2. • mucosa membrane is thin , mild, dry and
easily – wound;
• elastic and muscular tissues develop
insufficiently;
• the layer under mucosa membrane rich by
vessels of blood and friable cellulose;
• secretors function of glandular tissue is lower’
therefore is produce small quantity of
digestive ferments.
ANATOMICAL AND PHYSIOLOGICAL FEATURES
OF GASTROINTESTINAL TRACT
3. MOUTH CAVITY:
- savila is sticky and is produce in
small quantity, necessary for
germetizion of mouth cavity in during
sucking,
- a tongue appears relatively large
- the cheeks have fullness on both the
bucle and the external aspects owing
to the accumulation of the fat making
up the sacking pads.
4. • The stomach settles down horizontally in newborn.
• When child begin to walking axis of stomach is
standed more vertically and at 7-11 years it settle
down as adult.
• Stomach is in state of physiological hypertonia and
small volume: on first day 7ml in neonates, then
every day the volume increase, on 4-th day – 30ml.,
3 month – 150ml., after 4-5month -200ml., at 1 year
-250ml., 3year – 400ml., 8year – 1000ml., 10-
12year -1300-1500ml.
STOMACH
5. • The cardiac sphincter and cardiac
position of the stomach develop very
weakly, but pylorus sphincter – develop
very well.
• In consequence of this in newborns
often is observed vomiting. Therefore
after nursing is recommendation to put a
child in high position.
• The principal enzyme of stomach is
chimozin, which provide first phase of
digestion of milk.
6. • At birth liver is very big organ and it occupies half of
abdominal cavity.
• A liver carry out very important functions:
1. Produce bail, which take part in intestinal digestions,
2. Realize barriers function, lead out organism
endogenous and eczogenics pathogenic
substances,
toxins.
3. Take part in metabolism of substance and
reformation
of vitamins A,C,D,B12,K.
4. The liver is blood-forming organ in intra-uterine
period.
LIVER
7. • In common inspection define following signs:
1.Color of skin
2. physical development.
3. Position of child
• In SURVEY of abdomen in position of standing, laying on
back and on one side, reveal following signs:
1. Form, symmetry(in norm abdomen is rounded,
symmetric).
2. Sizes( in lying position in children of early age abdomen
prominents above level of chest, older age is a little lower
than its level).
• At SURVEY of mouth find out its color, state of tongue.( in
norm damp, clean, pink).
EXAMINATION OF GASTROINTESTINAL
TRACT
8. • In superficial palpation following signs are
defined:
• Sensitivity of abdominal wall – in norm patient
does not react on superficial palpation.
• Tenderness of abdominal wall – in norm pain
does not arise.
• resistance of abdominal wall – in norm
abdominal wall is soft.
PALPATION
1. SUPERFICIAL PALPATION
10. 2. DEEP PALPATION
• In deep palpation we palpate:
- sigmoid colon(in left iliac area);
- cecum(blind intestine, in right iliac area);
- ascending colon (in right lateral part);
- transverse colon(in umbilical area);
- descending colon (in left lateral part)
- stomach (in epigastric area);
- liver,
- pancreas.
11. • The general criteria of estimation of
abdominal cavity organ in deep
palpation:
• Iocalization, form, tenderness,
sizes,
• density and condition of surface,
mobility, borborygmus.
• In norm COLON is painless,
surface is smooth, soft, mobile,
borborygmus is not present.
12. PALPATION OF LIVER
• In palpation for estimation of liver properties the
following criteria are found out:
- Localization of lower liver edge: in norm in
children
of the first 5-7years of age the lower edge of liver
acts on 1-2 sm. from hypochondrium. From 7year
of age the lower edge of liver is not palpated.
- Painfulness (in norm painless)
- Form of edge( in norm sharp)
- Consistence (in norm soft)
- Surface (in norm smooth)
13. GALLBLADDER in children does not
in palpation.
PANCREAS and SPLEEN in
healthy children is not probed.
14. PERCUSSION
Percussion of liver is carried out in children
before 5-7years on which three sizes are
defined :
1. Distance between the upper and lower
border of liver on right anterior axillary line
2. Distance between the upper and lower
border of liver on middle-clavicle line
3. Distance between the upper and lower
border of liver on median line.
15. Percussion of liver in children after 5-7years
carried out on method of M.G.Kurlov on which
three are defined:
1. Distance between the upper and lower border
of liver on right middle-clavicle line
2. Distance between the upper and lower border
of liver on median line
3. Distance between the upper and lower border
of liver on the left costal arch up to the upper
border on median line.
