Certified Pediatric Nurse (CPN)

What finding in a child with Hirschsprung's disease would be most characteristic?

1. Liquid diarrhea with blood

2. Long, skinny stools resembling ribbons

3. Frequent normal bowel movements

4. Bulky stools that require straining

The correct answer is: Long, skinny stools resembling ribbons

The most characteristic finding in a child with Hirschsprung's disease is long, skinny stools resembling ribbons. This occurs due to the congenital absence of ganglion cells (aganglionosis) in the distal bowel, which leads to a lack of peristalsis in that segment. As a result, stool cannot pass through the affected area effectively, causing a buildup of fecal matter. When the feces finally pass through the narrow segment, they take on a ribbon-like appearance due to the constricted passage. In contrast, liquid diarrhea with blood typically suggests an inflammatory or infectious process, which is not characteristic of Hirschsprung's disease. Frequent normal bowel movements would not align with the presentation, as children with this condition usually experience constipation or infrequent stools due to the obstruction. Bulky stools that require straining may be seen in cases of chronic constipation but do not specifically indicate the ribbon-like stools characteristic of Hirschsprung's disease.