The document discusses common childhood gastrointestinal problems such as gastroenteritis, diarrhea, intestinal obstruction, and appendicitis. It provides details on the causes, symptoms, diagnosis, and treatment of each condition. For diarrhea specifically, it describes the various types, causes, assessment techniques involving dehydration status, and treatment approaches including oral rehydration and continued feeding. Intestinal obstruction is classified and common causes in children like intussusception are explained. For appendicitis, it notes the signs, diagnostic tests, and surgical treatment required.

1. Common Childhood GI Problems
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2. Gastroenteritis
 Gastroenteritis is an inflammatory disease of the
gastric, and enteric sites of the GIT.
It is characterized by a sudden onset of diarrhea
with or without vomiting.
Causes include; virus, bacteria, protozoa, and non
infectious causes.
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3. Diarrhea
Definition
Passage of loose stool > 3x/24hrs (WHO) or
watery stool of any frequency
Is abnormally liquid or unformed stools
associated with increased frequency of defecation.
The recent change in consistency and character
of stool is more important than number of stool.
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4. Causes
 Viral: account for the largest causes of diarrhea in pediatrics
 Rotavirus is the leading viral pathogen worldwide.
 Others; Cali virus, astovirus, and adenovirus in gastroenteritis.
 Bacterial: the second leading cause of diarhea in peadiatrics.
 Compylobacter Jejuni is the leading bacterial cause of
gastroenteritis
 Other forms of bacteria include; shigella, Enterohemorhagic E.
coli.
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5. Symptoms
 Viral
 Low grade fever.
 Vomiting
 Copious watery
diarrhea.
Bacterial
 High grade fevers.
 Shaking chills.
 Dysentery
 Abdominal cramping.
 Fecal leukocytes.
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6. Con…
Parasites: A number of protozoans like; Giardia
lamblia and Entamoeba hystolitica, remain the
leading cause of gastroenteritis in pediatrics.
 Symptoms include; watery stool and hx of travel
to an endemic area.
Non-infectious causes. Include medications like
NSAIDS, Crowns disease.
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7. Types
1. Acute watery diarrhea
2. Bloody diarrhea (Dysentery)
3. Persistent diarrhea
4. Chronic diarrhea
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8. Types Greatest Danger
1. Acute watery diarrhea (80%
of cases)
Dehydration
K +loss
2. Bloody diarrhea
(Dysentery) 10% of cases
Tissue damage
Toxemia(sepsis)
3. Persistent diarrhea(> 2 wks.)
10% of cases
Malnutrition
4. Chronic diarrhea
(6wks or more)
Malnutrition
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9. Assessment of Diarrhea
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— Is your child have Diarrhea?
— If yes, ask for how long?
— Is there blood in the stool?
— Assess for sign of DHN
— Look at the child’s general condition. Is the child:
Lethargic or unconscious? Restless and irritable?
— Look for sunken eyes.
— Offer the child fluid. Is the child: Not able to drink
or drinking poorly? Drinking eagerly, thirsty?
— Pinch the skin of the abdomen. Does it go back:
Very slowly (longer than 2 seconds)? Slowly?
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10. Assessment Con…
• Severe dehydration will have two of these signs:
– Abnormally sleepy or lethargic
– Sunken eyes
– Drinking poorly or not at all
– Very slow skin pinch
• Some dehydration will have two of these signs:
– Restlessness or irritability
– Sunken eyes
– Drinking eagerly
– Slow skin pinch
• No dehydration
– None of these signs
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11. Laboratory Investigation
CBC
Stool specimen(mucus, blood, WBC)
Rectal swab
Blood culture
 Stool culture: in bloody diarrhea,
WBC,
Serum electrolytes
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12. Treatment of diarrhea
Main principle in management of acute
diarrhea is:
1. Replace lost water and salts.
2. Continue to feed to prevent malnutrition.
3. Antibiotics & antiprotozoals when needed.
4. Prevention of diarrhea
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13. Treatment Con…
• No sign of DHN  Plan A
– Fluid deficit < 5 %
– Can be treated at home
– More fluid than usual to prevent DHN
– Appropriate supply of foods to prevent malnutrition
– Bring back the baby to the health institution, if
diarrhea doesn’t get better or gets worse.
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14. Con...
How much fluid to give in addition to the usual
fluid intake/loose stool?:
– Up to 2 years 50 to 100 ml after each loose stool
– 2 years or more 100 to 200 ml after each loose stool
 Give frequent small sips from a cup.
 If the child vomits, wait 10 minutes, continue,
but slowly.
 Continue giving extra fluid until the diarrhea stops.
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15. Some DHN  Plan B
Fluid deficit 5-10%
ORS 75ml/kg over 4-6 hrs.
Reassess the degree of DHN
If no sign of DHN home Rx with
replacement of on going losses.
If sign of some DHN repeat plan B
If worse  IV RX
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16. Severe DHN  Plan C
 Fluid deficit 10-15%.
 IV fluid RL
Ringer's lactate 100ml/kg
o For infants:
• 30 ml/kg in the first hour
• 70 ml/kg in the next 5 hours
o For children( >1yr)
• 30 ml/kg in the first 30 min
• 70 ml/kg in the next two and half hours
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17. Treatment Con…
Antimicrobial therapy is administered to
selected patients.
Give antiprotozoal for patients with proven
ameabiasis and no response to treatment for
shigella.
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18. Zinc supplementation
Reduce duration and severity of diarrhea
Prevents recurrence.
promotes ion absorption, restores epithelial proliferation,
and stimulates immune response.
 Children with diarrhea should receive oral zinc for 10-
14 days during and after diarrhea (10 mg/day for infants
<6 mo of age and 20 mg/day for those >6 mo).
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19. Intestinal obstruction
Is a partial or complete blockage of
the bowel
It prevents the contents of the
intestine from passing through.
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20. