Meconium Ileus

This is a neonatal disorder, which most often occurs in the term infant, and is the presenting sign in about 15% of children diagnosed with CF, usually those with PI. Although no specific CFTR mutations have been identified with meconium ileus (MI), a modifier locus on human chromosome 19 has been determined (Zielenski et al, 1999). Suspicion for MI may be raised with fetal ultrasounds (USs) demonstrating dilated loops of bowel on the second or third trimester scan. Meconium plug syndrome, attributed to a tight anus, should be ruled out. In this disorder, light-coloured gelatinous firm stool is present in the lower colon and rectum. The likelihood of MI is confirmed with a barium enema showing a microcolon. About 50% of infants have complications of the disorder with perforation, meconium peritonitis, atresias, or volvulus. A history of this should be sought when seeing these patients later in life.

For patients with uncomplicated ileus, a trial of medical management may be successful in alleviating the obstruction, but the infant should be at a center where surgical intervention is available, if and when required. As with distal intestinal obstruction syndrome (DIOS) (see later in chapter), a combination of acetyl-cysteine, polyethylenegly-col (PEG) or water-soluble contrast can be used to clear the obstruction. For complications, a resection with primary or secondary anastomosis may be performed. For some patients this results in loss of the ileocecal valve, loss of absorptive surface in the ileum, and vitamin B12 or bile salt malabsorption. This will then add to the PI of the child and make malnutrition a greater risk. Some patients with atre-sia or volvulus may end up with a true short gut.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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