Physiologic anatomical features of the digestive system in children.

Semiotics of digestive disorders and main diseases (gastritis, ulcer

diseases, cholecystitis, functional disorders of bile ducts .

By S.Nykytyuk
 The main functions of the
digestive system
 1. To process and absorb nutrients
2. The excretory function
3. Detoxification
4. Maintain fluid and electrolyte
balance
5. The mechanical function
Morphology peculiarities of all
parts of digestive system in
infant
 1. The mucous membrane is thin, soft, dry
and easy damage
2. The cubmucosal layer is well
vascularitied
3. The cubmucosal layer consist of loose
connective tissue
4. Underdevelopment (immaturity) of
muscular and elastic tissue
 Physiological peculiarities of
digestive system in infant
 1. The secretory function of digestive
system is impaired
2. Digestive system produces only
small amounts of digestive juice
3. Digestion is worsen when the food
doesn’t adequate of age of child
 Peculiarities of oral cavity in
infant
 1. It is relatively small
2. Teeth are absent
3. The palate is flat
4. The tongue is relatively thick and
wide.
5. The sucking fat in the cheeks fill the
mouth and help maintain negative
pressure.
 Peculiarities of pharynx in
infant

1. It is relatively wide and short
2. The oral part is on the same level as oral
cavity
3. The way which the food passage is lateral
of larynx
4. The baby can to breath and swallow the
food at once
Peculiarities of the esophagus
in infant
 1. Average length of the esophagus in newborn is 10
cm
2. It is relatively narrow
3. The entrance into the esophagus is:
in newborn -- between the III-IV cervical vertebra
2 years of live - IV-V cervical vertebra
12 years of live - VI-VII cervical vertebra
4. The localization of lower esophagusХ sphincter is
the same in children of different age groups (X-XI
thoracic vertebra)
5. Ratio between the length of the esophagus and the
length of the body is the same in children of
different age groups (1:5)
 Length of the esophagus in
children of different age
groups
 innewborn is 11-16 cm
in 1.5-2 years - 22-24.5 cm
in 15-17 years - 48-50 cm
 The constriction of the
esophagus
Anatomical
 1. Upper constriction - in place of entrance
into the esophagus is
2. Middle constriction - in place of adjacent
the trachea to esophagus
3. Lower constriction - in place of entrance
through the diaphragm
 Physiological
constrictions
 1. Upper constriction - at the begining of the
esophagus is
2. Middle constriction - in place of adjacent
the aorta to esophagus
3. Lower constriction - in place of entrance
into the cardial part of the stomach.
Peculiarities of the stomach in
infant
 1. The stomach lying horizontally, is round until
approximately 2 year of age.
2. In horizontally lying of baby the gastric fundus
is lower as the antral part of the stomach.
3. Gasroesophageal reflux is frequent.
4. Cardial sphincter has a poor development of
mucous membrane and muscular coat
 5. Pyloric part is developed well
6. The fundus of stomach is under the left
dome of diaphragm
7. The weight of the stomach is 6-7 g in
newborn, in a year 18-21 g
The anatomical capacity of the
stomach, cm3
 Newborn - 30-35
4 days - 45
14 days - 90
In next months the anatomical capacity of
the stomach increase for 25 cm3
2 years - 500
4 years - 700
8 years - 1000
An adult- 1200-1600
The physiological capacity of
the stomach, cm3
 In newborn - 7
a year - 250-350
3 years - 400-600
10 years - 1300-1500
Peculiarities of the stomach in
infant
 1. The protheolytic function of the stomach
juice in baby is in 1/3 less than in adult
2. Figures of common gastric acidity is in
2,5-3 times lower than in adult
3. The fats of cow’s milk arenХt digestion
in baby younger 3-5 months
4. The fats of humanХs milk is easy
digestion by enzyme lipase of humanХs
milk, saliva and stomach juice
5. Highly saturated fats is digestion only in
a small intestine
 Peculiarities of the bowels in
infant
 1. The length is relatively longer then in adult
2. Ratio of bowels length and body length are:
in newborn - 8.3:1
a year - 6.6:1
16 years - 7.6 1
an adult - 5.4:1
3. The increasing of bowels length is slower
than the increasing of length of the body
4. The bowels are more mobile in infant
 Peculiarities of the small
intestine in infant
 1. The length is in two time less than in adult
2. The length of small intestine mesentery is
relatively longer
3. The membrane is thin, is well vascularitied.
4. The intestinal glands are more bigger then in
adult
5. The lymph cells are in each little parts of
small intestine
 Peculiarities of the large
intestine in infant

