članak: 1 od 1  
Medicinski pregled
2005, vol. 58, br. 7-8, str. 357-361
jezik rada: srpski
pregledni članak
doi:10.2298/MPNS0508357B

Opstipacija - čest problem u dečjem uzrastu
Institut za zdravstvenu zaštitu dece i omladine, Novi Sad

Sažetak

Opstipacija je neredovno, otežano i bolno pražnjenje čvrstih fekalnih masa. Novorođenče normalno prazni mekonijalnu stolicu u prvih 24 do 48 sati života, a sposobnost voljnog zadržavanja fekalnih masa stiče se od šestog do osamnaestog meseca života, koordinisanom funkcijom pelvične muskulature i nervnih struktura. Ukoliko dete u prvoj godini života nema stolicu bar svakog drugog dana. opravdano je kliničko ispitivanje. Kod svega 5% slučajeva nalaze se organski uzroci opstipacije, a čak kod 95% pacijenata nagomilana čvrsta stolica u ampuli rektuma je jedini klinički nalaz. Dečji hirurg se često suočava sa problemom diferenciranja između Hiršprungove bolesti i hronične opstipacije. Anamnestički podaci, fizikalni pregled kao i irigografija pomažu u postavljnju dijagnoze opstipacije kao i u diferenciranju ova dva stanja. Ništa manje nije značajna ni anorektalna manometrija kombinovana sa elektromiografijom. Lečenje opstipacije zavisi od osnovnog uzroka. S obzirom da je u oko 95% slučajeva uzrok neorganske odnosno funkcionalne prirode, pristup rešavanju ovom problemu je kompleksan, i podrazumeva primenu klizmi, medikamenata, retraining i edukaciju dece i roditelja. Uspeh lečenja je zadivljujući jer 60-70% dece dobro reaguje na terapijski tretman tokom prvih nedelja, ali terapija održavanja se mora nastaviti najmanje šest meseci, ponekad i nekoliko godina.

Ključne reči

Reference

Baker, S.S., Liptak, G.S., Colleti, R.B., Croffie, J.M., DiLorenzo, C., Ector, W., i dr. (1999) Constipation in infants and children: Evalution and treatment. Pediatr Gastroenterol, 19, str. 2002-4
Bishop, E., McKinnon, E., Weir, E., Brown, D.W. (2003) Reflexology in the management of encopresis and chronic constipation. Paediatr Nurs, 15(3): 20-1
Burkitt, D., Morley, D., Walker, A. (1980) Dietary fibre in under- and overnutrition in childhood. Arch Dis Child, 55(10): 803-7
Castiglia, P. (2001) Constipation in children. Journal of pediatric Health care, 15(4), str. 200-2
Christensen, J. (1987) Motility of the colon. u: Johnson L.R. (ur.) Physilogy of the gastrointestinal tract, New York: Raven Press, str. 665-693
di Lorenzo, C., Benninga, M.A. (2004) Pathophysiology of pediatric fecal incontinence. Gastroenterology, 126(1 Suppl 1): S33-40
Dito, L. (2002) Constipation in children. Servizio Spec Gastroenterol, 153(4), str. 281-7
Farrell, M., Holmes, G., Coldicultt, P., Peak, M. (2003) Management of childhood constipation: Parents expiriences. Journal Article, 44(5), str. 479-89
Gremse, D.A., Hixon, J., Crutchfield, A. (2002) Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children. Clin Pediatr (Phila), 41(4): 225-9
Hampl, J.S., Betts, N.M., Benes, B.A. (1998) The 'age+5' rule: Comparisons of dietary fiber intake among 4- to 10-year-old children. J Am Diet Assoc, 98(12): 1418-23
Kirschner, B.S., Black, N.D.D. (1998) The gastrointestinal tract Constipation and encopreesis. Essential Pediatr, 11, str. 429-31
Kohli, R., Li, B.U. (2004) Differential diagnosis of recurrent abdominal pain: New considerations. Pediatr Ann, 33(2): 113-22
Lewis, C., Muir, J. (1996) A collaborative approach in the management of childhood constipation. Health Visitor, 69 (10);424-6
Lubowski, D.Z., Swash, M., Henry, M.M. (1988) Neural mechanisms in disorders of defaecation. Baillieres Clin Gastroenterol, 2(1): 201-23
Meunier, P., Louis, D., de Jaubert, B.M. (1984) Physiologic investigation of primary chronic constipation in children: Comparison with the barium enema study. Gastroenterology, 87(6): 1351-7
Molnar, D., Taitz, L.S., Urwin, O.M., Wales, J.K. (1983) Anorectal manometry results in defecation disorders. Arch Dis Child, 58(4): 257-61
Nurko, S., Garcia-Aranda, J.A., Worona, L.B., Zlochisty, O. (2000) Cisapride for the treatment of constipation in children: A double-blind study. J Pediatr, 136(1): 35-40
Nyhan, W.L. (1952) Stool frequency of normal infants in the first week of life. Pediatrics, 10(4): 414-25
Ogoreck, C.P., Reznolds, J.C. (1991) Chronic constipation: Diagnosis and treatment. J Pediatr Surg, 26, str. 513-5
Pashankar, D.S., Bishop, W.P. (2001) Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediatr, 139(3): 428-32
Rogers (1997) Chilhood constipation and the incidence of hospitalization. J Pediatr, 12(8), str. 40-2
Stafford, P.W., O'Neill, J.A. (1998) Other disorders of the anus and rectum, anorectal function. Pediatr Surg Int, 14:49-59
Sudhir, K., Dutta, M.D., Chernow, R.S. (1994) Crit Care Pharmacol, 11, str. 424-6
Thomson, J. (2001) The management of chronic constipation in children. Community Practitioner, 74(1), str. 29-30
van Ginkel, R., Buller, H.A., Heymans, H.S., Taminiau, J.A., Boeckxstaens, G.E., Benninga, M.A. (2003) Functional childhood gastrointestinal disorders. III. Constipation and solitary encopresis; diagnostic work-up and therapy. Ned Tijdschr Geneeskd, 147(26): 1267-71
Weaver, L.T., Steiner, H. (1984) The bowel habit of young children. Arch Dis Child, 59(7): 649-52