Preparation: of LI Examination :(C)
Cleaning :( Rectosopy/RAM/Anus op)
Syphon :((irigoscope/US/Fibrocolon of LI)
CI: H2O toxicity/ LI perforation!
I( Same as syphon)
CI: Mechanic/ Dynamic Ileus / GItis/ Perforation of Intesitine/toxic collitis!/Toxic Dilatation of LI /<10 YO/
I: LI Examination , Operation of LI
CI (same as Washing)
4- Med Per Rectum :
I (Rectosopy/RAM/Anus op)
I-Sx of Stool continence:
II-Sx of Evacuation disorder:
- stool in abdomen
-accumilation of Stool in Rectum
-Episodic evacuation of Large Volume
-Pain during Eveaution
-Blood/mucous in Stool
-Frequent Resp Disease
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
^^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.
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
-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
-Start when the dose of stimulant laxatives is approximately one-third of
the starting dose
-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!!
-aganglionic bowel is Unable to Relax ( PIC)
1-No PS ganglia plexus in submucosa
2-Hyperplasia of neuronal plexus in Mucosa!
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)
V-Ribbon Like Foul Smelling Stool+ RECTAL AMPULE IS EMPTY!!!
VI-Clinical & Radiological Sign of Bowel Perforation!
I-RADIOLOGICAL =Contrast Enema(XRAY)
Contrast Enema :
( Not effective in Newborn)
( Ultrashort aganglionic segment)
( Total aganglionic colonic)
-HD Child as Increase contraction of Anal Canal+ No Relaxation of Internal sphincter
-Surgical Resection of aganglionic Portion!+Restore Intestine whole!(anastomeses)
Indication For colostomy
-Signs of Bowel Obstruction for Newborn
-Incidental Reveal of HD
-Continue oral Feeds
-Daily emptying of bowel and saline!
-Incontance due to Organic Cause
-Incontance without organic cause in children >4
(when child does not
stop evacuation from the infant age)
(when disorders of
evacuation occur later)
-Changes after operations on anus and
rectum or injuries
-Psychologic and neurologic disorders
Subclinical incontinence -intermittent smearing
I°- gas incontinence
II°- incontinence of liquid stool
III°- incontinence of hard stool
Digital rectal examination
- (-)sacral-coccygeal angle
- ↑ straight rectum
-deep Douglas cavity
-(+) sigmoid + mesenterium
-more mobile rectal mucosa
-wrinkles are less expresed
-long sitting on the toilet
-neurologic disorders (myelomeningocele)
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)
-ARA without fistula
Lower > High>Middle
-Boys: Anorectal cutanous Fistula(#1
1-Boy: ARA with Recturthral or Rectavesicular fistula
(Anal Atrseia+Anocutnaous fistula)
(High anorectal Anomaly)
***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
-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
-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
-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!
-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
-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
-Short + Narrow(10 cm)
-Low development of Muscle of muscle and elastic tissue
-Lack of Glands
-Good blood supply
-High Location of Esophageal Entrace
Feeding = 30ml + (30mkx age in months)
-Crura of diaphragm are Not closed Enough! Only till age 12-13
-Cardia of stomach is not very muscular
-Esophagus pulls Cardia Up
-Pyloric Sphincter Is Well developed
-Stomach is in vertical position
-Villi in SI are not developed liek adult
-Th SI to LI connection also not developed( valve of Cecum)
-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!
-Very small 2-3 G
-4 x increas by Year 1
-adults 30 x
-Lobular Pancrease undeveloped!
-Islet of langers poducr insuline are Dominant
-Infla of Oral cavity
-SX: Hyperemia of oral Misa
-Types: Light / int / Hard!
-Hypermic Oral Mucousa
-desquamation of epithelium white dotted semonila in 2-3 Days!
-Local lesion mere toether to form mebrnae like scurf!
-esat taken off
-Membrane Like Scurf
-harderer to remove with possible bleeding
-Oral mucosa/ soft+ hard palate + uvula + posterior phanryx+Jowel+ Lips!
-Tingle burning snesation in mouth
-increase Submaxillary LN
-if Not Tx---->Candida Sepsis
1-Culture Show large grown colonie
2- Microscopic Test of smear-Banks + Pseumoceelis
3-Skin Test with allergens of barm!
-Avoid Sour substance as it liks thm
-UV radiation .Iodine, Antifungal X
-Tx of 2nd disorder of disgestive edocime sustec
-STOP ax / Hormone
-Mouth Wash 2-3% Soda solution 5-6 x Day!
***ACUTE GASTRITIS (exogenous origin)
Causes Could be any # But Mainly in Children
-Pain Not spreaded
-Pain Not spread
1 Time Vommit+ Relief
Loose Stool with no Px sign
-Initial Liquird in < 3 H from Sx
-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!
Infantile Colic(+ Q&A)
(Rule of 3)
● ↑ motilin
● ↑ alpha lactalbumin
● psychosocial stress during pregnancy
● immaturity of nervous system
● psychological atmosphere in the family
-Bringing legs over abbomen
-increased Gas in rectum
-Increase/ Decrease Meal
-Raise kid after feeding
-Education of PArent
-Anti cholinergic X
- 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.
2-Lab: CBC, Hb, ESR, amylase, lipase
3. Abdominal US, x -ray
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
Primay: Cause is only lower Esophageal disorder
Seconday: by somethign stimulating vommitign center in brain
-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
-Neruobehavioral change (due ot pain)
-Persistent Resp Syndrome!
-Other Sx to mention ( irritation arching /gagging/feeding aversion/failure to thrive/Aspiration pneumonitis
-Hx and Physical Examination
-24 hours of PH Study!
-Empiral trial of acid suppresion with PPI for 4 W
^^Tx:(according to severity)
-avoid high volume food
-small frequnrt meals
-PPI (proilosec), H2 Receptor Inhibiton