 1. The large intestine is not completely

developed
2. The length of the large intestine is the
same as the body length (in any age of a
child)
3. Haustrumes appear after 6 month of life
 Peculiarities of the sigmoid
colon in infant

 1. Is longer
2. Is mobile
3. Increasing in size during the life
4. In children younger 5 years is upper then
in schoolchildren (in schoolchildren is in
the pelvic cavity)
 Peculiarities of the rectum in
infant
 1. The localization is under the entrance
into the small pelvis in preschoolchildren
2. In schoolchildren the rectum is in the
small pelvis
3. Is longer
3. Is mobile
4. In newborn is absent ampulla
 Peculiarities of the liver in
infant

 Before the birth the liver is the largest organ

of the body
 It is in the upper quadrant of the abdomen
and one part of the left and epigastrium
 The left lobes before the birth is very great
 Liver functions

 Bile salts emulsify fats making them aviable to

intestinal lipases
 Help make and products soluble and aviable for
absorption by the intestinal mucosa ,aid peristalis,
fluid on enzyme ,bile ,sodium glucoholate sodium
taurocholate, cholesterol ,biliverdin, mucus, fat,
lecitin, cells and cell debris.
 Detoxification
 Glucose exchanges
 Hepatocytes functions

 Synthesis of bile
 Storage (glicogen,fat,vitamis,copper,iron
 biotransformation
 Synthesis of blood components
 Regulation of the digestive
system
 Cephalic phase
 Hypotalamus
 Hypophisis
 Endocrine regulation
 Vagus nerves of the stomach
 Regulation of the digestive
system
 Local reflexes,secretin,cholecystokinin stimulate
intestinal secretion
 Secretin stimulates the pancreas to secrete waters
solution and the liver to secrete bile
.Cholecystokinin stimulates the pancreas to secrete
an enzyme rich solution and stimulates the
gallbladder to contract,releasing large amounts of
stored bile into the intestinae neuronal stimulation
from the medulla also causes pancreatic
,hepatic,and intestinal secretion
 Disorder of peritoneum and
abdominal cavity
 Dispeptic disturbances
 Appetite(poor,excessive,moderate0
 Heartburn
 Hiccup belching
 Vomiting
 Diarrhea
 Constipation
 Nausea
 Special methods of
investigation
 Gastroscopy
 Duodenal intubation
 Esophageal intubation
 Colonoscopy
 Scanning of the liver
 Laparoscopy
 esophagoscopy
 Peculiarities of the esophagus in
infant
 1. Average length of the oesophagus in newborn is 10 cm.
 2. It is relatively narrow.
 3. The entrance into the oesophagus is:
in newborn - between the III-IV cervical vertebra;
2 years old - IV-V cervical vertebra;
12 years old - VI-VII cervical vertebra.
 4. The localization of lower oesophagus' sphincter is the
same in children of different age groups (X-XI thoracic
vertebra).
 5. Ratio between the length of the oesophagus and the
length of the body is the same in children of different age
groups (1:5).
 The anatomical constriction of
the oesophagus

 1. Upper constriction - at the place of

entrance into the oesophagus.
 2. Middle constriction - at the place of
adjacent the trachea to oesophagus.
 3. Lower constriction - at the place of
entrance through the diaphragm.
 Physiological constriction of the
oesophagus

 1. Upper constriction - at the begining of

the oesophagus.
 2. Middle constriction - at the place of
adjacent the aorta to esophagus.
 3. Lower constriction - at the place of
entrance into the cardial part of the
stomach.
 Peculiarities of the stomach in
infant

