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Child with gastrointestinal dysfunctions

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Title: Child with gastrointestinal dysfunctions


1
Child with gastrointestinal dysfunctions
  • Emad Al Khatib, RN,MSN,CNS

2
Appendicitis
  • The appendix is a small finger-shaped tube that
    branches off the first part of the large
    intestine. The appendix can become inflamed or
    infected causing pain in the lower right part of
    the abdomen.

3
  • Appendicitis is when the appendix becomes blocked
    and inflamed. The appendix is a small pouch
    attached to the large intestine, whose function
    is not well known.

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Causes, incidence, and risk factors
  • Appendicitis is one of the most common causes of
    emergency abdominal surgery in the United States.
    Appendicitis usually occurs when the appendix
    becomes blocked by feces, a foreign object, or
    rarely, a tumor .

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Symptom of Appendicitis
  • Appendicitis is the most common surgical
    emergency seen in hospitals. Six of every hundred
    persons will get it at some point in their life.

8
  • It's use is unknown but sometimes it gets blocked
    by stool passing by. Once this happens bacteria
    in the stool start to multiply and cause an
    infection of the appendix. It's like having a
    river of stool passing by. If it stops it gets
    stagnant just like a real pool of water allowing
    bacteria to grow - which is why stagnant water
    starts to smell bad.

9
The symptoms of Appendicitis
  • Abdominal pain-Pain may begin in the
    upper-middle abdomen (epigastric), then develop
    to sharp localized pain
  • Pain may shift from the epigastric area to become
    most intense in the lower right side of the
    abdomen ("typical" case), tenderness of this area
    is common
  • Pain initially may be vague, but becomes
    increasingly more severe

10
  • Point tenderness, especially over the right
    lower quadrant of the abdomen
  • Nausea and vomiting
  • Fever usually occurs within several hours
  • Abdominal pain may be worse when walking or
    coughing. The patient may prefer to lie still
    sudden jarring motions or bumping can cause pain.

11
  • Later symptoms
  • Fever
  • Loss of appetite
  • Nausea
  • Vomiting
  • Constipation
  • Rectal tenderness
  • Chills and shaking

12
  • Additional symptoms that may be associated with
    this disease include bloody urine (microscopic
    hematuria).

13
Signs and tests
  • With appendicitis, pain increases when the
    abdomen is gently pressed and then the pressure
    is suddenly released. Touching the abdomen may
    cause a spasm of the abdominal muscles if
    peritonitis is present. Rectal examination may
    also cause pain, localized on the right side.

14
  • The health care provider may perform other tests,
    including having the patient lie on his or her
    back with the following
  • The right leg is extended straight up.
  • The knee and hip are flexed, and then the leg is
    rotated inward and outward.
  • The lower left portion of the abdomen is palpated.

15
  • Each of these actions will cause pain in the
    lower right quadrant of the abdomen of a person
    with appendicitis.
  • Appendicitis may be strongly suspected based on
    the following tests
  • CBC, often shows an increased white blood cell
    count
  • Abdominal sonography
  • Abdominal CT scan

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  • Appendicitis is diagnosed from a history of the
    above symptoms and by pressing with his/her hand
    on the tummy. If there is pain over the right
    lower abdomen, especially if worse on jerking the
    area, appendicitis is strongly suspected - except
    in females where ovaries and other structures can
    also lead to pain in this area.

18
  • The surgeon may confirm the diagnosis during an
    exploratory laparotomy. The operation may be done
    as an open procedure or through a laparoscopic
    approach that uses a small camera and requires a
    smaller incision.
  • It is important to realize that not all surgical
    explorations for appendicitis reveal an abnormal
    appendix.

19
  • Approximately 10-15 of operations for suspected
    appendicitis reveal either no obvious
    abnormality, or a disease process other than
    appendicitis. This relatively high rate of
    "negative appendectomies" is tolerated because
    the consequences of not diagnosing appendicitis
    in patients with abdominal pain can be severe and
    sometimes life-threatening.

20
  • If an operation for suspected appendicitis
    reveals a normal appendix, the surgeon will
    probably remove the appendix anyway, and then
    explore the rest of the abdomen for other
    possible causes of pain. In some cases, this may
    require extension of the surgical incision.

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inflammatory bowel diseases
  • These diseases each exhibit very different
    symptoms that make them appear to be completely
    unrelated. However, they all have one
    commonality. They are all autoimmune disorders in
    which the body's immune system has been
    accidentally triggered to attack a specific
    protein tissue of your own body.

23
  • The original cause is most likely Leaky Gut
    Syndrome. Therefore, autoimmune diseases such as
    arthritis, multiple sclerosis and lupus have a
    very close connection with inflammatory bowel
    diseases. Many people exhibit several of these
    diseases for this reason.

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  • Doctors will typically prescribe drugs to treat
    the multitude of possible symptoms which leads
    people to think the diet should be different for
    each. Doctors also prescribe drugs to suppress
    the immune system in an attempt to stop the
    attack. Most of these drugs have very harmful
    side effects.

