GASTROINTESTINAL PEDIATRIC DISORDERS.pptx

Commonest world burden

1. GASTROINTESTINAL DISORDERS

2. MECONIUM ILEUS This is a bowel obstruction that occurs when the meconium in the baby’s intestine is even thicker and stickier than normal meconium creating a blockage in a part of the small intestine called the ileum Signs and symptoms - earliest signs are abdominal distention, bilious(green) vomit and failure to pass meconium

3. MECONIUM ILEUS (cont) Cause. Hyper viscous mucous secreted by abnormal intestinal glands coupled with deficiency of pancreatic enzymes - your doctor will order n X-ray which will show dilated intestinal loops Treatment: - nil per os - IV fluids - Obstruction may be relived by giving enema with a dilute radiographic contrast medium plus N- acetylcysteine lavage of the proximal and distal loops which will liquefy the meconium

4. IMPERFORATE ANUS This is a defect in which there is no opening where the anus is supposed to be Cause: - unknown The defect may be low or high. In low defects, the colon remains close to the skin. High defects, the colon is higher up in the pelvis. There might be a fistula connecting the rectum and bladder, vagina and the urinary tract joined into a single channel. Other associated anomalies are spina bifida, heart problems , tracheoesophageal fistula and oesophageal atresia ,

5. DUODENAL ATRESIA Absence or complete closure of a portion of the duodenum Signs and symptoms Abdominal distension and vomiting Treatment: Nil per os NGT to compress the stomach IV fluids Surgical intervention

6. EXOMPHALOS Weakness of the baby’s abdominal wall where the umbilical cord joins. This weakness allows the abdominal contents to protrude outside the abdominal cavity where they are contained in a loose sac that surrounds the umbilical cord Cause Unknown

7. cont Treatment: Surgical intervention

8. HIRSHSPRUNG’S DISEASE Absence of nerve cells in a segment of the bowel wall that leads to a peristalsis and functional obstruction History: - delay in passage of meconium, and eventually bile stained vomiting Physical examination: - Abdominal distension, empty rectum on rectal examination

9. Investigations: Abdominal X-rays shows dilated loops of bowel and airless rectum. Rectal biopsy will show an absence of the nerve cells. Management: - colostomy followed at a later stage by resection of the abnormal bowel and closure of the colostomy

10. CLEFT LIP/ CLEFT PALATE Cleft lip: Hypoplasia of the mesenchymal layer resulting in a failure of the medial nasal and the maxillary processes to join. Cleft lip: failure of the palate shelves to approximate or fuse Cause: Maternal drugs eg anticonvulsants, methotraxate , genetic factors especially in cleft lip with or without cleft palate than cleft palate alone

11. Clinical: May vary from small notch to a complete separation extending to the floor of the nose May be unilateral(more often on the left side)or bilateral May involve only the uvula or may extend into or through the soft and hard palate

12. Care: Use a specialized cleft palate bottle Baby to be positioned in upright sitting position to prevent the milk from flowing back into the nostrils Keep the bottle fitted so that the nipple is always filled with milk and pointed away from the cleft

13. Complications: Feeding difficulties Recurrent serous otitis media Hearing and language delay Speech problems –hyper nasality and articulation errors Dental and orthodontic complications Psychological problems

14. Treatment: Cleft lip can be corrected in the few months of life. Cleft palate before 18 months followed by speech therapy and dental care

15. CONGENITAL MALFORMATIONS OF CENTRAL NERVOUS SYSTEM HYDROCEPHALUS: A condition in which an accumulation of cerebrospinal fluid(CSF) occurs within the brain. This excess fluid causes an abnormal widening of the spaces in the brain called ventricles Causes: 1. Problems of absorption of CSF 2.Problems of absorption of CSF 3. Over production( rare) Can be congenital or acquired

16. Congenital: in some babies the condition is genetic such as congenital aqueduct stenosis , neural tube defects(like spina bifida) Acquired: Tumours , infection, bleeding inside the brain, trauma prematurity Symptoms: -full or bulging fontanelle (soft areas on top of the head) -i ncreased head circumference -Seizures

17. -bulging eyes and inability look upward with the head facing forward (sun setting) -prominent scalp veins -increased irritability -high pitched cry -projectile vomiting -d evelopmental delay

18. Diagnosis: -prenatal ultrasound (note hydrocephalus does not develop until the third trimester) -MRI -CT scan TREATMENT: - depends on the extent of the condition - type or cause -baby’s tolerance for specific medications or procedures

19. Surgical intervention; The goal is to reduce the pressure in the baby’s head and to drain the CSF. The surgery may be needed which involve placing a mechanic shunting device into the baby’s head to help drain the extra CSF to another part of the body to be absorbed especially to the abdominal cavity Complications: Infection Shunt malfunction which may lead to under draining or over draining bleeding

20. Medical treatment: Acetazolamide and frosemide treat post haemorrhagic hydrocephalus ion neonates. Both are diuretics but also appear todecrease secretion of CSF at the level of choroid plexus. Both can be used in combination. Medication for treatment of hydrocephalus is controversial. It should only be used as a temporary measure for post haemorrhagic hydrocephalus in neonates or when shunting is not possible