 1. The stomach lies horizontally, is round until

approximately 2 year of age.
 2. In horizontally lying baby, the gastric fundus is lower
as the antral part of the stomach.
 3. Gastroesophageal reflux is frequent.
 4. Cardial sphincter has a poor development of mucous
membrane and muscular tunic.
 5. Pyloric part is developed well.
 6. The fundus of stomach is -under the left dome of
diaphragm.
 7. The weight of the stomach is 6-7 g in newborn, in 1
year old 18-21 g.
 The anatomical capacity of the
stomach, cm3
 Newborn - 30-35.
 4 days - 45.
 14 days - 90.
 6 months - 200.
 1 year - 250-350.
 2 years - 500.
 4 years - 700.
 8 years - 1000.
 An adult - 1200-1600.
The physiological capacity of the
stomach, cm2
 Newborn - 7.
 1 year - 250-350.
 3 years - 400-600.
 10 years - 1300-1500.
 Peculiarities of the stomach
secretion in infant
 1. The proteolytic function of the stomach juice in
baby is 1/3 less than in adult.
 2. Figures of common gastric acidity is in 2.5-3
times lower than in adult.
 3. The fats of human's milk are easy digested by
enzyme lipase of human's milk, saliva and
stomach juice.
 4. Highly saturated fats are digested only in a
small intestine.
 Peculiarities of the bowels in
infant
 1. The length is relatively longer than in adult.
 2. Ratio of bowels length and body length are:
in newborn - 8.3:1; 1 year - 6.6:1; 16 years - 7.6:1;
in adult - 5.4:1.
 3. The increasing of bowels length is slower than
the increasing of length of the body.
 4. The bowels are more mobile in infant.
Peculiarities of the small intestine
in infant
 1. The length is two times less than in adult.
 2. The length of small intestine mesentery is
relatively longer.
 3. The membrane is thin and well vascularisied.
 4. The intestinal glands are bigger than in adult.
 5. The lymph cells are located in each little part of
small intestine.
 Peculiarities of the large
intestine in infant

 1. The large intestine is not completely

developed.
 2. The length of the large intestine is the
same as the body length (in any age of a
child).
 3. Haustrume appear after 6 months of life.
Peculiarities of the sigmoid colon
in infant
 1. It is longer.
 2. It is mobile.
 3. Increasing in size during the life.
 4. The localization of sigmoid colon is
upper in children who are younger 5 years
than in schoolchildren (in schoolchildren it
is in the pelvic cavity).
 Peculiarities of the rectum in
infant
 1. The localization is under the entrance
into the small pelvis in preschoolchildren.
 2. In schoolchildren the rectum is in the
small pelvis.
 3. It is longer.
 3. It is mobile.
 4. The ampulla of rectum is absent in
newborn.
 Peculiarities of the liver in infant

 1. Before the birth the liver is the largest

organ of the body.
 2. It is in the upper quadrant of the
abdomen and one part of the right
epigastrium.
 3. The left lobe is very large before the
birth.
 Liver functions

 1. Bile salts emulsify fats making them

available to intestinal lipases.
 2. Bile helps make the products soluble and
available for absorption by the intestinal
mucosa; it stimulates peristals.
 3. Detoxification.
 4. Glucose metabolism.
 Hepatocytes functions