26
  • This diet program addresses the root cause by
    eliminating those foods that trigger the immune
    system to attack the body. Eating one bite of a
    "Forbidden Food" as listed below can trigger an
    autoimmune flare that will last for weeks.
    Therefore, strictly compliance with this diet
    program is required.

27
  • Most people suffering from chronic intestinal
    problems have been found to be addicted to the
    very foods that made them sick and continue to
    prevent their recovery. These people typically
    refuse to change their nutritional philosophy.

28
Pyloric stenosis
  • The stomach connects the esophagus to the small
    intestines The pylorus of the stomach is a small,
    narrow muscular sphincter through which food
    passes into the duodenum after it has been
    partially digested in the stomach.

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  • Pyloric stenosis is a congenital defect in which
    the opening of the pylorus is too narrow. Food is
    thus unable to pass into the duodenum. Children
    with pyloric stenosis usually manifest forceful,
    "projectile" vomiting within the first 1-2 weeks
    of life.

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  • After general anesthesia is administered and the
    patient is in deep sleep and pain free, the
    abdomen is cleaned and draped. A small incision
    is made in the abdomen.

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  • The surgeon makes a cut into the pyloric muscle
    (stomach outlet) down to the mucosa, the inner
    layer of the stomach, thus releasing the
    restriction. No tissue is removed and the stomach
    lining is not opened. The pyloric muscle returns
    to normal size with time.

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36
  • Children usually recover quickly. There are no
    long-term disadvantages to surgery. One to two
    days of hospitalization may be all that is
    required. Feedings by mouth are usually delayed
    for 12 hours after the operation. The stomach
    requires this short time to regain its ability to
    contract and to empty.

37
  • Most infants can advance from clear liquids to
    normal amounts of formula or breast feedings
    within 36 hours after the operation. Vomiting of
    one or two feedings in the first 24 to 48 hours
    after the operation is not uncommon.

38
  • Paper tapes will cover a small incision located
    on the childs right upper abdomen. A firm ridge
    may appear at the incision site, which is no
    cause for concern. Avoid bathing for at least 5
    days after the operation. Sponge bathing is
    permitted the day of discharge. Carefully pat dry
    the incision tapes after the sponge bath.

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Celiac disease
  • is a life-long autoimmune disorder of the
    intestinal tract, which may have its onset in
    childhood or adulthood. (Celiac disease occurs
    with greater incidence in persons with other
    autoimmune disorders.)
  • The disorder is characterized by sensitivity to
    the predominant wheat protein, gluten (or more
    specifically, the gliadin portion of the
    molecule).

41
  • The disease varies in severity with classic
    symptoms of malabsorption noted in some persons
    while others remain completely asymptomatic.

42
  • The disease has also been known as celiac sprue,
    nontropical sprue and gluten sensitive
    enteropathy. It is a genetic condition in which
    the immune system damages the small intestine
    when gluten enters the digestive system.

43
  • The body produces immune cells, which damage the
    villi. The villi in a healthy intestine have the
    appearance of a deep pile carpet. All these villi
    give the small intestine enormous absorptive
    surface.

44
Gluten
  • Gliadin, a protein portion of gluten, is the
    specific offender. Gluten is found in wheat,
    oats, rye.
  • A gluten-free diet is not simply avoidance of
    bread and pasta. Starch, flour or additives from
    the toxic grains are added to many prepared foods
    and some medications.

45
  • Corn and rice and their byproducts contain no
    toxic gluten and are considered safe.

46
Celiac disease
  • Celiac disease is an absorption problem found in
    the small intestinal tract.  Celiac is caused by
    an excessive amount of mucous secreted by the
    cellular walls of the tract.  This mucous is
    produced in abundance to protect the already
    deformed and damaged cellular surface due to
    bacterial attacks and or parasite attacks

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  • This typically occurs in the lower portion of the
    small intestinal tract because this area is the
    farthest away from the hydrochloric acid of the
    stomach.
  • The organism either travel from the large colon
    into the small intestinal tract which is only
    achievable if the large intestinal tract is
    extremely dirty and constipated,

49
  • or through ingesting food that contained the
    germ.  Low levels of stomach acid may allow these
    microbes to survived the secretion of
    hydrochloric acid.
  • An absorption problem develops when the mucous of
    the tract becomes too deep to allow nutrients to
    be absorbed.

50
  • This causes malnutrition in the body and weakens
    the immune system leaving the individual
    susceptible to many viruses.  The whole body
    becomes weakened as essential vitamins and
    mineral are not being absorbed.   

51
  • Nutrients  The best nutrient for protecting the
    lower intestines is vitamin B12 in the
    methylcobalmin form.  This type of B12 does not
    require any breakdown by the liver and is ready
    for absorption into the blood system via the
    mouth, stomach and duodenum.  From here the B12
    will make its way to the tissues that require the
    vitamin and the individual get healing from the
    inside out.

