際際滷

際際滷Share a Scribd company logo
73807 usx-2104 bowel conditions in children webinar
Conditions in Children
that may lead to
Bowel Dysfunction
Bev Collins
Clinical Nurse Lead
Conditions in Children affecting Bowel Function
 Hirschsprungs
 Spinal cord injury
 Sacral agenesis
 Necrotising Enterocolitis NEC
 EhlersDanlos syndromes EDS
 Spina Bifida / hydrocephalus
Spinal Cord Injury
 Neurogenic bowel
 Level of injury will determine
function and bowel dysfunction
 Specialist care: paediatrics
and / or Specialist Spinal Centre
Cervical
Thoracic
Lumbar
Sacral
Coccygeal
C1-C3 Neck Muscles
C4 Diaphragm
C5 Deltoid (shoulder)
C6 Wrist
C7 Triceps
C7-C8 Fingers
T1 Hand
T2-T12 Intercostals (Trunk)
T7-L1 Abdominals
T11-L2 Ejaculation
L2 Hips
L3 Quadriceps
L4-L5 Hamstrings  Knee
L4-S1 Foot
S2 Penile erection
S2-S3 Bowel and bladder
Sacral agenesis
 Congenital disorder
 Abnormal development of
lower spine whilst developing
 1:25,000 live births
 Absence of sacrum
Necrotising Enterocolitis (NEC)
 Neonatal condition
 1: 250 live Births
 Premature, low birth weight babies
and in fewer babies born at term
 1:4 babies will require surgery
 3:5 babies will require further surgery
 3 babies in UK die every
week with NEC
Diseased part
of bowel removed
Ostomy created Cut ends of
bowel joined
First surgery Second surgery
(weeks later)
EhlersDanlos syndromes (EDS)
 Genetic tissue disorder 
often misdiagnosed
 Symptoms include:
loose joints, stretchy skin
 1:5000 globally
 No cure. Prognosis depends
on type of EDS
 Heartburn / Constipation /
Stress incontinence
EhlersDanlos syndromes (EDS)
Bowel issues:
 Constipation
 Weak peristalsis
 Slow transit
 Laxatives often prescribed
exploding nappies!!!
EhlersDanlos syndromes (EDS)
Spina Bifida  Split spine
 Spina bifida is when a baby's spine and
spinal cord does not develop properly in
the womb, causing a gap in the spine.
 In spina bifida, part of the neural tube does not
develop or close properly, leading to defects in the
spinal cord and bones of the spine (vertebrae).
 Spina bifida is a type of neural tube defect.
The neural tube is the structure that eventually
develops into the baby's brain and spinal cord.
 The neural tube starts to form in early pregnancy
and closes about 4 weeks after conception.
Dura Mater
Spinal Cord
Spinal Fluid
Vertebra
Spina Bifida
Spina bifida occulta
(opened posterior vertebral body)
Meningocele
(protrusion of the meninges)
Myelomeningocele
(protrusion and opened spinal cord)
Types of Spina Bifida  Open SB
 Myelomeningocele is the most serious and more common of the two forms of
cystic spina bifida. Here the cyst not only contains tissue and cerebrospinal fluid
(CSF) but also nerves and part of the spinal cord. The exposed spinal cord is
damaged by the fluid in the womb during pregnancy and may also not develop
properly. As a result, there is nearly always some resulting paralysis and loss of
sensation. Nerves to and from the spinal cord emerging below the damaged
