Examination of child's gastrointestinal system

Gastrointestinal (GIT) diseases are very common in childhood.

Vomiting

 * often accompanied by nauzea
 * in young children it is difficult to "distinguish" regurgitation "of gastric contents in gastroesophageal reflux (not accompanied by nausea, gastric contents return to the esophagus spontaneously, without active expulsion)
 * vomiting + diarrhea – in acute gastroenteritis
 * reactive vomiting – in acute pyelonephritis, in AA
 * repeated vomiting without nausea + headaches + afebrilia – in intracranial hypertension
 * bile admixture in vomit – ileus, duodenogastric reflux, long-term persistent vomiting
 * in vomit leftover food ingested more than 12 hours ago – lined GIT motility
 * blood admixture in vomit – in case of mucosal damage by persistent vomiting, bleeding from esophageal varices or from peptic ulcer
 *  'vomiting of digested blood'  – after massive epistaxis with blood swallowing

Abdominal pain

 * is one of the most common symptoms for a child to see a doctor
 * children often localize pain to the periumbilical area
 * visceral (diffuse, dull pain of inaccurate localization)
 * parietal (sharp, precisely localized pain)
 * pain may come from the abdominal wall, or be vertebrogenic etiology or metabolic (pseudoperitonitis diabetica in diabetic ketoacidosis; lead intoxication)
 * psychogenic pain (diagnosis by exclusion – exclusion of organic cause)
 * we ask about the intensity of pain, the duration of the problem, the triggering factor and the accompanying symptoms

Constipation

 * difficult bowel movements (low frequency, painful defecation)
 * the frequency of bowel movements varies in children (infants have 1-7 stools per day; fully breastfed children can only have 1 stool in 10 days)
 * constipation functional x organic – Hirschprung's disease, cystic fibrosis
 * important information – departure pitch after childbirth
 * accompanying difficulties: abdominal pain, meteorism, abdominal pain, vomiting
 * functional constipation most often in toddlers – during the cleanliness training period
 * spotting – the consequence of overflowing the anal canal and ampoule of the rectum with faeces and a reduction in the tone of the rectal sphincters with the consequent departure of a smaller amount of faeces; we palpate skybal during the large intestine, especially in the rectosigmoid
 * in older children and adolescents, constipation is a frequency of 3 or less stools per week + difficult bowel movements in min. 25% defecation''

Diarrhea in children

 * more frequent emptying of loose stools
 * Loss of fluid in the stool can lead to dehydration
 * according to course: acute x chronic x recurrent
 * according to pathophys. mechanism: increased fluid secretion, decreased water absorption, exudation
 * by etiology: viral x bacterial x parasitic x drug x non-specific intestinal inflammation
 * may be a sign of malabsorption (celiac disease, brush border disaccharidase deficiency)
 * see also Diarrheal diseases in infancy

Physical examination
* we examine while lying on back with bent knees and arms along the body

View
* we monitor: size and shape of the abdomen, possible herniation in the inguinal canal area, distension (aerophagy, meteorism, hepatosplenomegaly, ascites, tumors), sunken abdomen (Congenital diaphragmatic hernia, spider nevi) and traumas

Palpation

 * an essential part of the examination
 * first surface palpation, then deep palpation
 * we monitor the child's facial expression

Tap

 * allows to detect enlargement of intra-abdominal organs, presence of free fluid, peritoneal irritation,…
 * examination of the liver by tapping – we determine their upper and lower edge in the medioclavicular line – the total length of the liver in children is 6-10cm
 * in infants in the first half of life, the liver may extend the rib arch by 1-3 cm
 * the upper edge of the liver is usually in the 5th intercostal space in the medioclavicular line

Listening

 * we detect the presence of peristalsis, its acceleration (eg. in gastroenteritis) or disappearance (e.g. in ileus)

Per rectum

 * we are looking for excoriations (roups), fistulas, perianal skin growths, .. (non-specific intestinal inflammations)
 * we assess the tone of the sphincter, the content of the ampoule, the pain during the examination (during AA)

Hydrogen test
(reduced lactase activity –> higher hydrogen content in the intestinal lumen and in the exhaled air)
 * the amount of hydrogen in the exhaled air depends inversely on the breakdown of lactose by intestinal lactase
 * method:
 * fasting 20% ​​lactose solution (2g lactose/kg body weight, maximum 50g)
 * then the subject exhales air through the reduction valve into the syringe
 * we evaluate the last third of the tidal volume
 * We perform measurements at 30-minute intervals for a total of 180 minutes
 * conclusion: pathological finding is a concentration of more than 10 ppm per basal value

24-hour esophageal pH measurement

 * to detect reflux of gastric contents into the distal third of the esophagus
 * method:
 * Insert a pH-metric probe with an antimony sensor into the distal third of the esophagus
 * we continuously monitor the pH for 4 sec. after 24 hours.

Enterobiopsy

 * to take a sample of the intestinal mucosa for histological examination
 * Crosby capsules attached to a probe that the patient swallows
 * the capsule is made of X-ray contrast material
 * we perform on an empty stomach (6 hours of fasting), for infants and toddlers in premedication

Liver biopsy

 * Mengini needle percutaneous liver biopsy
 * in infants, toddlers and uncooperative children in general anesthesia in apnea pause
 * in cooperating children under premedication and local anesthesia
 * collection in the supine position with the right hand in the lining or behind the head, injection in the apnea pause (in the expiration)
 * after the biopsy, the child lies on his right side for 24 hours

Related articles

 * Examination of the child: Examination of the child's cardiovascular system ▪ Examination of the child's respiratory system ▪ Examination of the child's uropoietic system ▪ Examination of the child's endocrine system ▪ Examination of the child's musculoskeletal system ▪ Examination of child's skin and skin adnexa ▪ Examination of the child's sight and hearing
 * Digestive system development
 * Congenital malformations of digestive system

Literature


Portal:Pediatrics Portal:Gastroenterology