 1. Synthesis of bile.
 2. Storage (glycogen, fat, vitamins, copper,
iron).
 3. Biotransformation.
 4. Synthesis of blood components.
 Diagnostic Procedures
Laboratory tests:
 albumin level
Below-normal levels of albumin, a protein made
by the liver, found in the bloodstream are
associated with many chronic liver disorders.
 bilirubin level
Bilirubin is produced by the liver and is excreted
in the bile. Elevated levels of bilirubin may
indicate an obstruction of bile flow or a defect in
the processing of bile by the liver.
 Diagnostic Procedures
 fecal fat test
child is asked to eat a high-fat diet for several days. You
collect small samples of stool in sealed containers for 3
days. The amount of fat contained in child's stool is
measured. If the digestive tract is working properly, only
small amounts of fat will be present in the stool; the rest of
the fat that was in the diet will have been digested and
reabsorbed by the body. If child has a condition known as
malabsorption, then the intestinal tract cannot digest fats as
well as it should, and elevated amounts of fat will pass
through into the stool.
 fecal occult blood test
A fecal occult blood test checks for hidden (occult) blood
in the stool. It involves placing a very small amount of
stool on a special card, which is then tested
 Diagnostic Procedures
 complete blood count (CBC)
Red blood cells will be present in smaller amounts
than normal if blood has been lost, if the diet has
been inadequate, or with certain diseases.
 electrolyte tests
Up to 22 electrolytes can be measured, including
sodium, potassium, calcium, and glucose. These
minerals are important for the body to function
properly. Children who have lost large amounts of
fluid due to vomiting or diarrhea often lose large
amounts of the various electrolytes as well.
 Diagnostic Procedures
 lactose tolerance test
This test helps determine if a child has trouble digesting lactose
properly. child is given a liquid containing lactose to drink. Several
blood samples are taken over a 2 hour period to measure the amount of
glucose (sugar) present in the bloodstream. If lactose is digested
normally, blood glucose rises. If lactose is not digested as it should be,
then the blood glucose level does not change throughout the test.
 liver enzymes
Elevated levels of liver enzymes can alert physicians to liver damage
or injury, since the enzymes leak from the liver into the bloodstream
under these circumstances.
 prothrombin time (PT) test
This test measures the time it takes for blood to clot. Blood clotting
requires vitamin K and a protein made by the liver. Liver cell damage
and bile flow obstruction can both interfere with proper blood clotting.
 Diagnostic Procedures
 stool culture
A stool culture checks for the presence of abnormal
bacteria in the digestive tract that may cause diarrhea and
other problems.
 urea breath test
This test helps diagnose the presence of Helicobacter
pylori (H.pylori) in the digestive tract. Child swallows a
capsule containing urea. If H.pylori is present in the
stomach, then the urea will be converted into nitrogen and
carbon. The carbon changes to carbon dioxide and moves
into the bloodstream, and then into the lungs where it is
exhaled. Child breathes into a balloon, and the amount of
carbon in the breath is measured. A positive test, meaning
carbon is present, indicates the presence of H.pylori.
 Diagnostic Procedures
Imaging tests:
 computed tomography scan (CT or CAT scan)
A diagnostic imaging procedure that uses a combination of x-rays and
computer technology to produce cross-sectional images (often called
slices), both horizontally and vertically, of the body. A CT scan shows
detailed images of any part of the body, including the bones, muscles,
fat, and organs. CT scans are more detailed than general x-rays.
 lower GI (gastrointestinal) series (also called barium enema)
A procedure that examines the rectum, the large intestine, and the
lower part of the small intestine. A fluid called barium (a metallic,
chemical, chalky, liquid used to coat the inside of organs so that they
will show up on an x-ray) is given into the rectum as an enema. An x-
