Scribd Logo
Upload

Welcome to Scribd!

  • 28 views

    Digestive System in The Pediatric Age Group: 4 Session

    Uploaded by

    Sven Ordanza
    This document summarizes several common digestive conditions seen in the pediatric population. It discusses meconium ileus and peritonitis, necrotizing enterocolitis, acute appendicitis, and several conditions of the anus and rectum including imperforate anus, anal fissures, hemorrhoids, and rectal prolapse. For each condition, it provides information on pathophysiology, clinical presentation, diagnostic evaluation, treatment approaches, and complications. The document aims to educate medical professionals on managing digestive issues commonly encountered in children.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Digestive System in The Pediatric Age Group: 4 Session

    Uploaded by

    Sven Ordanza
    28 views23 pages
    This document summarizes several common digestive conditions seen in the pediatric population. It discusses meconium ileus and peritonitis, necrotizing enterocolitis, acute appendicitis, and several conditions of the anus and rectum including imperforate anus, anal fissures, hemorrhoids, and rectal prolapse. For each condition, it provides information on pathophysiology, clinical presentation, diagnostic evaluation, treatment approaches, and complications. The document aims to educate medical professionals on managing digestive issues commonly encountered in children.

    Original Description:

    pedia gastro 4th session

    Original Title

    Pedia 4th Session

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document summarizes several common digestive conditions seen in the pediatric population. It discusses meconium ileus and peritonitis, necrotizing enterocolitis, acute appendicitis, and several conditions of the anus and rectum including imperforate anus, anal fissures, hemorrhoids, and rectal prolapse. For each condition, it provides information on pathophysiology, clinical presentation, diagnostic evaluation, treatment approaches, and complications. The document aims to educate medical professionals on managing digestive issues commonly encountered in children.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    28 views23 pages

    Digestive System in The Pediatric Age Group: 4 Session

    Uploaded by

    Sven Ordanza
    This document summarizes several common digestive conditions seen in the pediatric population. It discusses meconium ileus and peritonitis, necrotizing enterocolitis, acute appendicitis, and several conditions of the anus and rectum including imperforate anus, anal fissures, hemorrhoids, and rectal prolapse. For each condition, it provides information on pathophysiology, clinical presentation, diagnostic evaluation, treatment approaches, and complications. The document aims to educate medical professionals on managing digestive issues commonly encountered in children.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 23

    Digestive System in the

    Pediatric age group

    4th session
    Topics:
    Meconium Ileus and Peritonitis

    Acute Appendicitis

    Necrotizing enterocolitis

    Anus and rectum

    Imperforate anus

    Anal fissures

    Pruritus ani

    Rectal prolapse

    Hemorrhoids
    Meconium ileus
    Impaction of meconium; associated with Cystic fibrosis:
    absence of fetal pancreatic enzymes limits normal digestive
    activities of the intestines meconium becomes viscid and
    mucilaginous clings to intestinal wall inspissated and
    impacted meconium fills intestinal canal (lower part of the
    ileum) abdominal distention, vomiting

    Diagnosis:

    Palpation of doughy or cordlike mass of intestines

    Xray: loops vary in width and not evenly filled with gas; with
    contrast: bubbly, granular appearance

    Genetic testing to r/o CF


    Treatment:

    Gastrografin enema (high osmolality 1,900mOsm/L) draws


    fluid into the intestinal lumen (need to dilute with equal part of
    water to prevent DHN and shock)

    Laparotomy

    Complication: meconium peritonitis (treat by elimination of


    intestinal obstruction, drainage of peritoneal cavity)
    Neonatal Necrotizing Enterocolitis
    Most common life threatening emergency in the NB

