Pediatric Gastrointestinal Lecture Notes

Introduction

• Focus: Structural function of the GI tract, development, assessment, and disorders in pediatric population.
• Main functions of GI Tract:
  • Digestion and absorption of nutrients.
  • Excretory function for digestive residue and blood waste.
  • Detoxification and fluid/electrolyte balance.
  • Lymphoid function and immune support via liver.

Development of the GI Tract

• Stages from conception to birth.
• Divided into foregut, midgut, and hindgut.
• Development of esophagus and stomach by fourth week of gestation.
• Importance of gestational age and nutrient exposure on GI adaptation.

Assessment of GI Tract

• Common consequences of GI disease: malabsorption, fluid/electrolyte disturbances, malnutrition, and poor growth.
• Assessment includes history, observation, clinical examination, tests, and procedures.

Disorders of Motility

• Diarrhea:
  • Caused by abnormal water/electrolyte transfer.
  • Major cause: Rotavirus in children under 5.
  • Management: Fluid/electrolyte assessment, rehydration, and diet reintroduction.
• Constipation:
  • Defined by infrequent or difficult stool passage.
  • Treatment: Dietary changes and bowel habits.
• Vomiting:
  • Causes include infections, mechanical obstructions, and CNS issues.
  • Management focuses on cause identification and complication prevention.

GI Disorders

• Hirschsprung's Disease:
  • Congenital anomaly causing intestinal obstruction.
  • Symptoms: Distended abdomen, delayed meconium passage.
  • Treatment: Surgical.
• Appendicitis:
  • Inflammation of the appendix.
  • Symptoms: RLQ pain, nausea, vomiting, fever.
  • Treatment: Appendectomy.

More GI Disorders

• Celiac Disease:
  • Autoimmune disorder from gluten intolerance.
  • Treatment: Dietary management.
• Short Bowel Syndrome:
  • Malabsorption due to reduced intestinal surface.
  • Treatment: Surgical preservation of bowel and nutritional support.
• GI Bleeding:
  • Upper and lower GI causes.
  • Management involves stabilization and cause identification.

Structural Defects

• Esophageal Atresia/TE Fistula:
  • Failure of esophagus and trachea separation.
  • Symptoms: Frothy saliva, respiratory distress.
• Gastroschisis and Omphalocele:
  • Abdominal wall defects requiring careful perioperative care.

Hernias

• Umbilical Hernia:
  • Protrusion through umbilical ring.
  • Treatment: Outpatient surgical repair.
• Inguinal Hernia:
  • Common in boys, requires elective surgery.

Anorectal Malformations

• Caused by abnormal development, absence of anal opening.
• Symptoms: Abdominal distension, vomiting, abnormal meconium passage.
• Treatment: Surgical intervention after evaluation.

---

Additional Notes:

• Important facts to remember:
  • 99% of term infants pass meconium in first 48 hours.
  • Right lower quadrant pain suggests appendicitis.
  • Effective management involves prompt surgical interventions and careful perioperative care.