In norm the size of liver are: I – 9-11sm, II – 7-
9sm, III -6-8sm
16. AUSCULTATION as method of GIT
examination is not enough
informative.
In auscultation of abdominal cavity
organs is possible to establish
borborygmus (rumbling) – sounds
similar on breaking of big bubbles,
transfusion of liquid.
17. ANALYSIS OF BLOOD ON HEPATIC
TESTS is carried out with purpose of
finding-out of function of liver and includes
following parameters:
1. BILIRUBIN: in norm the general bilirubin
makes 8,5-20,5 mkmol/l (direct -2,05-5,1
mkmol/l, indirect – 6,5-15,4mkmol/l)
2. 2. Thymol test – specifies state of protein-
synthetic function of liver. Norm of 1-6,5 units
18. 3. Alanintranspherase(ALT) 0,1-
0,75mkmol/l,
• Aspartattranspherase (AST) 0,1-
0,45mkmol/l.
• ANALYSIS OF URINE on amylase
(diastase). Amylase(diastase) is
pancreatic enzyme, in norm – 4-64
units.
19. Most frequently the following methods are applied to diagnostics of
digestion organs disorders in children:
Roentgenological research Urinary analysis on amylase
Endoscopic research Bacteriological research
Intragastric pH probe Coprological research
Duodenal probe Research on helminths
Blood analysis on hepatic tests Faeces analysis on latent blood
20. URINARY SYSTEM
ANATOMICAL SPECIALITY OF KIDNEYS in
children:
1. Size of kidneys is comparatively large
2. Upper pole of kidneys finded on level XI-XII of
thoracic vertebra, lower pole finded on level IV
of lumbal vertebra.
3.Structure of kidneys is lobary in first year of life
4. Fat capsula developed weak
5. Pyels of kidneys developed well. Muscular and
elastic tissues developed weak
21. • 6.Glomerular stratum of kidneys developed
insufficiently, morphological development finished
at 3-5 years.
• 7. Canalicular apparatus are short in newborn,
diameter is narrow on twicy,than in adults
• 8. Uxtaglomerular apparatys undeveloped in
children at little ages.
• 9. Quantity of glomerular filtration decreased in
newborn
• 10. Lymphatic system has unity with bowels
• 11. Quantity of hephrons increased to 5 year in
superficial stratum
22. URETERS
• Their diameter is wigth, hypotonic,winding than
adults.
• Muscular and elastic fiber developed weak.
URINARY BLADDER
• Their placement is higp in baby, than in adults
• Volume of urinary bladder : in newborn – 30ml , in 1
year – 35-50ml, 1-3year – 50-90ml, 3-5year – 100-
150ml, 5-9year – 200ml,12-15year -300-400ml.
23. • In first 3-4days newborn have small number
urine. Frequency of urine: in newborn-
• 2-25, in infants – 15every 24 hour.
• Daily diyresis: in newborn - 300ml, in
• 1 year – 600ml.
• Formula of daily diuresis in children after 1year
• 600+100(n-1), n - year
• In 1-10 year: 100(n+5), n –year
24. • Examination of urinary system
Inspection
Colour of skin
Present of swallowing
• Palpation
Bimanual for “Obrassova” (in norm kidney no palpated)
• Percussion
For definition of upper border of urinary bladder.
Symptom of Pasternasky (to define illness on area of
kidneys)
25. Laboratory examination
Investigation of urine
1.Common analys of urine
•Physic-chemical relationships:
Quantity
Colour- yellow
Transparence is full
Specific gravity or relative density (1 year- 1002-1007, 1-3 year-1010-1017,
3-5 year-1012-1020, 6-12 year-1011-1025.
Protein- in norm 0,033%
Glucosae- absent
Ketones-absent
Bilirubin-absent
Blood-absent
•Microscopical examination
Leykocity befor 5-6
Red cells- absent
Casts-absent
Crystals- absent
Salts- oxalate, phosfat, uratus- in healthy varialle
Bacteria- absent
26. 2. Probe of Addis- Kakovsky- to definite- red
and white cells in 10ml- healthy children have
Erytrocity- before 1000000, Leycocyt- before
2000000
3.Probe of Nechiporenco- to definite erytrocity
and leycocyt in 1ml- in norm Erytrocity- before
1000, Leycocyt- before 2000
4. Probe of Zimnisky- examination of the
secretory and concentration function of kidney.
To collect urine during 1 day- every 3 hour.
To definite specific gravity and quantity in every
portion.
