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GASTROINTESTINAL DYSFUNCTION IN CHILDREN

FAILURE TO THRIVE
• Deceleration from established growth pattern or consistently below the 5th percentile for height and weight on standard growth charts; sometimes accompanied by developmental delays

Spitting up or regurgitation
• Passive transfer of gastric contents into the esophagus or mouth

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

Projectile vomiting • Vomiting accompanied by vigorous peristaltic waves and typically associated with pyloric stenosis or pylorospasm .

Nausea • Unpleasant sensation vaguely referred to the throat or abdomen with an inclination to vomit .

Constipation • Passage of firm or hard stools or infrequent passage of stool with associated symptoms such as difficulty expelling the stools. and abdominal discomfort . blood streaked stools.

often caused by fecal retention or impaction .Encopresis • Overflow of incontinent stool causing soiling.

may be acute or chronic .Diarrhea • Increase in the number of stools with increased water content as a result of alterations of water and electrolyte transport by the gastrointestinal(GI) tract.

Hypoactive. or absent bowel sounds • Evidence of intestinal motility problems that may be caused by inflammation or obstruction . hyperactive.

or obstruction .Abdominal distension • Protuberant contour of the abdomen that may be caused by delayed gastric emptying. accumulation of gas or stool. inflammation.

acute or chronic.Abdominal pain • Pain associated with the abdomen that may be localized or diffuse. obstruction or haemorrhage . often caused by inflammation.

may be acute or chronic .Gastrointestinal bleeding • Bleeding from an upper or lower GI source.

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 .

tarry stools caused by denatured blood. suggesting upper GI tract bleeding or bleeding from the right colon .Melena • Passage of dark-colored.

usually indicating lower GI tract bleeding .Hematochezia • Passage of bright red blood per rectum.

Jaundice • Yellow coloration of the skin and sclerae associated with liver dysfunction .

Dysphagia • Difficulty swallowing caused by abnormalities in the neuromuscular function of the pharynx or upper esophageal sphincter or by disorders of the esophagus .

pharynx or esophagus. can cause feeding problems or aspiration .Dysfunctional swallowing • Impaired swallowing resulting from central nervous system defects or structural defects of the oral cavity.

infection or inflammation .Fever • Common manifestations of illness in children with GI disorders. usually associated with dehydration.

GASTROINTESTINAL DIAGNOSTIC PROCEDURES .

microscopic.Stool examination • Gross. and chemical examination of stool specimen • to detect normal and abnormal constituents .

Ova and parasites (O&P) • Microscopic examination of stool contents for parasites of their eggs • To aid in diagnosis of parasitic infection .

Bacterial Culture • Sample contents grown on culture medium • Detect bacterial pathogens in stool .

Stool assay for viral pathogens • ELISA(enzyme-linked immunosorbent assay) • Detect viral pathogens in stool .

Quantitative fat • Detection of abnormal quantities of fat in stool • Diagnosis of pancreatic insufficiency or malabsorption by measuring stool-reducing substances .

which are abnormal and suggest carbohydrate malabsorption .Reducing substances • unabsorbed sugars measured in stool • To detect elevated levels of reducing substances in stool.

which lower stool pH . colonic bacterial fermentation produces short-chain fatty acids.pH • Stool pH <5 suggestive of carbohydrate malabsorption.

Occult blood guaiac test • Stool smeared on guaiac-impregnated paper. blue color indicates hemoglobin • detect presence of blood in stool . and 2 drops of developing solution added to reverse side.

Serology test • Blood test for antibody to H.pylori • assess for exposure to H. pylori .

measures labelled carbon dioxide in expired air • Determine if there is active infection with H.pylori in the stomach .Urea breath test • Collection of breath after ingestion of isotopic urea with either carbon 14 or carbon 13.

Urease test • Biopsy of stomach.pylori . which is stained and placed in Christensen urea medium which turns color in presence of H.

Pancreatic function • pancreatic secretions collected via duodenal tube under stimulated conditions and analyzed for water. ions and enzymes • determine functional secretory capacity of pancreas .

serum levels of D-xylose measured at 30. to measure Dxylose excretion • Evaluate absorptive capacity of small intestinal mucosa • diagnose small-bowel malabsorption caused by celiac disease . and 120 min • urine collected for total of 5 hr. 90.D-Xylose absorption test • D-xylose solution administered orally. 60.

such as biliary atresia . and bowel obtained • evaluate conditions of liver and biliary tract abnormalities and gallbladder disease • diagnosis and monitoring of these conditions. biliary system.Hepatobiliary scintigraphy • Nuclear medicine study • Radiopharmaceutical administered intravenously. then sequential images of liver.

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Breath hydrogen test • non-invasive study to asses for carbohydrate intolerance • Hydrogen is generated in colon by bacterial fermentation of undigested carbohydrates and is then absorbed into blood. lactase or sucraseisomaltase deficiency • evaluate malabsorption or bacterial overgrowth by detecting rise in expired hydrogen after oral loading with specific carbohydrate . where it diffuses into expired air via lungs • evaluate bacterial overgrowth.

wheezing) and acid reflux . failure to thrive. asthma.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.

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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. flexible sigmoidoscopy.Upper GI. detect lesions. obtain biopsies • perform therapeutic procedures . colonoscopy.

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Ultrasonography • To locate. measure and delineate abdominal organs .

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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permits soft tissue discrimination unavailable with many technique .Magnetic resonance imaging (MRI) • to visualize internal body structures in any plane.