小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 排便困难或疼痛
- 排便间的长间隔
- 大便失禁
- 少量、软便失禁
- 腹部可触及粪块
- 其他方面健康的儿童
其他诊断因素
- 腹痛
- 肛裂
- 相关的膀胱问题
- 异常肛门外观
- 神经学检查异常
危险因素
- 低膳食纤维饮食
- 食物营养摄入不足
- 遗传易感性
- 感染
- 压力
- 肥胖
- 低出生体重
- 精神病史
- 免疫失调
- 液体摄入不足
- 创伤
诊断性检查
首要检查
- 无初始检查
需考虑的检查
- 腹部 X 线检查
- 不透射线标志物结肠通过试验
- 腹部超声
- 盆腔超声检查
- 直肠粘膜活检
- 心理评估
新兴检查
- 经直肠腔内超声检查
- 肛门直肠测压
- 结肠测压
治疗流程
无粪便嵌塞：＜1 岁
无嵌塞：≥1 岁
有嵌塞：＜1 岁
有嵌塞：1-3 岁
有嵌塞：≥4 岁
撰稿人
作者
Jaime Belkind-Gerson, MD, MSc
Director Neurogastroenterology and Motility Program
Digestive Health Institute
Children's Hospital Colorado
Associate Professor of Pediatrics
University of Colorado School of Medicine
Colorado
CO
利益声明
JB-G declares that he has no competing interests.
Claire Zar-Kessler, MD
Instructor in Pediatric Gastroenterology
Massachusetts General Hospital for Children
Boston
MA
利益声明
CZ-K has been reimbursed by Genzyme for speaking at several conferences.
Corey Baker, MD
Fellow in Pediatric Gastroenterology
Massachusetts General Hospital for Children
Boston
MA
利益声明
CB declares that he has no competing interests.
鸣谢
Dr Jaime Belkind-Gerson, Dr Claire Zar-Kessler, and Dr Corey Baker would like to gratefully acknowledge Dr Wael El-Matary, Dr Steffen Reinsch, and Dr Meghan McPherson, the previous contributors to this topic. WE-M, SR, and MM declare that they have no competing interests.
同行评议者
David C.A. Candy, MB.BS, MSc, MD, FRCP, FRCPCH, FCU
Consultant Paediatric Gastroenterologist
Royal West Sussex NHS Trust
Chichester
UK
利益声明
DCAC has served as a consultant to, and spoken at symposia sponsored by, Norgine Ltd.
Vikram Boolchand, MD
Gastroenterology Fellow
University of Arizona
Tucson
AZ
利益声明
VB declares that he has no competing interests.
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh
PA
利益声明
DJH declares that he has no competing interests.
鉴别诊断
- 先天性巨结肠
- 肛门直肠异常
- A 型链球菌肛周皮肤感染
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