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{{Constipation}}
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==Overview==
An [[abdominal X-ray]] may be helpful in the [[diagnosis]] of constipation. Findings on an [[X-ray]] suggestive of constipation is interpreted according to three scoring system, including Barr, Blethyn, and Leech systems. Barr scoring system is the first scoring method used to interpret [[abdominal X-ray]] suggestive of constipation. The total score of more than 10 was postulated as [[diagnosis]] of constipation. The revised scoring system of Blethyn (simplified version of Barr scoring system) is based on the amount of remained [[feces]] in [[large bowel]]. The Blethyn scoring system consists of 4 grades of [[fecal]] retention in [[bowels]]. The most progressed and organized scoring system for diagnosis of constipation is Leech method. The score of more than 8 is considered as constipation.


==Overview==
==Abdominal X-ray==
*An [[abdominal X-ray]] may be helpful in the [[diagnosis]] of constipation.
*Findings on an [[X-ray]] suggestive of constipation is interpreted according to three scoring system, including Barr, Blethyn, and Leech systems.
 
=== Barr scoring system ===
* Barr scoring system is the first scoring method used to interpret [[abdominal X-ray]] suggestive of constipation.
* The main identifier in Barr system is [[stool]] retention severity in [[bowels]] seen on [[abdominal X-ray]].
* The total score of more than 10 was postulated as [[diagnosis]] of constipation.<ref name="pmid498690">{{cite journal |vauthors=Barr RG, Levine MD, Wilkinson RH, Mulvihill D |title=Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children |journal=Clin Pediatr (Phila) |volume=18 |issue=11 |pages=674, 676, 677–9, passim |year=1979 |pmid=498690 |doi=10.1177/000992287901801103 |url=}}</ref>
{| class="wikitable"
!Scoring elements
!Scores
|-
|The quantity of [[stool]] in [[ascending colon]]
|0-1-2 points
|-
|The quantity of [[stool]] in [[transverse colon]]
|0-2-5 points
|-
|The quantity of [[stool]] in [[descending colon]]
|0-3-4 points
|-
|The quantity of [[stool]] in [[rectum]]
|0-2-5 points
|-
|The quality of the retained [[stool]] is expressed in scybala
|0-1-2-3 points
|-
|The quality of the retained [[stool]] is expressed in granular [[feces]]
|0-2-4-5 points
|}
 
=== Blethyn scoring system ===
* The revised scoring system of Blethyn (simplified version of Barr scoring system) is based on the amount of remained [[feces]] in [[large bowel]].
* The Blethyn scoring system consists of 4 grades of [[fecal]] retention in [[bowels]].<ref name="pmid8546512">{{cite journal |vauthors=Blethyn AJ, Verrier Jones K, Newcombe R, Roberts GM, Jenkins HR |title=Radiological assessment of constipation |journal=Arch. Dis. Child. |volume=73 |issue=6 |pages=532–3 |year=1995 |pmid=8546512 |pmc=1511442 |doi= |url=}}</ref>
{| class="wikitable"
!Scoring element
!Grade
!Constipation severity
|-
|''F''eces in [[rectum]] and [[caecum]] only
|0
|Normal
|-
|Feces in [[rectum]] and [[caecum]] and discontinuous elsewhere
|1
|Mild
|-
|Feces in [[rectum]] and [[caecum]], continuous and affecting all segments
|2
|Moderate
|-
|Feces in [[rectum]] and [[caecum]], continuous elsewhere and dilated [[colon]] and impacted [[rectum]]
|3
|Severe
|}


