Presentation on theme: "Prepared by ass.prof. V.Slyva."— Presentation transcript:
1 Prepared by ass.prof. V.Slyva. Anatomical and physiological features of the digestive system in children. Semiotics of digestive disorders and main diseases.Prepared by ass.prof. V.Slyva.
2 Functions of Digestive System: 1. Ingestion2. Propulsion3. Mechanical processing: chewing, churning, mixing, compacting4. Chemical digestion: enzymatic breakdown of large molecules into building blocks5. Secretion: enzymes, acids, mucus, water, cell wastes6. Absorption: move organic molecules, electrolytes, vitamins, water from gut to interstitial fluid, lymph, blood7. Excretion: cell waste, secretions, indigestible foodstuffs ejected from body
4 Human deciduous teeth X = n – 4, 2nd year of life: The milk teeth erupts during1st year of life:6-7 month – 2 lower middle incisor teeth8-9 month – 2 upper middle incisor teeth9-10 month - 2 upper lateral incisor teeth11-12 month – 2 lower lateral incisor teeth2nd year of life:12-14 month – first 4 molars14-20 month – 4 canine teeth20-24 month – second 4 molarsA child 2 years should have 20 milk teethX = n – 4,x – number of teethn - age in years
5 An adult person should have 32 permanent teeth Human permanent teethThe permanent teeth erupts:6-7 years – first molars7-8 years – incisors10-11 years – canine teeth11 years – first premolars12-13 years – second premolars, second molar17-25 years - third molarAn adult person should have 32 permanent teethX = 4n – 20,x – number of teethn - age in years
6 Salivary glands Produce 1-2 L saliva/day Saliva = 99% water plus: enzymes (amylase for starch digestion),electrolyte buffersmucin (lubrication)antibodiesantimicrobials (lysozyme and defensins)Functions of saliva:1. Cleanse mouth, control oral bacteria2. Dissolve food chemicals for taste3. Moisten food for bolus formation4. Begin chemical digestion of carbohydrates5. Buffer oral pH
7 Deglutition (swallowing) SequenceVoluntary stagePush food to back of mouthPharyngeal stageRaiseSoft palateLarynx + hyoidTongue to soft palateEsophageal stageContract pharyngeal musclesOpen esophagusStart peristalsis
8 Esophagus Usually collapsed (closed) 3 constrictions Surrounded by Aortic archLeft primary bronchusDiaphragmSurrounded bySNS plexusBlood vesselsFunctionsSecrete mucousTransport food
9 Peculiarities of the esophagus in children of different age Average length of the esophagus in newborn is 10 cmIt is relatively narrowRatio between the length of the esophagus and the length of the body is the same in children of different age groups (1:5)Length of the esophagus:in newborn is cmin years cmin years cm
10 The constriction of the esophagus AnatomicalUpper constriction - in place of entrance into the esophagusMiddle constriction - in place of adjacent the trachea to esophagusLower constriction - in place of entrance through the diaphragmPhysiologicalUpper constriction - at the begining of the esophagusMiddle constriction - in place of adjacent the aorta to esophagusLower constriction - in place of entrance into the cardial part of the stomach.
11 Stomach Mix food Reservoir Start digestion of Protein Nucleic acids FatsActivates some enzymesDestroy some bacteriaAbsorbsAlcoholWaterLipophilic acidB 12
12 Capacities of the stomach Anatomical, cm3Newborn4 days – 4514 days – 90In next months increase for 25 cm32 years – 5004 years – 7008 years – 1000An adultPhysiological , cm3In newborn - 71 year3 years10 years
13 Small Intestine Regions Duodenum Jejenum Ileum Absorbs 80% ingested waterElectrolytesVitaminsMineralsCarbonatesProteinsLipidsMovementsSegmentationPeristalsis
14 Peculiarities of the small intestine in infant The length is in two time less than in adultThe length of small intestine mesentery is relatively longerThe membrane is thin, is well vascularitied.The intestinal glands are more bigger then in adultThe lymph cells are in each little parts of small intestine
16 Peculiarities of the large intestine in infant The large intestine is not completely developedThe length of the large intestine is the same as the body length (in any age of a child)Haustrumes appear after 6 month of lifeIn schoolchildren the rectum is in the small pelvisIn newborn ampulla is absent
18 Peculiarities of the liver in infant Before the birth the liver is the largest organ of the bodyThe left lobes before the birth is very greatIn newborn is functionally undevelopedNormally the lower edge of the liver till 7 years is palpated below the edge of the right costal margin
19 PancreasA. Pancreatic islets (endocrine) (1%) cells secrete insulin and glucagon to control blood sugarB. Pancreatic acini (exocrine) produce digestive enzymes and buffers: pancreatic juice
20 Gathering complains (Pain in the abdomen) It is necessary to distinguish the following signs:1. Is it constant or colicky.2. Location of pain.3. Character of pain.4. Intensity.5. The connection with the time of eating.6. The connection with the kind of intakes food.7. The connection with the time of day.8. The connection with the act of defecation.
