Whose mucosa secretes the potent gastric juice in the stomach, the food is stirred until becoming
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Preparation: of LI Examination :(C)
1-Enema Cleaning :( Rectosopy/RAM/Anus op) Syphon :((irigoscope/US/Fibrocolon of LI) CI: H2O toxicity/ LI perforation! |
2-Washing Intestine I( Same as syphon) CI: Mechanic/ Dynamic Ileus / GItis/ Perforation of Intesitine/toxic collitis!/Toxic Dilatation of LI /<10 YO/ |
3-Laxatative I: LI Examination , Operation of LI CI (same as Washing) |
4- Med Per Rectum : I (Rectosopy/RAM/Anus op) |
***Constipation:
^^Sx:
I-Sx of Stool continence: | II-Sx of Evacuation disorder: | III-Distended Bowel: | V-Chronic toicivty: |
- stool in abdomen -accumilation of Stool in Rectum -Episodic evacuation of Large Volume | -Pain during Eveaution -Blood/mucous in Stool -Rectal ptolpse | -Abd Distention -Chest deformity -Frequent Resp Disease | Fever Aenmia dizziness headache |
^^Evacuation:
Evacuation:
1-external sphincter and puborectal muscle relax
2-rectoanal angle becomes flat
3-abdominal muscles and diaphragm contract
4-pressure inside rectum is higher than in anal canal
evacuation occures
^^Indication for Special Examination (C)
1-Constipation in newborns and infants.
2-Constipation in older children, if:
3-Constipation in Down disease.
4-Ineffective treatment for 6 months.
^^LECTURE Tx:
I-Primary counseling should consist of:
-Adjustment of diet
-Increased water in diet +fiber .
II-Emptying the bowel (if fecaloma formation and overflow soiling)
-Large enemas for 1–3 days
-Confirm evacuation
-Avoid long-term enema regimens
IIII-Establish toileting routines
-Stimulant laxatives (bisacodyl, senna, picosulfate)
--Start with high doses, taper slowly according to response
IV-Maintenance of bowel movements
-Bulk laxatives
-Start when the dose of stimulant laxatives is approximately one-third of
the starting dose
***HIRSCHPRUNG:
^^Gx:
-equivalent to megacolon in adults!
-AGANGLIONOSIS of bowel( lack of Ganlig)
-Cause: Abscenes of ganglion cell in rectum & Colon(rectosigmoid area)
-Genetically acquired with failed To Form in Utero!!
^^Px:
-aganglionic bowel is Unable to Relax ( PIC)
^^Morphology:
1-No PS ganglia plexus in submucosa
2-Hyperplasia of neuronal plexus in Mucosa!
^^CF /Sx:
I-No Meconium > 24-48 hours
(There is no poop when we feed them because food is backed up and colon is really big)
II-Distended Abdomen and Need to Vomit(Bile vommiting)
III-Sx of enterocolitis( Inflammation,Distention ,Spesis ,Vommiting)
IV-Chronic Constipation
V-Ribbon Like Foul Smelling Stool+ RECTAL AMPULE IS EMPTY!!!
VI-Clinical & Radiological Sign of Bowel Perforation!
^^Dx:(C)
I-RADIOLOGICAL =Contrast Enema(XRAY) Contrast Enema : ( Not effective in Newborn) ( Ultrashort aganglionic segment) ( Total aganglionic colonic) |
II-Anorectal Manometry -HD Child as Increase contraction of Anal Canal+ No Relaxation of Internal sphincter |
III-Biopsy! |
^^Tx:
-Surgical Resection of aganglionic Portion!+Restore Intestine whole!(anastomeses)
Indication For colostomy | Conservative Tx |
-Signs of Bowel Obstruction for Newborn -Incidental Reveal of HD | -Continue oral Feeds -Daily emptying of bowel and saline! |
Incontinentia alvi: -Incontance due to Organic Cause | Encopresis : -Incontance without organic cause in children >4 Primary encopresis (when child does not stop evacuation from the infant age) Secondary encopresis (when disorders of evacuation occur later) |
^^Reasons: -Anal malformations -Changes after operations on anus and rectum or injuries -Myelomeningocele | Reasons: -Psychologic and neurologic disorders -Chronic constipation |
^^Clasification: Subclinical incontinence -intermittent smearing I°- gas incontinence II°- incontinence of liquid stool III°- incontinence of hard stool | |
^^Examination: Inspection Digital rectal examination Rektoromanoscopy Rectoanal manometry Electromiography |
***RECTAL PROLAPSE:(D)
^^Predisposing factors: | ^^Factors, stimu |
- (-)sacral-coccygeal angle - ↑ straight rectum -deep Douglas cavity -(+) sigmoid + mesenterium -more mobile rectal mucosa -wrinkles are less expresed -hipotrophy | -constipation -long sitting on the toilet -diarrhea -neurologic disorders (myelomeningocele) -cystic fibrosis |
