小结
定义
病史和体格检查
关键诊断因素
- 肛门直肠、神经系统或脊柱异常病史，或胃肠道手术史
- 粪便污染或腹泻
- 便秘
- 肛周皮肤刺激
- 直肠检查结果异常
- 脊柱畸形
- 无力和反射减弱或消失
其他诊断因素
- 行为问题
- 排便疼痛
- 腹痛/绞痛
- 姿势-臀部收缩
- 遗尿
- 肛门直肠畸形
- 异常的腹部检查
- 潜在疾病史
危险因素
- 慢性便秘
- 男性
- 年龄： 5 岁至 6 岁
- 膳食纤维缺乏
- 液体摄入不足
- 排便训练延迟或不足
- 肛门直肠畸形
- 先天性巨结肠
- 脊柱异常
- 由于家庭压力事件导致的心理或行为问题
- 精神障碍
- 过度用药
诊断性检查
首要检查
- 腹部 X 线检查
需考虑的检查
- 即时钡灌肠
- 脊柱 X 线
- 脊柱 MRI 检查
- 不透 X 线标志物法
- 结肠直肠测压检查
- 直肠活检
- 血清促甲状腺激素水平
- 血清游离甲状腺素（T4）水平
- 汗液氯化物检测
- 组织谷氨酰胺转移酶免疫球蛋白 A
治疗流程
伴有便秘和粪便堵塞
无便秘
解除粪便堵塞
撰稿人
作者
Brian D. Riedel, MD
Clinical Associate Professor of Pediatrics Emeritus
Pediatric Gastroenterology, Hepatology and Nutrition
West Virginia University School of Medicine
Morgantown
WV
利益声明
BDR declares that he has no competing interests.
鸣谢
Dr Brian D. Riedel would like to gratefully acknowledge Dr Linda S. Nield and Dr Uwe Blecker, previous contributors to this topic.
利益声明
UB declares that he has no competing interests. LSN is an author of a reference cited in this topic.
同行评议者
John C. Thomas, MD
Assistant Professor
Division of Pediatric Urology
Monroe Carell Jr. Children's Hospital at Vanderbilt
Nashville
TN
利益声明
JCT declares that he has no competing interests.
David C. A. Candy, MBBS, MSc, MD, FRCP, FRCPCH, FCU
Consultant Paediatrics Gastroenterologist
Western Sussex Hospitals NHS Trust
Chichester
Honorary Consultant Paediatric Gastroenterologist
Royal Alexandra Children's Hospital
Brighton and Sussex University Hospitals
Brighton
UK
利益声明
DCAC has received research grants, consultancy fees, and reimbursement of conference expenses from Norgine UK, the manufacturer of Movicol. He is the author of a systematic review of polyethylene glycol-based laxatives; convenor of the Paris Consensus on Constipation Terminology Group; and external advisor of the National Institute for Health and Care Excellence paediatric constipation guideline development group.
鉴别诊断
- 非特异性幼儿腹泻
- 伴有交替性便秘和腹泻的肠易激综合征 (IBS)
- 感染性腹泻
更多 鉴别诊断指南
- 便秘
- 国际科学委员会第六届国际失禁咨询委员会的建议：尿失禁、盆腔脏器脱垂和大便失禁的评估与治疗
更多 指南患者教育信息
儿童便秘
更多 患者教育信息
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