Transcript Child with gastrointestinal dysfunctions

Child with gastrointestinal
dysfunctions
Emad Al Khatib,
RN,MSN,CNS
Appendicitis
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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.
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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.
Causes, incidence, and risk
factors
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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 .
Symptom of Appendicitis
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Appendicitis is the most common
surgical emergency seen in hospitals.
Six of every hundred persons will get it
at some point in their life.
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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.
The symptoms of Appendicitis
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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
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.
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Later symptoms:
Fever
Loss of appetite
Nausea
Vomiting
Constipation
Rectal tenderness
Chills and shaking
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Additional symptoms that may be
associated with this disease include
bloody urine (microscopic hematuria).
Signs and tests
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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.
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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.
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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.
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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.
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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 lifethreatening.
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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.
inflammatory bowel diseases
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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.
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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.
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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.
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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.
Pyloric stenosis
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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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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.
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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.
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Paper tapes will cover a small incision
located on the child’s 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.
Celiac disease
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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).
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The disease varies in severity with
classic symptoms of malabsorption
noted in some persons while others
remain completely asymptomatic.
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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.
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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.
Gluten
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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.
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Corn and rice and their byproducts
contain no toxic gluten and are
considered safe.
Celiac disease
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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,
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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.
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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.
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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.
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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.
Complications of CD
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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.
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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.
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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.
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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.
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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.
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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).
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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.
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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.
Side Effects
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Bone disease
Short stature in children
Joint and bone aches
Muscle weakness and cramps
Anemia
Lactose intolerance
Chronic fatigue
Edema (swelling)
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Hyperactivity
Personality change
Attention deficit
Neurological disorders
Ataxia (stumbling gait)
Spinal cord lesions
Eye problems
Dental defects
Diagnosis
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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)
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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.
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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.
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It is still advisable to obtain annual CBC,
biochemical panel, iron levels, B12, folic acid
and vitamin D-250H. A one-year posttreatment 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.
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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.
Treatment
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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.