Refractory Constipation in Pediatric Practice | Peds GI Boards Ep04

GastroPrep Episode 4 — Refractory Constipation in Pediatric Practice. This pediatric gastroenterology board-review lecture, written for fellows and practicing pediatric gastroenterologists, walks through pediatric refractory functional constipation from definition through the full escalation algorithm: normal defecation physiology and the Rome IV pediatric functional constipation definition (2016) as a positive diagnosis (not a diagnosis of exclusion); systematic history and exam (the Bristol stool scale, the rectal exam findings that distinguish functional retention from Hirschsprung, the role of the rectoanal inhibitory reflex on anorectal manometry); the right and wrong use of imaging in pediatric constipation (when an abdominal radiograph helps, when contrast studies are warranted, and when imaging is unnecessary); red flags and the organic differential covering Hirschsprung disease, anal stenosis, hypothyroidism, hypercalcemia, lead toxicity, celiac disease, cow's milk protein allergy, and medication-induced constipation; disimpaction protocols done right (polyethylene glycol PEG 3350 1 to 1.5 grams per kilogram per day for 3 to 6 days with a 100 grams per day daily maximum, mineral oil, sodium phosphate enemas, saline enemas, the indications and contraindications for each); the maintenance pharmacology layer (PEG 3350 0.4 to 0.8 grams per kilogram per day in 17 gram packets, lactulose, magnesium hydroxide, senna and bisacodyl as second-line stimulants, lubiprostone as a chloride-channel activator, linaclotide as a guanylate-cyclase-C agonist at 72 micrograms by mouth once daily for ages 6 to 17 years); the refractory escalation algorithm (anorectal manometry to rule out adult-onset Hirschsprung, biofeedback for dyssynergic defecation, transanal irrigation, anal sphincter botulinum toxin, the Malone appendicostomy / antegrade continence enema procedure, sacral nerve stimulation in selected adolescents); post-Hirschsprung pull-through constipation and Hirschsprung-associated enterocolitis with the Pastor HAEC scoring system, the Soave / Duhamel / Swenson operations and their constipation patterns; post-anorectal-malformation constipation after PSARP repair; spinal-cord and colonic-resection constipation; five high-yield pearls; and a board-style case on a five-year-old with refractory functional constipation.

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⏰ CHAPTERS:
00:00 Introduction
01:50 Learning Objectives
03:12 Normal Defecation and the Rome IV Functional Constipation Definition
06:08 Evaluation — History, Exam, and the Right Use of Imaging
09:40 Red Flags and Organic Differential
12:41 Disimpaction Protocols — Doing the First Step Right
15:25 Maintenance — Building a Long-Term Regimen That Works
18:47 Refractory Functional Constipation — The Escalation Algorithm
22:18 Post-Hirschsprung Pull-Through Constipation and HAEC
25:55 Post-Surgical Constipation Beyond Hirschsprung — ARM, Spinal, and Colonic Resection
28:47 Pearls
30:46 Board-Style Case
33:53 References and Closing

📺 NEXT EPISODE:
Coming soon — see full playlist below

📚 FULL PLAYLIST (Pediatric Gastroenterology):
https://youtube.com/playlist?list=PLUXCz1Up6ZmD-v4dyl2_gmQs0vAtFcgWD

🔥 RELATED EPISODES:
Episode 3: Chronic Diarrhea and Malabsorption → https://youtu.be/FsXnJCCIz_c
Episode 2: Vomiting in Pediatric GI → https://youtu.be/u8qjHUuRFLk

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APPNA Pediatrics is the Pediatric Component Society of the Association of Physicians of Pakistani Descent of North America, advancing pediatric medical education globally.

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