blackmer, A., & Farrington, E. (2010).Constipation in the Pediatric Patient: An Overview and Pharmacologic Considerations. J Pediatr. 24(6); 385-399

Halachmi1, S., & Farhat, W. (2010).Interactions of Constipation, Dysfunctional Elimination Syndrome, and Vesicoureteral Reflux.Adv Urol

Hee Chang, S. Park, Y., & Kil Kang, S. (2013).Prevalence, Clinical Characteristics, and Management of Functional Constipation at Pediatric Gastroenterology Clinics.J Korean Med Sci. 28(9): 1356–1361

Tabbers, M. Boluyt, N. Berger, M., & Benninga, A (2011) Clinical practice: diagnosis and treatment of functional constipation. Eur J Pediatr. 170:955–963