    Mucosal or transmural necrosis of the intestines

    Cause: unclear; multifactorial

    Distal ileum and proximal colon

    Risk factor: prematurity

    Pathophysiology: intestinal ischemia, enteral nutrition


    (metabolic substrate), bacterial translocation

    Agents: E. coli, Klebsiella, Clostridium perfringens, S. epidermidis,


    astrovirus, norovirus, rotavirus)
    Intestinal ischemia leads to loss of bowel integrity
    inflammatory response development of necrotic
    segment gas accumulates into the submucosa of the
    bowel pneumatosis intestinalis necrosis to perforation,
    peritonitis, sepsis and death
    Onset: 2nd or 3rd week of life or late (3mos) in VLBW infants
    Clinical manifestations: nonspecific: lethargy, temperature
    instability, abdominal distention, gastric retention
    Diagnosis: plain abdominal radiographs (ant-posterior cross
    table lateral or lateral decubitus); hepatic UTZ portal
    venous gas
    Treatment: no definitive treatment

    Cessation of feeding (NPO), NG decompression,


    administration of IVF, blood cultures, start antibiotics

    Surgery: Explorative laparotomy

    Peritoneal drainage (cautiously considered but has


    complications death or neurodev. Outcome)

    Pot-op complications: wound dehiscence, stomal problems,


    intestinal strictures, short bowel syndrome
    Acute Appendicitis
    Pathophysiology: bacterial invasion of appendiceal wall
    Luminal obstruction increase intraluminal pressure from
    bacterial proliferation and mucus secretion leads to
    lymphatic and venous congestion and edema impaired
    arterial perfusion ischemia , inflammation, necrosis
    12-18 yrs. Old
    Signs and symptoms: classic or atypical (absence of fever,
    Rovsings / Psoas/ Obturator/Guarding) or variable; abdominal
    pain, nausea and vomiting, low grade fever to severe
    manifestations (24-48hrs. later); perforation (beyond 36-48 hrs.)
    Localized abdominal tenderness single most reliable finding
    (McBurneys)
    Diagnostic findings
    CBC, UA, C-reactive protein

    Radiologic studies: Plain films, UTZ, CT scan (gold standard imaging


    study)

    Complications: wound infection and intraabdominal abscess

    Treatment: Appendectomy; laparoscopic appendectomy; interval


    appendectomy; antibiotics and interventional radiology (drainage)

    Antibiotics: Cefoxitin (nonperforated); perforated (Ampicillin,


    Gentamicin and Clindamycin or Metronidazole) or (Ceftriaxone,
    metronidazole or Ticarcillin-clavulanate plus Gentamicin)

    HIGH LEVEL OF SUSPICION + COLLECTIVE REVIEW OF LABS +


    SURGICAL REFERRAL
    Surgical conditions of the
    Anus and Rectum
    Anorectal Malformations
    Defined by the relationship of the rectum to the sphincter
    complex (mass of muscle fibers: puborectalis, levator ani,
    internal and external sphincter and superficial external
    sphincter)

    1/3,000 live births

    Concerns on bowel control, urinary and sexual function


    Embryology of Anorectal
    malformations
    2nd week AOG hindgut forms as part of the primitive gut
    Day 13 hindgut ventral diverticulum (allantoin or primitive
    bladder) junction of the hindgut and allantoin become
    the CLOACA (where genital, urinary and intestinal tubes
    empty); covered by a cloacal membrane
    7th week AOG urorectum septum descends and form
    lateral ridges to divide the cloaca into ANTERIOR and
    POSTERIOR
    8TH week AOG Posterior portion OPENS (anal membrane)
    Associated anomalies: VATERR and VACTERL
    Imperforate Anus
    Inspection of the perineum of the NB

    Normal position of the anus: approx. halfway (0.5


    ratio)between the coccyx and scrotum or
    introitus

    A. LOW lesion rectum has descended into the


    sphincter complex

    B. HIGH lesion rectum has not


    LOW lesion associated with perineal fistula or if
    no fistula, thisckened raphe or bucket handle
    HIGH lesion associated with fistula (boys:
    retrobulbaurethral, rectoprostaticurethral,
    rectovesicular) (girls: rectovaginal fistula)
    PERSISTENT CLOACA treatment is repositioning
    the urethra, vagina and rectum; rewuire a
    COLOSTOMY before repair
    RECTAL ATRESIA features a normal anal canal
    and anus; rectal temperature: obstruction 2 cm
    above skin level: protective colostomy
    Approach to patients with
    Anorectal Malformations
    Clues:

    Failure to pass meconium

    Perineal inspection

    - Do prone cross table lateral films

    Plain xray of the entire sacrum

    Abdominal-pelvic UTZ and VCUG

    Other anomalies: pass NGT (esophagus); 2-D-echo


    Operative Repair
    LOW lesion if < 1cm from the skin minor perineal
    procedure or do simple perineal anoplasty
    - dilatation with HEGAR DILATORS
    - if with fistula: posterior approach of PENA ffed by post-op
    dilation
    HIGH lesions colostomy 1st then do PSARP (posterior sagittal
    anorectoplasty) at 1 year old; close colostomy 6 wks later or
    Laparoscopic technique
    OUTCOME: ability to achieve rectal continence (low > high);
    ACE or antegrade continence enema
    Anal Fissures
    Minor lacerations of the anal mucocutaneous junction

    Unknown but usually due to forceful passage of a hard stool in <


    1yr old infants

    Inspection of perineal area skin tags (epithelialized


    granulomatous tissue formed because of chronic inflammation)

    Goal: ensure soft stool (avoid overstretching of anus)


    dietary and behavioral modification
    stool softeners (water intake and oral polyethylene glycolate)
    surgical intervention not indicated or supported by scientific
    evidence (internal and sphincterotomy or excision of the fissure)
    Perineal Abscess and Fistula
    Unknown etiology

    Mixed aerobic (E. coli, K. pneumoniae, S. aureus) and anaerobic


    (Bacteroides, Clostridium, Veillonella) or associated with IBD,
    leukemia, immunocompromised states

    Ssx: low grade fever, mild rectal pain, areas of perianal cellulitis

    Treatment: self limiting condition conservative mgt; antibiotics


    are not useful except for systemic illness

    - extreme patient discomfort abscess is drained under LA;


    Fistulotomy (unroofing or opening), Fistulectomy or placement of
    SETON
    Hemorrhoids
    Does not occur in children and adolescent
    Related to a diet deficient of fiber and poor hydration
    If present in younger children: portal HPN
    2 types: EXTERNAL below the dentate line; extreme pain and
    itching due to acute thrombosis
    INTERNAL above the dentate line; bleeding, prolapse and occ.
    Incarceration
    Treatment: conservative mgt (diet, avoid straining/prolonged
    sitting) discomfort (hot SITZ baths, topical analgesics);
    THROMBECTOMY excruciating pain;
    rubber band ligation, open excision and use of transanal stapling
    device (painful internal hemorrhoids)
    Rectal Mucosal Prolapse
    Exteriorization of rectal mucosa through the anus

    PROCIDENTIA all layers of the rectal wall

    Idiopathic; onset: 1-5 yrs (standing) resolves in 3-5yrs.

    Other predisposing factors: intestinal parasite, malnutrition,


    diarrhea, UC, pertussis, CF, chronic constipation,
    meningocoele, Ehlers-Danlos syndrome

    Occurs during defecation


    Treatment: reduction of protrusion push it back into the
    rectum, aided with warm compress

    Conservative management: careful manual reduction


    avoid excessive pushing during BM; use of laxatives or stool
    softeners; treatment of intestinal parasites; surgical treatment
    (insertion of a Theirsch wire or Altemeir perineal
    rectosigmoidoscopy); others: sclerosing injections, linear
    cauterization
    Pruritus Ani
    Enterobiasis - nocturnal perianal pruritus
    (Mebendazole100mg/day/Albendazole
    400mg/day/Pyrantel pamoate 11 mkd)

    Cholestasis xanthomas (accumulation of cholesterol bile


    acids (Urodeoxycholic acid 15mkd)

    Liver disease

    Opioid use
    End of 4th session

    You might also like