ray of the abdomen shows strictures (narrowed areas), obstructions
(blockages), and other problems.
 Diagnostic Procedures
 (magnetic resonance imaging) MRI
A diagnostic procedure that uses a combination of
large magnets, radiofrequencies, and a computer
to produce detailed images of organs and
structures within the body. child lies on a bed that
moves into the cylindrical CT scanner. The
machine takes a series of pictures of the inside of
the body using a magnetic field and radiowaves.
The computer enhances the pictures produced.
The test is painless, and does not involve exposure
to radiation.
 Diagnostic Procedures
 upper GI (gastrointestinal) series
A diagnostic test that examines the organs
of the upper part of the digestive system:
the esophagus, stomach, and duodenum (the
first section of the small intestine). A fluid
called barium is swallowed. X-rays are then
taken to evaluate the digestive organs.
 Diagnostic Procedures
 oropharyngeal motility (swallowing) study
child is given small amounts of a liquid containing barium
to drink with a bottle, spoon, or cup. Barium shows up well
on x-ray. A series of x-rays are taken to evaluate what
happens as your child swallows the liquid.
 ultrasound
A diagnostic imaging technique which uses high-frequency
sound waves and a computer to create images of blood
vessels, tissues, and organs. Ultrasounds are used to view
internal organs as they function, and to assess blood flow
through various vessels.
 Diagnostic Procedures
Endoscopic procedures:
 Colonoscopy is a
procedure that allows the
physician to view the
entire length of the large
intestine, and can often
help identify abnormal
growths, inflamed tissue,
ulcers, and bleeding. It
involves inserting a
colonoscope, a long,
flexible lighted tube, in
through the rectum up into
the colon.
 Diagnostic Procedures
 esophagogastroduodenoscopy
(EGD) (also called upper
endoscopy)
is a procedure that allows the
physician to look at the inside
of the esophagus, stomach, and
duodenum. A thin, flexible,
lighted tube called an
endoscope is guided into the
mouth and throat, then into the
esophagus, stomach, and
duodenum. The endoscope
allows the physician to view the
inside of this area of the body,
as well as to insert instruments
through a scope for the removal
of a sample of tissue for biopsy
(if necessary).
 Diagnostic Procedures
 esophageal pH monitoring
An esophageal pH monitor measures the acidity inside of the esophagus. It is
helpful in evaluating gastroesophageal reflux disease (GERD). A thin plastic
tube is placed into a nostril, guided down the throat and then into the
esophagus. The tube stops just above the lower esophageal sphincter, which is
at the connection between the esophagus and the stomach. At the end of the
tube inside the esophagus is a sensor that measures pH, or acidity. The other
end of the tube outside the body is connected to a monitor that records the pH
levels for a 12 to 24 hour period.
 liver biopsy
A liver biopsy helps diagnose liver diseases. A small sample of liver tissue is
obtained with a special biopsy needle and examined for abnormalities.
Children are sometimes given medication to minimize their anxiety during the
procedure. A small area of skin over the liver is numbed with a local
anesthetic. The anesthetic is then injected deeper under the skin to numb the
area that the biopsy needle will pass through and reduce the discomfort of the
test.
 Diagnostic Procedures
 anorectal manometry
This test helps determine the strength of the muscles in the rectum and
anus. These muscles normally tighten to hold in a bowel movement
and relax when a bowel movement is passed. Anorectal manometry is
helpful in evaluating anorectal malformations and Hirschsprung's
disease, among other problems. A small tube is placed into the rectum,
and the pressures inside the anus and rectum are measured.
 esophageal manometry
This test helps determine the strength of the muscles in the esophagus.
It is useful in evaluating gastroesophageal reflux and swallowing
abnormalities. A small tube is guided into the nostril, then passed into
the throat and finally into the esophagus. The pressure the esophageal
muscles produce at rest is then measured.
 Appendicitis