region may not pass messages to the brain. The extent of this can be patchy and
difficult to predict.
 The lower on the spine, and smaller the lesion, the less severe the resulting
impairments are likely to be. Bladder and bowel problems occur in most people
with myelomeningocele, as the nerves come from the very bottom of the spinal
cord, and are always below the lesion. It is also necessary to have intact nerve
pathways to the brain for complete control and sensation.
73807 usx-2104 bowel conditions in children webinar
73807 usx-2104 bowel conditions in children webinar
Types of Spina Bifida
Meningocele
In this form, the sac contains meninges (tissues
which cover the brain and spinal cord) and CSF,
but no spinal tissue. Development of the spinal
cord may be affected, but impairment is usually
less severe than myelomeningocele. Meningocele
is the least common form of spina bifida.
Spina Bifida Occulta
Spina bifida occulta (SBO) is a type of spinal
dysraphism or closed, skin-covered form
of spina bifida. Estimates vary, but between
5% and 10% of people may have spina bifida
occulta.
Closed Spina Bifida
Open Spina Bifida
Hydrocephalus
 A build up of cerebrospinal fluid on the
brain. Hydrocephalus can have a range
of physical and cognitive effects.
 Congenital hydrocephalus means
it is present at birth.
 Can be genetic, due to a maternal
infection or cysts in brain.
 Acquired hydrocephalus means
it has occurred during life.
 Maybe due to haemorrhage,
prematurity, tumour, meningitis.
Folic Acid
Folic acid before and during pregnancy
 Recommended dose 400 micrograms folic acid tablet every day
before pregnancy and until 12 weeks of pregnancy.
 Folic acid can help prevent birth defects known as neural tube
defects, including spina bifida.
 If folic acid is not taken before pregnancy, it should be started
as soon as pregnancy is confirmed.
 Eating foods that contain folate (the natural form of folic acid),
such as green leafy vegetables are recommended.
 Some breakfast cereals and some fat spreads, such as margarine,
may have folic acid added to them.
 It's difficult to get the amount of folate recommended for a healthy
pregnancy from food alone, which is why it's important to take a
folic acid supplement.
Vitamin B12
 Taking vitamin B12
 Vitamin B12 works closely with folate, and low levels in the
bloodstream increase the chance of the baby having NTD.
Many foods rich in B12 are out of fashion these days, such as
eggs and red meat; vegetarians and vegans may need to take
extra B12 to get enough.
Challenges for the child
with bowel issues
 Negative impact on quality of life
 Are still taboo to talk about
 Lack of knowledge about treatment options
is often the reason why some children are
left untreated, or get suboptimal treatment
 Often other co-morbidities
 Potential bullying
Under 3s treatment
 Laxatives
 Anti diarrhoeal medication
 Abdominal massage
 Surgery
Wellspect HealthCare, Aminogatan 1, P.O. Box 14, SE-431 21 M旦lndal, Sweden. Phone: +46 31 376 40 00.