^^Dx: -inspection -DRE -rectoanal manometry -rectoromanoscopy | ^^Tx: 1-Manual reduction (gently replace using lubricant) 2-The nonoperative : 3-Circumferential injection procedures 4-Thiersch’s operation (synthetic materials are used to create a perianal sling to support rectum) 5-Abdominal rectopexy |
***Anorectal Malformation:
I-High: -ARAgnesia ( Rurethra.,Rvesiculat) -ARA without fistula -Rectal Atresia | I-High: -ARA (Rectovaginal) -ARA (without fistula) -Rectal Atresia |
II-Middle: -ARAgenia (Rectubadlubular) -Ana agenses (no fistula) | II- -ARA (rectovaginal) (rectovestibular) -Anus Agensis (no fistula |
III- -Anal Membrane -Anal Stensosis -Anacutanous fitua | III- ... + anovestibular |
Cloaca |
Lower > High>Middle
Low:
-Boys: Anorectal cutanous Fistula(#1
-Girls:Anovestibular Fistula(#1)
High:
1-Boy: ARA with Recturthral or Rectavesicular fistula
2Girl: Rectovaginal
Dx:
-CF(see it)
-Urine Test
-Inverogram(12 H)
-Colostogram
PIC
(Anal Memebrane)
(Anal Atrseia+Anocutnaous fistula)
(High anorectal Anomaly)
(Anorectal Agensis+Rectovesitbular)
***ANATOMY:
***BASICS of BABY GI System**
^^In 24 hours of Newborn, there should be Meconium passage( Type of Feces) which is a sign of GI Health
^^Anatomical Difference:
-Greater Peristalsis
-Relaxed Cardiac Sphincter
-Enzyme Deficient until 4-6 M
(this is why we don't feed them Food At first and instead Breastfeed)
-Abdominal Distention From Gas is common in Infants
-Immature Liver at birth
-Stomach has a smaller capacity
^^Absorption Difference:
-Children Need More H2O
-they Get Dehydrated Quicker !
(2/3 H2O Leve through skin due to kidney not being mature enough)
^^Oral Cavity In Babies
-Small Size
-the tongue is short, Wide & Thick
-Sucker shaped lips Faitly thick & Elastic
-inside mucous membrane is thin & flexible!
-Muscle of the lips+Cheecks are Well Developed
-The pad in cheeks for sucking atrophy at year 4
-Can Drink and Eat at same Time
-Lower Jaw is Small
-The palate is: Thin / Rich in Blood Vessels,/Vulnerable!
-Salivary glands poorly developed(develop at 3-4 M)
the entire anatomy of the mouth is adapted to breastfeed so that the breast nipple is sufficiently massaged and maximally sealed, otherwise, a baby will not be able to suckle
-unlike an adult, baby can Breathe while eating because of the entrance of the laryngotracheal groove is located higher than the structure of pharynx!
^^Pharnyx:
-Funnel-shaped
-Located High Above the Inferior posterior edge of velamen and connected with OP!---->So the child can Breath and swallow at the same time! Without interrupting sucking
^^Teeth:
-Milk teeth Start Growing at 6-8th Month
-The Central incisors grow in Lower Jaw
-Then Central Incisors appear in upper Jaw
-Then Lateral Incisors Grow in the upper Jaw and finally, the lateral incisors appear in the lower jaw!
----> A Baby os 12 Month should have 8 teeth
MILK Teeth Formula:
# Of teeth= (Number of Months) -4
-A child up to 2 years should have all 20 milk Teeth, With No premolars ( Like in adults)
^^3rd molars/wisdom teeth emerge from 17-21 bringing total # of permanent Teeth to 32 |
^^Esophagus:
-Short + Narrow(10 cm)
-Low development of Muscle of muscle and elastic tissue
-Thin walls
-Lack of Glands
-Good blood supply
-High Location of Esophageal Entrace
-Physiologically undeveloped
Feeding = 30ml + (30mkx age in months)
^^Stomach:
-Crura of diaphragm are Not closed Enough! Only till age 12-13
-Esophagus Short
-Cardia of stomach is not very muscular
-Esophagus pulls Cardia Up
-Pyloric Sphincter Is Well developed
-Stomach is in vertical position
^^SI:
-D/J/I
-Villi in SI are not developed liek adult
-Th SI to LI connection also not developed( valve of Cecum)
^^LI:
-Cecum/Colon/Rectum
-Not Formed well
-haustra appear at 6 M
-Only at 4YO the intestin is like in adult!
-Topography complete at 2-4 YO
-Sigmoid colon adhere to weak bands
-Rectum Not Mature & Not Ampule!
^^Prancrease:
-Very small 2-3 G
-4 x increas by Year 1
-adults 30 x
-Lobular Pancrease undeveloped!
-Islet of langers poducr insuline are Dominant
atits candidosa
-Infla of Oral cavity
-SX: Hyperemia of oral Misa
-Types: Light / int / Hard!