52
  • Suggestion  Diet free of sugar, starches, milk
    and gluten products such as wheat and rye. 
  • Exclude refined products e.g. sugars, flour,
    table salt as it contains up to 70 sugar!  Sea
    salt from a health food store is a better choice
    as it contains many minerals.

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Complications of CD
  • The disease usually is worse in the first
    portions of the small intestines. When only the
    top of the small intestine is smooth (flattened
    villi), gastrointestinal symptoms may not be
    present.
  • There may or may not be discomfort, bloating or
    gas, possibly no diarrhea and/or constipation.

55
  • The presentation of CD is very serious (in spite
    of no intestinal symptoms) because many nutrients
    are absorbed in this area of the digestive
    system.

56
  • Vitamin B1 and B12 (numbness in extremities),
    Iron (anemia), Folic Acid (birth defects),
    Calcium and Vitamin D (bones and muscles),
    Vitamin E (nerves), Vitamin A (eyes) and Vitamin
    K (blood clotting) may be malabsorbed. That is,
    the nutrients from food and supplements are not
    absorbed properly.

57
  • When a larger portion of the small intestine is
    damaged, gas, bloating and discomfort can be
    present in addition to the malabsorption of
    nutrients.
  • Until recently diagnosis was made when much of
    the intestine had been damaged, diarrhea and
    wasting appear in addition to malabsorption of
    nutrients.

58
  • Additional explanation of the complications of
    malabsorption include (besides weight loss,
    vitamin and mineral deficiencies) coagulopathy,
    osteopenia, bone fractures, lymphocytic gastritis
    and lymphocytic colitis/intestinal strictures and
    ulcerations may occur.
  • Other complications include refractory and
    collagenous sprue as well as malignancy.

59
  • There is a three to four-fold increased incidence
    of all malignancies among undiagnosed celiac,
    half of which occur in the intestinal tract.
  • Of those, there is a particularly high incidence
    of enterocyte associated T cell lymphoma of the
    small intestine (EATL).

60
  • This is very difficult to diagnose and warning
    symptoms may include unexplained or worsening
    diarrhea, weight loss and abdominal pain. There
    is also a much greater incidence of
    adenocarcinoma of the small intestine. The risk
    of malignancy returns to that of the general
    population after five years of maintaining a
    gluten-free lifestyle.

61
  • Untreated celiac disease will also negatively
    affect pregnancy outcome with relative incidences
    of spontaneous abortion and low birth weight
    being nearly nine and six times higher
    respectively. These improve markedly in treated
    celiac patients with unexplained neurological
    dysfunction.

62
Side Effects
  • Bone disease                                   
  • Short stature in children
  • Joint and bone aches                       
  • Muscle weakness and cramps
  • Anemia                                           
  • Lactose intolerance
  • Chronic fatigue                              
  •   Edema (swelling)

63
  • Hyperactivity                                 
  • Personality change
  • Attention deficit                            
  • Neurological disorders
  • Ataxia (stumbling gait)                   
  • Spinal cord lesions
  • Eye problems                                 
  • Dental defects

64
Diagnosis
  • Diagnosis of celiac disease should be considered
    when symptoms or laboratory findings indicate
    celiac disease could be an explanation of the
    person's health condition. A reliable assessment
    of gluten sensitivity is a celiac disease
    evaluation panel (of blood tests) which includes
  • IgG and IgA Gliadin Antibodies (AGA)

65
  • IgA Endomysial Antibodies (EmA)
  • IgA Reticulin Antibodies (ARA)
  • These studies, whether positive or negative, are
    only suggestions and reasonably predictive of the
    possibility of celiac disease. Confirmation or
    exclusion of the disease requires a biopsy of the
    small intestine.

66
  • The biopsy is usually performed through an
    endoscope - commonly done under sedation - in
    which a flexible tube is passes through the mouth
    into the small intestine where several biopsies
    are obtained.

67
  • It is still advisable to obtain annual CBC,
    biochemical panel, iron levels, B12, folic acid
    and vitamin D-250H. A one-year post-treatment
    biopsy is important in establishing a new
    baseline, as all patients do not heal completely
    in spite of strict adherence to the diet. Bone
    densitometry at the time of diagnosis and
    periodically thereafter is important -
    particularly in female patients.

68
  • Celiac antibodies may be helpful in monitoring
    some patients, particularly those in whom
    noncompliance is suspected.
  • It should be stated also that first-degree
    relatives of celiac should also be screened since
    celiac disease is a genetic disease.

69
Treatment
  • A life-long adherence to a gluten-free diet.
  • This is a very under diagnosed disease because
    the symptoms are so varied. Until recently, only
    persons were diagnosed with celiac disease who
    presented with the most severe gastrointestinal
    symptoms such as diarrhea and weight loss.
    Currently, celiac disease experts advise that all
    the listed SIDE EFFECTS, ASSOCIATED AUTOIMMUNE
    DISORDERS and the FAMILY HISTORY should be
    considered diagnosis.

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