Appendicitis is acute inflammation and

infection of the vermiform appendix, which
is usually referred to as the appendix. The
appendix is a blind-ending structure that
arises from the cecum. Acute appendicitis is
one of the most common causes of
abdominal pain and is the most frequent
condition that leads to emergent abdominal
surgery in children.
 Age: Appendicitis occurs in all age groups. The
mean age in the pediatric population is 6-10 years.
Appendicitis is rare in the neonate, and the
diagnosis is typically made after perforation for
the reasons discussed above .Younger children
have a higher rate of perforation (50-85%
reported).
 What are the symptoms of
appendicitis?
 pain in the abdomen which:
– may start in the area around the belly button, and move over to the
lower right-hand side of the abdomen, but may also start in the
lower right-hand side of the abdomen.
– usually increases in severity as time passes.
– may be worse with moving, taking deep breaths, being touched,
and coughing or sneezing.
– may spread throughout the abdomen if the appendix ruptures.
 nausea and vomiting
 loss of appetite
 fever and chills
 changes in behavior
 diarrhea or constipation
 How is appendicitis
diagnosed?
 Pain: The initial symptom is poorly defined periumbilical
pain. Acute onset of severe pain is not typical in acute
appendicitis but is seen with acute ischemic conditions
such as volvulus, testicular torsion, ovarian torsion, or
intussusception. If the pain is initially located in the right
lower quadrant, severe constipation should be considered.
 Nausea and vomiting: Generally, vomiting that occurs
prior to pain is unusual. However, in retrocecal
appendices, particularly those that extend cephalad along
the posterior surface of the right colon, inflammation of the
appendix irritates the nearby duodenum, resulting in
nausea and vomiting prior to the onset of right lower
quadrant pain.
 How is appendicitis
diagnosed?
 Diarrhea: Likewise, significant diarrhea is atypical in appendicitis,
and the physician should consider other diagnoses while not ruling out
appendicitis. In patients with an appendix in a pelvic location,
inflammation of the appendix occasionally results in an irritative
stimulation of the rectum. These patients often report diarrhea.
 Shift to right lower quadrant pain: After a few hours, pain shifts to
the right lower quadrant because of inflammation of the parietal
peritoneum. This pain is more intense, continuous, and localized than
in the initial pain.
 Fever: Most children with appendicitis are afebrile or have a low-
grade fever and characteristic flushness of their cheeks. Severe fever is
not a common presenting feature unless perforation has occurred, in
which case it may still be a rare finding.
 How is appendicitis
diagnosed?
Abdominal examination
– The child's abdomen should be examined in the same way an adult's
abdomen is examined. Full exposure of the abdomen is key. Localization
of the pain is also key but may depend on the position of the appendix.
– Observing the patient cough and asking them to localize their pain with
one finger often localizes their discomfort to the right lower quadrant.
Typically, maximal tenderness can be found at the McBurney point in the
right lower quadrant. However, the appendix may lie in many positions.
 A medially positioned appendix may present as suprapubic tenderness.
 A laterally positioned appendix often presents as flank tenderness.
 A retrocecal appendix may not have any tenderness until it is advanced or
perforated.
– Rovsing sign is pain in the right lower quadrant in response to left-sided
palpation or percussion and strongly suggests peritoneal irritation.
– The cough sign (ie, sharp pain in the right lower quadrant after a voluntary
cough) suggests peritoneal irritation.
 How is appendicitis
diagnosed?
Rectal examination
– A rectal examination is important and should be performed in all
patients who are evaluated for appendicitis.
– The rectal examination in a young child may be completely
objective, as they may not be able to communicate variations in
tenderness or may have general discomfort from the examination.
– Objective information to ascertain includes impacted stool or an
inflammatory mass.
– A patient who is able to communicate during a subjective
examination should be asked if any tenderness is present in
different areas of the rectum.
– Right-sided tenderness of the rectum is the classic finding in pelvis
appendicitis or in pus that pools in the pelvis from an inflamed
appendix elsewhere in the abdomen.
 How is appendicitis
diagnosed?
 abdominal ultrasound - Ultrasounds are used to
view internal organs as they function, and to
assess blood flow through various vessels.
 computed tomography scan of the abdomen,
with or without barium (Also called a CT or CAT
scan.) - A CT scan shows detailed images of any
part of the body, including the bones, muscles, fat,
and organs. CT scans are more detailed than
general x-rays.
 barium enema - An x-ray of the abdomen shows
strictures (narrowed areas), obstructions
(blockages), and other problems.
 Laboratory analysys
 blood tests - to evaluate the infection, or to
determine if there are any problems with
other abdominal organs, such as the liver or
pancreas.
 urinalysis - to detect a bladder or kidney
infection, which may mimic the symptoms
of appendicitis.
After surgery, children are not allowed to eat or drink
anything for a specified period of time so the intestine can
heal. Fluids are given into the bloodstream through small
plastic tubes called IVs until child is allowed to begin
drinking liquids. child will also receive antibiotics and
medications to help him/her feel comfortable through the
IV. Eventually, children will be allowed to drink clear
liquids and then gradually advance to solid foods.
A child whose appendix ruptured will have to stay in the
hospital longer than the child whose appendix was
removed before it ruptured. Some children will need to
take antibiotics by mouth for a period of time specified by
the physician after they go home.
 Medical Care:
Making a timely diagnosis is a difficult challenge when
evaluating children with abdominal pain. Classifying
patients with abdominal pain into the following 3 major
categories may be helpful:
Diagnosis not consistent with appendicitis
– This group includes patients whose history and physical
examination findings are not consistent with appendicitis or any
significant abdominal process.
– Performing a complete physical examination, including rectal
palpation and urinalysis, before discharge is important.
– Few patients require sophisticated radiological evaluation.
However, as discussed above radiographic evaluation of the
kidney, ureters, bladder, and chest may lead to the correct
diagnosis (constipation or pneumonia) and treatment.
 Classic history for appendicitis

 Patients with a classic history require prompt surgical consultation.

 Maintain nothing-by-mouth status in patients with suspected appendicitis and
start intravenous fluids to restore intravascular volume.
 Ensure adequate hydration for patients who present with suspected
appendicitis.
 Even in early acute appendicitis, children frequently have not had sufficient
oral intake and present with some degree of intravascular dehydration.
 Antibiotic therapy is an important aspect of the preoperative treatment of
appendicitis but should not be administered until consulting with a surgeon.
 Direct antibiotic therapy against gram-negative and anaerobic organisms (eg,
Escherichia coli, Bacteroides species).
 Most of these patients do not require radiological evaluation if their history,
physical, and laboratory evaluations are convincing. However, some surgeons
still prefer ultrasonography in female patients because of the possibility of a
gynecological etiology.
 Unclear diagnosis

– In these children, the history may be consistent with

appendicitis; however, the examination is not
supportive. In other children, the inverse may be true.
– This is the main group who benefit from double-
contrast abdominal CT scanning. Serial examinations
and test results may also help to clarify the diagnosis.
– Reevaluate the patient over a few hours to determine
the need for surgical consultation. If uncertainty
persists after a period of observation, obtain a
consultation with a surgeon.
Crohn's Disease
 What is Crohn's disease?