More Related Content

73807 usx-2104 bowel conditions in children webinar

  • 2. Conditions in Children that may lead to Bowel Dysfunction Bev Collins Clinical Nurse Lead
  • 3. Conditions in Children affecting Bowel Function Hirschsprungs Spinal cord injury Sacral agenesis Necrotising Enterocolitis NEC EhlersDanlos syndromes EDS Spina Bifida / hydrocephalus
  • 4. Spinal Cord Injury Neurogenic bowel Level of injury will determine function and bowel dysfunction Specialist care: paediatrics and / or Specialist Spinal Centre Cervical Thoracic Lumbar Sacral Coccygeal C1-C3 Neck Muscles C4 Diaphragm C5 Deltoid (shoulder) C6 Wrist C7 Triceps C7-C8 Fingers T1 Hand T2-T12 Intercostals (Trunk) T7-L1 Abdominals T11-L2 Ejaculation L2 Hips L3 Quadriceps L4-L5 Hamstrings Knee L4-S1 Foot S2 Penile erection S2-S3 Bowel and bladder
  • 5. Sacral agenesis Congenital disorder Abnormal development of lower spine whilst developing 1:25,000 live births Absence of sacrum
  • 6. Necrotising Enterocolitis (NEC) Neonatal condition 1: 250 live Births Premature, low birth weight babies and in fewer babies born at term 1:4 babies will require surgery 3:5 babies will require further surgery 3 babies in UK die every week with NEC Diseased part of bowel removed Ostomy created Cut ends of bowel joined First surgery Second surgery (weeks later)
  • 7. EhlersDanlos syndromes (EDS) Genetic tissue disorder often misdiagnosed Symptoms include: loose joints, stretchy skin 1:5000 globally No cure. Prognosis depends on type of EDS Heartburn / Constipation / Stress incontinence
  • 8. EhlersDanlos syndromes (EDS) Bowel issues: Constipation Weak peristalsis Slow transit Laxatives often prescribed exploding nappies!!!
  • 10. Spina Bifida Split spine Spina bifida is when a baby's spine and spinal cord does not develop properly in the womb, causing a gap in the spine. In spina bifida, part of the neural tube does not develop or close properly, leading to defects in the spinal cord and bones of the spine (vertebrae). Spina bifida is a type of neural tube defect. The neural tube is the structure that eventually develops into the baby's brain and spinal cord. The neural tube starts to form in early pregnancy and closes about 4 weeks after conception. Dura Mater Spinal Cord Spinal Fluid Vertebra
  • 11. Spina Bifida Spina bifida occulta (opened posterior vertebral body) Meningocele (protrusion of the meninges) Myelomeningocele (protrusion and opened spinal cord)
  • 12. Types of Spina Bifida Open SB Myelomeningocele is the most serious and more common of the two forms of cystic spina bifida. Here the cyst not only contains tissue and cerebrospinal fluid (CSF) but also nerves and part of the spinal cord. The exposed spinal cord is damaged by the fluid in the womb during pregnancy and may also not develop properly. As a result, there is nearly always some resulting paralysis and loss of sensation. Nerves to and from the spinal cord emerging below the damaged region may not pass messages to the brain. The extent of this can be patchy and difficult to predict. The lower on the spine, and smaller the lesion, the less severe the resulting impairments are likely to be. Bladder and bowel problems occur in most people with myelomeningocele, as the nerves come from the very bottom of the spinal cord, and are always below the lesion. It is also necessary to have intact nerve pathways to the brain for complete control and sensation.
  • 15. Types of Spina Bifida Meningocele In this form, the sac contains meninges (tissues which cover the brain and spinal cord) and CSF, but no spinal tissue. Development of the spinal cord may be affected, but impairment is usually less severe than myelomeningocele. Meningocele is the least common form of spina bifida. Spina Bifida Occulta Spina bifida occulta (SBO) is a type of spinal dysraphism or closed, skin-covered form of spina bifida. Estimates vary, but between 5% and 10% of people may have spina bifida occulta. Closed Spina Bifida Open Spina Bifida
  • 16. Hydrocephalus A build up of cerebrospinal fluid on the brain. Hydrocephalus can have a range of physical and cognitive effects. Congenital hydrocephalus means it is present at birth. Can be genetic, due to a maternal infection or cysts in brain. Acquired hydrocephalus means it has occurred during life. Maybe due to haemorrhage, prematurity, tumour, meningitis.
  • 17. Folic Acid Folic acid before and during pregnancy Recommended dose 400 micrograms folic acid tablet every day before pregnancy and until 12 weeks of pregnancy. Folic acid can help prevent birth defects known as neural tube defects, including spina bifida. If folic acid is not taken before pregnancy, it should be started as soon as pregnancy is confirmed. Eating foods that contain folate (the natural form of folic acid), such as green leafy vegetables are recommended. Some breakfast cereals and some fat spreads, such as margarine, may have folic acid added to them. It's difficult to get the amount of folate recommended for a healthy pregnancy from food alone, which is why it's important to take a folic acid supplement.
  • 18. Vitamin B12 Taking vitamin B12 Vitamin B12 works closely with folate, and low levels in the bloodstream increase the chance of the baby having NTD. Many foods rich in B12 are out of fashion these days, such as eggs and red meat; vegetarians and vegans may need to take extra B12 to get enough.
  • 19. Challenges for the child with bowel issues Negative impact on quality of life Are still taboo to talk about Lack of knowledge about treatment options is often the reason why some children are left untreated, or get suboptimal treatment Often other co-morbidities Potential bullying
  • 20. Under 3s treatment Laxatives Anti diarrhoeal medication Abdominal massage Surgery
  • 21. Wellspect HealthCare, Aminogatan 1, P.O. Box 14, SE-431 21 M旦lndal, Sweden. Phone: +46 31 376 40 00.

Editor's Notes

  • #22: Usually near to caecum Whole of large intestine emptied 30 mins to 1 hour for procedure Usually allows alternate day evacuation.