Constipation — Risk for Alternative Diagnoses, Differential Diagnosis — Clinical Pathway: Emergency Department and Inpatient

Constipation Clinical Pathway — Emergency Department and Inpatient

Risk for Alternative Diagnoses, Differential Diagnosis

Indications/Considerations for Lab Testing

  • The diagnosis of functional constipation is most often made through careful history and physical
  • Abdominal X-ray and laboratory evaluation is not indicated

Further Evaluation is Indicated if Concern for Alternative Diagnoses
Tests should be targeted to findings by History and Physical Exam.

Concerns for Alternative Diagnoses
  • Delayed passage meconium after 48 hrs of life
  • Symptom onset < 1 mos
  • Persistent abdominal distention, vomiting
  • Bloody diarrhea
  • Bilious emesis
  • Family history Hirschsprung’s disease
  • Malnutrition
  • Tight rectum gripping finger; explosive stool and air from rectum upon withdrawal examining finger
  • Poor growth, significant weight loss
  • Concern for abdominal mass
  • Abnormal neurologic exam — especially lower extremities, rectal exam
  • Lower spin abnormalities
Differential Diagnosis of Constipation
  • Functional constipation
  • Cow’s milk allergy
  • Crohn’s disease
  • Celiac disease
  • Malnutrition, starvation, poor fluid intake
  • Motility disorders
    • Hirschsprung disease
    • Congenital pseudo-obstruction
  • Neurologic
    • Infant botulism
    • Spinal cord abnormality
      • Meningomyelocele, tethered cord
      • Sacral teratoma, NF
  • Endocrine
    • Thyroid disorders
  • Toxins
    • Lead
  • Medications known to cause constipation
    • Antidepressants, antipsychotics, iron, loperamide, anticholinergics, antihistamines