==Overview==
=== Leech scoring system ===
[[X-ray]]s of the abdomen, generally only performed on hospitalized patients or if bowel obstruction is suspected, may reveal impacted fecal matter in the colon, and confirm or rule out other causes of similar symptoms.
*The most progressed and organized scoring system for diagnosis of constipation is Leech method.
*Leech divided the [[colon]] to 3 different regions in plain [[abdominal X-ray]], include:
*#[[Ascending colon]] and proximal [[transverse colon]]
*#Distal [[transverse colon]] and [[descending colon]]
*#Rectosigmoid
*The scoring is based on the amount of [[feces]] remained in each section (0-5 points).
*The score of more than 8 is considered as constipation.<ref name="pmid10199902">{{cite journal |vauthors=Leech SC, McHugh K, Sullivan PB |title=Evaluation of a method of assessing faecal loading on plain abdominal radiographs in children |journal=Pediatr Radiol |volume=29 |issue=4 |pages=255–8 |year=1999 |pmid=10199902 |doi=10.1007/s002470050583 |url=}}</ref>
{| class="wikitable"
!Scoring element
!Scores
|-
|No [[feces]] visible
|0
|-
|Scanty [[feces]] visible
|1
|-
|Mild [[fecal]] loading
|2
|-
|Moderate [[fecal]] loading
|3
|-
|Severe [[fecal]] loading
|4
|-
|Severe [[fecal]] loading with [[bowel]] dilatation
|5
|}


==References==
==References==

Revision as of 14:54, 14 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

An abdominal X-ray may be helpful in the diagnosis of constipation. Findings on an X-ray suggestive of constipation is interpreted according to three scoring system, including Barr, Blethyn, and Leech systems. Barr scoring system is the first scoring method used to interpret abdominal X-ray suggestive of constipation. The total score of more than 10 was postulated as diagnosis of constipation. The revised scoring system of Blethyn (simplified version of Barr scoring system) is based on the amount of remained feces in large bowel. The Blethyn scoring system consists of 4 grades of fecal retention in bowels. The most progressed and organized scoring system for diagnosis of constipation is Leech method. The score of more than 8 is considered as constipation.

Abdominal X-ray

  • An abdominal X-ray may be helpful in the diagnosis of constipation.
  • Findings on an X-ray suggestive of constipation is interpreted according to three scoring system, including Barr, Blethyn, and Leech systems.

Barr scoring system

  • Barr scoring system is the first scoring method used to interpret abdominal X-ray suggestive of constipation.
  • The main identifier in Barr system is stool retention severity in bowels seen on abdominal X-ray.
  • The total score of more than 10 was postulated as diagnosis of constipation.[1]
Scoring elements Scores
The quantity of stool in ascending colon 0-1-2 points
The quantity of stool in transverse colon 0-2-5 points
The quantity of stool in descending colon 0-3-4 points
The quantity of stool in rectum 0-2-5 points
The quality of the retained stool is expressed in scybala 0-1-2-3 points
The quality of the retained stool is expressed in granular feces 0-2-4-5 points

Blethyn scoring system

  • The revised scoring system of Blethyn (simplified version of Barr scoring system) is based on the amount of remained feces in large bowel.
  • The Blethyn scoring system consists of 4 grades of fecal retention in bowels.[2]
Scoring element Grade Constipation severity
Feces in rectum and caecum only 0 Normal
Feces in rectum and caecum and discontinuous elsewhere 1 Mild
Feces in rectum and caecum, continuous and affecting all segments 2 Moderate
Feces in rectum and caecum, continuous elsewhere and dilated colon and impacted rectum 3 Severe

Leech scoring system

Scoring element Scores
No feces visible 0
Scanty feces visible 1
Mild fecal loading 2
Moderate fecal loading 3
Severe fecal loading 4
Severe fecal loading with bowel dilatation 5

References

  1. ↑ Barr RG, Levine MD, Wilkinson RH, Mulvihill D (1979). "Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children". Clin Pediatr (Phila). 18 (11): 674, 676, 677–9, passim. doi:10.1177/000992287901801103. PMID 498690.
  2. ↑ Blethyn AJ, Verrier Jones K, Newcombe R, Roberts GM, Jenkins HR (1995). "Radiological assessment of constipation". Arch. Dis. Child. 73 (6): 532–3. PMC 1511442. PMID 8546512.
  3. ↑ Leech SC, McHugh K, Sullivan PB (1999). "Evaluation of a method of assessing faecal loading on plain abdominal radiographs in children". Pediatr Radiol. 29 (4): 255–8. doi:10.1007/s002470050583. PMID 10199902.

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