gastrointestinal dysfunction in children.pptx
TRANSCRIPT
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GASTROINTESTINAL DYSFUNCTION
IN CHILDREN
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FAILURE TO THRIVE
Deceleration fromestablished growthpattern or consistently
below the 5thpercentile for heightand weight on standardgrowth charts;
sometimesaccompanied bydevelopmental delays
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Spitting up or regurgitation
Passive transfer of gastric contents into the
esophagus or mouth
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Vomiting
Forceful ejection of gastric contents; involves
a complex process under central nervous
system control that causes salivation, pallor,
sweating, and tachycardia; usually
accompanied by nausea
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Projectile vomiting
Vomiting accompanied by vigorous peristaltic
waves and typically associated with pyloric
stenosis or pylorospasm
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Nausea
Unpleasant
sensation vaguely
referred to the
throat or abdomen
with an inclination
to vomit
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Constipation Passage of firm or
hard stools orinfrequent passageof stool withassociated
symptoms such asdifficulty expellingthe stools, bloodstreaked stools,and abdominal
discomfort
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Encopresis
Overflow of incontinent stool causing soiling;
often caused by fecal retention or impaction
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Diarrhea
Increase in the numberof stools with increasedwater content as aresult of alterations ofwater and electrolytetransport by thegastrointestinal(GI)tract; may be acute orchronic
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Hypoactive, hyperactive, or absent
bowel sounds
Evidence of intestinal motility problems that
may be caused by inflammation or obstruction
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Abdominal distension
Protuberant contour of the abdomen that may
be caused by delayed gastric emptying,
accumulation of gas or stool, inflammation, or
obstruction
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Abdominal pain
Pain associated with the abdomen that may
be localized or diffuse, acute or chronic; often
caused by inflammation, obstruction or
haemorrhage
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Gastrointestinal bleeding
Bleeding from an upper or lower GI source;
may be acute or chronic
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Hematemesis
Vomiting of bright red blood or denatured
blood that results from bleeding in the upper
GI tract or from swallowed blood from the
nose or oropharynx
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Melena
Passage of dark-colored, tarry stools caused
by denatured blood, suggesting upper GI tract
bleeding or bleeding from the right colon
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Hematochezia
Passage of bright red blood per rectum,
usually indicating lower GI tract bleeding
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Jaundice
Yellow coloration of the skin and sclerae
associated with liver dysfunction
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Dysphagia
Difficulty swallowing caused by abnormalities
in the neuromuscular function of the pharynx
or upper esophageal sphincter or by disorders
of the esophagus
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Dysfunctional swallowing
Impaired swallowing resulting from central
nervous system defects or structural defects of
the oral cavity, pharynx or esophagus; can
cause feeding problems or aspiration
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Fever
Common manifestations of illness in children
with GI disorders; usually associated with
dehydration, infection or inflammation
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GASTROINTESTINAL DIAGNOSTIC
PROCEDURES
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Stool examination
Gross, microscopic,
and chemical
examination of stool
specimen
to detect normal and
abnormal
constituents
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Ova and parasites (O&P)
Microscopic examination of stool contents for
parasites of their eggs
To aid in diagnosis of parasitic infection
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Bacterial Culture
Sample contents grown on culture medium
Detect bacterial pathogens in stool
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Stool assay for viral pathogens
ELISA(enzyme-linked immunosorbent assay)
Detect viral pathogens in stool
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Quantitative fat
Detection of abnormal quantities of fat in
stool
Diagnosis of pancreatic insufficiency or
malabsorption by measuring stool-reducing
substances
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Reducing substances
unabsorbed sugars measured in stool
To detect elevated levels of reducing
substances in stool, which are abnormal and
suggest carbohydrate malabsorption
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pH
Stool pH
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Occult blood guaiac test
Stool smeared on guaiac-impregnated paper,
and 2 drops of developing solution added to
reverse side; blue color indicates hemoglobin
detect presence of blood in stool
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Serology test
Blood test for antibody to H.pylori
assess for exposure to H. pylori
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Urea breath test
Collection of breath after ingestion of isotopic
urea with either carbon 14 or carbon 13;
measures labelled carbon dioxide in expired
air
Determine if there is active infection with
H.pylori in the stomach
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Urease test
Biopsy of stomach, which is stained and
placed in Christensen urea medium which
turns color in presence of H.pylori
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Pancreatic function
pancreatic secretions collected via duodenal
tube under stimulated conditions and
analyzed for water, ions and enzymes
determine functional secretory capacity of
pancreas
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D-Xylose absorption test
D-xylose solution administered orally; serum
levels of D-xylose measured at 30, 60, 90, and120 min
urine collected for total of 5 hr. to measure D-xylose excretion
Evaluate absorptive capacity of small intestinalmucosa
diagnose small-bowel malabsorption caused
by celiac disease
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Hepatobiliary scintigraphy
Nuclear medicine study
Radiopharmaceutical administered
intravenously, then sequential images of liver,
biliary system, and bowel obtained
evaluate conditions of liver and biliary tract
abnormalities and gallbladder disease
diagnosis and monitoring of these conditions,
such as biliary atresia
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Breath hydrogen test
non-invasive study to asses for carbohydrateintolerance
Hydrogen is generated in colon by bacterialfermentation of undigested carbohydrates and is
then absorbed into blood, where it diffuses intoexpired air via lungs
evaluate bacterial overgrowth, lactase or sucrase-isomaltase deficiency
evaluate malabsorption or bacterial overgrowthby detecting rise in expired hydrogen after oralloading with specific carbohydrate
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Esophageal pH monitoring
probe that measures pH placed through nose
into distal esophagus and records pH over
time
determine frequency and duration of gastric
acid reflux into the esophagus
establish association between patient
symptoms(pain, apnea, failure to thrive,
asthma, wheezing) and acid reflux
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Upper GI, colonoscopy; flexible
sigmoidoscopy, anoscopy
Endoscope introduced into area to be
examined
Endoscope has flexible-tip light source and
aspiration and instrument channel
directly visualize GI tract to evaluate
abnormalities, detect lesions, obtain biopsies
perform therapeutic procedures
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Ultrasonography
To locate, measure and delineate abdominal
organs
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Computed tomography (CT)
to visualize horizontal and vertical cross
section of abdomen at any axis
To distinguish density of various tissue
structure or organs
To detect blunt trauma to internal organs and
masses
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( )
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Magnetic resonance imaging (MRI)
to visualize internal body structures in any
plane; permits soft tissue discrimination
unavailable with many technique