 Crohn's disease is an inflammatory bowel disease.

It is a chronic condition that may recur at various
times over a lifetime. It usually involves the small
intestine, most often the lower part called the
ileum. However, inflammation may also affect the
entire digestive tract, including the mouth,
esophagus, stomach, duodenum, appendix, or
anus.
 Crohn's disease is also called ileitis or enteritis.
 Who is affected by Crohn's
disease?
 While Crohn's disease may affect persons of all
ages, the age group most often affected is between
15 years to 35 years. However, Crohn's disease
may also be seen in young children. Males and
females are affected equally. It appears to run in
some families, with about 20 percent of people
with Crohn's disease having a blood relative with
some form of inflammatory bowel disease. In
those who have a family history, it is very likely
that Crohn's disease will begin in the teens and
twenties.
 What are the symptoms of
Crohn's disease?
The following are the most common symptoms for Crohn's disease.
However, each individual may experience symptoms differently.
Symptoms may include:
 abdominal pain, often in the lower right area
 diarrhea
 rectal bleeding
 obvious blood in the stools or black, tar like stools
 fever
 weight loss
 failure to grow
Some people have long periods of remission when they are free of
symptoms, sometimes for years. There is no way to predict when a
remission may occur or when symptoms will return.
The symptoms of Crohn's disease may resemble other conditions or
medical problems. Consult your child's physician for a diagnosis.
 How is Crohn's disease diagnosed?

People who have experienced chronic abdominal pain,

diarrhea, fever, weight loss, and anemia may be examined
for signs of Crohn's disease. In addition to a complete
medical history and physical examination, diagnostic
procedures for Crohn's disease may include:
 blood tests - to determine if there is anemia resulting from
blood loss, or if there is an increased number of white
blood cells, suggesting an inflammatory process.
 stool culture - to determine if there is blood loss, or if an
infection by a parasite or bacteria is causing the symptoms.
 How is Crohn's disease diagnosed?

 endoscopy - a test that uses a

small, flexible tube with a light
and a camera lens at the end
(endoscope) to examine the
inside of part of the digestive
tract. Tissue samples from
inside the digestive tract may
also be taken for examination
and testing.
 biopsy - taking a sample of
tissue (from the lining of the
colon) for examination in a
laboratory.
 How is Crohn's disease diagnosed?

 colonoscopy - a test
that uses a long,
flexible tube with a
light and camera lens
at the end
(colonoscope) to
examine inside the
large intestine.
What is the long-term outlook
for a child with Crohn's
disease?
Crohn's disease is a chronic condition that
may recur at various times over a lifetime.
Children may experience physical,
emotional, social, and family problems as a
result of the disease, increasing the
importance for proper management and
treatment of the condition.
 Emotional Responses
 Mood swings due to illness and medications
 Blaming self for disease
 Frustration with physical problems
 Feeling different from everyone else
 Anger: "Why me?“
 Worry about appearance, slow growth, weight loss
 Feeling vulnerable; unable to rely on body to
function normally like everyone else
 Frustration at physical limitations, being unable to
keep up with friends
 Social Problems
 Coping with being teased by classmates
Embarrassment over frequent bathroom use
 Peer pressure regarding food choices
 Handling other people's lack of knowledge
about the disease
 Change in physical stamina
 Changes in ability to concentrate on
schoolwork
 Effects on the Family

 Understanding the needs of the child with Crohn's disease,

as well as the rest of the family's needs Need for mutual
support of all family members
 Need for all family members to learn about the disease and
understand its effects on the child
 Learning to cope with unexpected changes in family
routine
 Trying to channel frustration when angry
 Respect for privacy
 Encouraging independence of the child with Crohn's
disease
Gastroesophageal Reflux Disease

(GERD) / Heartburn
 Gastroesophageal reflux disease (GERD) is a
digestive disorder that is caused by gastric acid
flowing from the stomach into the esophagus.
 Gastroesophageal refers to the stomach and
esophagus, and reflux means to flow back or
return.
 Gastroesophageal reflux (GER) is the return of
acidic stomach juices, or food and fluids, back up
into the esophagus.