21 Inspection Common physical examination: Color of integuments The condition of physical developmentThe position of the childExpression of fair on the child's faceMoving by legs (children of early age)Physical examination of abdomen:The form, symmetry, size of abdomenA degree of participation of the muscles of the abdominal cavity in active breathe process
22 Palpation (General rules) The doctor's hands should be dry, warmWell-lighted roomThe position during examination:lying on the begon hard surfacechild should band his legs at an angle 45*
23 Palpation (General rules) The front abdominal wall is divided into 9 arias by lines:1-3 – epigastria arias4-6 – mesogastria arias7-9 – hypogastria arias
24 Palpation Points for palpation А – Сhauffard’s zone Б – Kehr’s point B – Desgandin’s pointГ – Mayo-Robson’s pointД – Mc-Burney’s pointE – Lants’s point
26 Superficial palpation Signs determined during superficial palpation:SensitivityPainfulnessThe tension of abdominal wallRelaxation of abdominal wallThe sizes of the internal organsAt abdominal distension
27 Deep palpation according to Obrazcov-Stragesko’s Sigmoid colonin normal case it is:PainlessWith a smooth surface1-2 cmSoftMobileGrumbling is absent
28 Deep palpation according to Obrazcov-Stragesko’s The cecumin normal case it is:PainlessWith a smooth surface3-3,5 cmRather denseMobileGrumbling can be heard
29 Deep palpation according to Obrazcov-Stragesko’s Shchotkin-Blumberg’s symptomThe pain is increased at fast taking away hand (peritonitis, acute apendicitis)
30 Deep palpation according to Obrazcov-Stragesko’s Mc-Burney’s symptomThe pain is increased at pressing (peritonitis, acute apendicitis)
31 Deep palpation according to Obrazcov-Stragesko’s Lants’s symptomThe pain is increased at pressing in point (peritonitis, acute apendicitis)
32 Deep palpation according to Obrazcov-Stragesko’s The ascending part of the large intestineIs palpated according to the rulesOften is not palpable
33 Deep palpation according to Obrazcov-Stragesko’s Transverse colonin normal case it is:PainlessWith a smooth surface2-4 cmSoftMobileGrumbling is absent
34 Deep palpation according to Obrazcov-Stragesko’s The descending part of the large intestineIs palpated according to the rulesOften is not palpable
35 Grott’s method of palpation (pancreas) The fist of the left hand is placed under the join. Palpation is carried out the right hand when child exhales.
36 Palpation of pancreas Desgandin’s point Painfulness in this point arises at diseases of the head of pancreas
37 Palpation of pancreas Mayo-Robson’s point Painfulness in this point arises in children with the pathology of the pancreatic tail.
38 Palpation of the liver (bimanual) In normal case the inferior margin of the liver is:0.5-3 cm lower than inferior margin of the costal ribPainlessThe margin is sharpenedSoftSmooth
39 Palpation of the gall bladder Kehr’s pointThe pain is increased at pressing in point (diseases of gall bladder)
40 Palpation of the gall bladder Lepine’s symptomeThe pain is increased by percussion with the 3rd finger (diseases of gall bladder)
41 Palpation of the gall bladder Ortner’s symptomThe pain is increased by percussion with the hand
42 Palpation of the gall bladder Murphy’s symptomThe pain is increased at pressing in Kehr’s point while child inhales (diseases of gall bladder)
43 Palpation Mussy symptom (phrenicus- symptom) Pain appears at pressing with a finger between the crus of the right sterno-cleido-mastoideus muscle.
44 Palpation Acromealic point Pain appears at pressing with a finger an acromeon of the left scapula.
45 Palpation Boas’s symptoms Pain appears at pressing on the processus transversus of the X-XII thoracic vertebras (diseases of gall bladder and stomach).
46 Percussion Mendel’s symptom It is positive when pain arises at percussion in Сhauffard’s zone (duodenitis, duodenal ulcer)
48 PercussionAccumulation of the liquid in the abdominal cavity (ascites)Dull sound at percussion
49 Auscultation It is possible to determine: Grambling Lower margin of the stomach
50 Additional methods of investigation Instrumental diagnostic:Computed tomography scan (CT or CAT scan)Lower GI (gastrointestinal) series (also called barium enema)Magnetic resonance imaging (MRI)Magnetic resonance cholangiopancreatography (MRCP)Oropharyngeal motility (swallowing) studyUltrasoundUpper GI (gastrointestinal) seriesEndoscopic procedures:ColonoscopyEndoscopic retrograde cholangiopancreatography (ERCP)Esophagogastroduodenoscopy (EGD)
51 DISEASES OF DIGESTIVE SYSTEM PylorostenosisPylorostenosis is a disease of infants of the first month of life due to a narrowing of the pyloric canal’s aperture because of muscular hypertrophy of the pylorus.Clinical manifestationlatent period, begin on II-IV week after birth,regurgitations up to fountain-like vomit without bile,condition of child is mostly quite, may be exited before vomiting
52 Pylorostenosis dehydration, volume of urine and frequency of urination are considerably reduced (3-4 times),malnutrition,stomach peristalsis in a form of sand –glass,constipation.
53 Pylorostenosis X-ray examination: There is a contraction of the stomach like «hour-glass», the barium remains in it for about 24 hours or moreUltrasound:hypertrophy of the wall > 4mm,Increase in length >20 mmEfficiency of treatment with cholinolytics:no effect