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)


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/ 

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:

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

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.


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


-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!

^^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!


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


-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)

-Anal malformations

-Changes after operations on anus and
rectum or injuries


-Psychologic and neurologic disorders

-Chronic constipation

Subclinical incontinence -intermittent smearing

I°- gas incontinence

II°- incontinence of liquid stool

III°- incontinence of hard stool



Digital rectal examination


Rectoanal manometry



^^Predisposing factors:

^^Factors, stimu
- (-)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)
-cystic fibrosis

-rectoanal manometry

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:
( Rurethra.,Rvesiculat)
-ARA without fistula
-Rectal Atresia


(without fistula)

-Rectal Atresia


-Ana agenses
(no fistula)


-Anus Agensis
(no fistula

-Anal Membrane
-Anal Stensosis
-Anacutanous fitua


Lower > High>Middle

-Boys: Anorectal cutanous Fistula(#1
-Girls:Anovestibular  Fistula(#1)

1-Boy: ARA with Recturthral or Rectavesicular fistula
2Girl: Rectovaginal

-CF(see it)
-Urine Test
-Inverogram(12 H)
(Anal Memebrane)
(Anal Atrseia+Anocutnaous fistula)
(High anorectal Anomaly)
(Anorectal Agensis+Rectovesitbular)


***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!

-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
-Thin walls
-Lack of Glands
-Good blood supply
-High Location of Esophageal Entrace
-Physiologically undeveloped

Feeding = 30ml + (30mkx age in  months)


-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


-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

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 

-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

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 heugeie!
-Mouth Wash 2-3% Soda solution 5-6 x Day!

***ACUTE GASTRITIS (exogenous origin)

Causes Could be any # But Mainly in Children
Food posionng
-Raw Fruit
-Chemical Overating
-Old Food

-Pain Not spreaded
-Poor localied
-Pain Not spread
-Poorly Localized
1 Time Vommit+ Relief
2-3 X
Loose Stool with no Px sign

Some Mucous!

-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:
Non Infectious
-H Pylori
(epigastric pain)
( fullness)
( N+V)
( flatulence)
( malaise)
Epigastric tenderness
Abd pain/Bloating


3-Gastric biopsy
Triple Tx

Infantile Colic(+ Q&A)
(Rule of 3)

-90% ??
● ↑ motilin
● ↑ alpha lactalbumin
● psychosocial stress during pregnancy
● immaturity of nervous system
● temperament
● passive smoking
● psychological atmosphere in the family

-distended abdomen 
-pain Facies
-Bringing legs over abbomen
-increased Gas in rectum

-CLinical Features:

Non X
-Swing baby
-Increase/ Decrease Meal
-Change meal
-Raise kid after feeding
-Education of PArent
-Anti cholinergic X


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 

1-Past illnesses, 
2-Lab: CBC, Hb, ESR, amylase, lipase 
3. Abdominal US, x -ray
 4. Esophagogastroduodeno

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
-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

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