A-Light form: -Hypermic Oral Mucousa (lips.Jowel ,Tongue) -desquamation of epithelium white dotted semonila in 2-3 Days! -Local lesion mere toether to form mebrnae like scurf! -esat taken off |
B-Intermediate: -Membrane Like Scurf -harderer to remove with possible bleeding |
C- hard: -Oral mucosa/ soft+ hard palate + uvula + posterior phanryx+Jowel+ Lips! -Tingle burning snesation in mouth -increase Submaxillary LN -if Not Tx---->Candida Sepsis |
^^Dx:
1-Culture Show large grown colonie
2- Microscopic Test of smear-Banks + Pseumoceelis
3-Skin Test with allergens of barm!
^^Tx:
-Avoid Sour substance as it liks thm
-UV radiation .Iodine, Antifungal X
-Tx of 2nd disorder of disgestive edocime sustec
-STOP ax / Hormone
-Mouth heugeie!
-Vitamins
-Mouth Wash 2-3% Soda solution 5-6 x Day!
***ACUTE GASTRITIS (exogenous origin)
Causes Could be any # But Mainly in Children
Food | Food posionng |
-Raw Fruit -Chemical Overating | -Old Food -undercooked |
-incubation: 2-12H | -Incubation: 6-24H |
-<38C - | 39-40> |
-Pain Not spreaded -Poor localied | -Pain Not spread -Poorly Localized |
1 Time Vommit+ Relief | .... |
2-3 X Loose Stool with no Px sign | 5-6X Some Mucous! |
^^Tx:
I-Diet:
-Initial Liquird in < 3 H from Sx
-Sugarless tea
-Eat < 3H After Flid intake
D1: Rice/Porride/No Butten
D2: Grain+ Pasta
D3:Broth and Meat
20-30 Day Rstrict Diet:No spicty/Fried Food!
II-No X . Give IV if DH
***Chronic Gastritis:
Infectious | Non Infectious |
-H Pylori (epigastric pain) ( fullness) ( N+V) ( flatulence) ( malaise) | -Autoimmune -NSAID |
DX: I-CF Epigastric tenderness Abd pain/Bloating 2-Endoscopy 3-Gastric biopsy | Same |
Tx: Triple Tx (Metronidazole/Teracyclin/Bismuth) |
Infantile Colic(+ Q&A)
(Rule of 3)
Cause:
-90% ??
-Possible
COWMILK ● ↑ motilin ● ↑ alpha lactalbumin ● psychosocial stress during pregnancy ● immaturity of nervous system ● temperament ● passive smoking ● psychological atmosphere in the family |
^^CF:
-Crying
-distended abdomen
-pain Facies
-Bringing legs over abbomen
-increased Gas in rectum
^^Dx:
-CLinical Features:
^^Tx:
Non X | X |
-Swing baby -massage -Increase/ Decrease Meal -Change meal -Raise kid after feeding -Education of PArent | -Sedative -Anti cholinergic X -Atispasmic -Antihistamin |
**PEPTIC ULCER:
^^CF
I-Duodenal ulcers:
- pain typically occurs several hours after meals and often awakens patients at night (Nocturnal pain).
-Eating tends to relieve the pain.
II-Gastric ulcers :
-pain may be aggravated by eating -resulting in weight loss.
astrointestinal bleeding
^^Dx:
1-Past illnesses,
2-Lab: CBC, Hb, ESR, amylase, lipase
3. Abdominal US, x -ray
4. Esophagogastroduodeno
^^Treatment:
1. H2 antagonists
2. PPI –omeprazole for 4 weeks
3. In case of presence of h.Pylori PPI+ eradication of h.Pyloi by combination of 2 AB
Multidrug therapy: omeprazole+clarithromycin+metronidazole given twice daily for 7 -14d. 1. Diet and meal regim
***GERD In Babies
^^Gx:(depends on severity)(
-Gastric content into the esophagus!
-Reflux ---------->Cause is tissue Damage
-May also Resolve spontaneously in 24 M
^^Causes:
Primay: Cause is only lower Esophageal disorder
Seconday: by somethign stimulating vommitign center in brain
^^Px:
-Normal in Small babies due to laying position+ Relaxation of LOS!
^^CF:(depends on Severity as it can be physiological and Px)
-Poor Weight Gain
-Esophagitis
-Neruobehavioral change (due ot pain)
-Persistent Resp Syndrome!
-Other Sx to mention ( irritation arching /gagging/feeding aversion/failure to thrive/Aspiration pneumonitis
^^Dx:
-Hx and Physical Examination
-Blood vommit
-Do Endoscopy!
-24 hours of PH Study!
-Empiral trial of acid suppresion with PPI for 4 W
^^Tx:(according to severity)
-avoid high volume food
-weight control
-small frequnrt meals
-Elevate Head
-PPI (proilosec), H2 Receptor Inhibiton