More Gastro Intestinal - Constipation, Trapped Wind, Reverse Peristalsis & Gastritis

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Niamh's Journey

Constipation

Observations

A very unhappy little girl who would just cry and cry when she needed to poo. She would often go days sometimes a week without going and her vomiting during these times would increase. Her bottom would also sometimes bleed when she finally went.

What is Constipation?

This is caused when food moves throuh the gut too slowly and the body is able to absorb too much water making is hard and painful for the child to pass a stool. Again this is common in children with neurological disorders due to the brains inability to properly regulate the digestive system.

How Can it be Treated?

  1. Incresing fluid intake softens stools making them easier to pass.

  2. Sugar based supplements absorb water from the gut lining and keep it in the intestine having the effect of
  softening stools. These can be artificial supplements like lactulose or more natural supplements like prune juice -
  both work in the same way.

3. Fibre based supplements - fibre passes through the body unchanged (as the body cannot remove water from it). Some fibre even absorbs water from the intestine,
  therefore making stools easier to pass. Dietary fibres are readily available, but if you child is tube fed there are soluble power supplement available (eg. benefibre) that
  can be used.

4. Antibiotics are well known to cause diarohea because of their inclination to reduce good bactria in the colon and and although it is not common practice to prescribe
  antibiotics as a treatment for constipation they actually do work.
  Niamh went on a low dose erythromycin to help with her tummy empting for her reflux and the long term use of this antibiotic had the added benefit of reducing her
  constipation.

5. Other effective methods include enemas & suppositries to physically expell stools or massage to help naturally stimulate movement.

Trapped Wind

Observations & What is Trapped Wind?

Trapped Wind (or bloating) is any abnormal general swelling, or increase in diameter of the abdominal area. As a symptom, the child feels a full and tight abdomen, which may cause abdominal pain.

How Can it be Treated?

1. For a child without a Gastrostomy, treatment can involve:

 - Medication: Infacol contains the active ingredient simeticone which is a type of medicine called an 'anti-foaming agent'. It reduces the amount of trapped wind in the gut by gathering all the tiny bubbles together and making t into one big bubble which is easier to burp up. The belief is that it is the tiny bubbles when trapped in the intestine that cause the pain.

 - Regular position changes, back patting and abdominal massage may release/move trapped wind into a position that is easier to expel. Particularly good techniques involve knees to the chest and cycling with legs.

2. For a child with Gastrostomy there are further options:

 - A very effective way of reducing discomfort from trapped wind for Niamh was to "vent" her.
We attached a large syringe (without plunger) to the open end of her gastrostomy attachment and gently put pressure on different areas of her abdomen and gently moved her position side to side. This allowed any trapped air to vent through the open syringe thus releasing it out of the stomach.
This was done before every feed and additionally as required when she became irritable.

As Niamh's problem was severe, we extended her "venting" to use a method known as "free drainage".
Instead of an open syringe attached to the gastrostomy extension, a bile bag (or other inflatable vessel) was placed onto the end. The trapped wind was allowed to pass freely out of the open gastrostomy. This can be used continuously at any time the child does not have a full stomach.

The insertion of Niamh's G-J tube (see Reflux notes) meant that Niamh could be on free drainage whist she was being fed as the feed would pass in a tube through to her jejunum whilst air could escape from her gastrostomy. Since this method was introduced her discomfort decreased dramatically

This is a condition where you intestine squeezes food (and bile) the wrong way and it ends up back in your stomach. In our children, it is believed to be caused by a loss of ability of the brain to coordinate normal gut movement.
Children suffering from this condition display the same symptoms as for many of the other gastro-intestinal problems including vomiting, abdominal pain and poor weight gain.
It is often identified by children being sick several hours after feeding and the vomit being stained with bile (a green colour).
If your child has a gastrostomy it can also be identified by the presence of bile in the stomach. Bile in the stomach can irritate the stomach lining and in turn lead to gastritis.

We were able to identify when Niamh was demonstrating anti-peristalsis using pH indicator paper on aspirate taken from her stomach. Her readings showed alkaline (ph8-10) which is unusual for the stomach which is usually highly acidic (pH4-5)
We did have to be aware of false pH readings though, as some medications (eg. sodium bicarbonate) were themselves alkaline and can therefore effect the pH of the
stomach - in fact, it is their job to neutralize stomach acids.

The presence of a green/yellow colouring is the most obvious indicator that bile was present. The colouring of the bile ranged from fluorescent yellow/green to dark green.

Gastritis

Observations & What is Gastritis?

Gastritis is an inflammation of the lining of the stomach in severe cases causing the stomach to bleed. It can be caused by many things including intolerance to food types, the presence of bile it the stomach (through reverse peristalsis) as well as bacterial infection.

In Niamh, it was identified by her vomit being stained a dark brown colour. The appearance of the vomit also showed darker flecks and is termed 'Coffee Ground' vomit due to its appearance. The reason that the staining is dark brown is because the blood seeps from the stomach lining very slowly and it therefore is quite old by the time it is vomited.

How can it be Treated?

Medications like used to treat reflux by reducing the amount of acid produced are can be effective in reducing irritation. We found Ranitdine (Zantac) to be particularly effective as reducing gastric bleeding.

Pain relief medications like Ibuprofen can make gastritis considerably worse as can act on the stomach lining increasing inflammation.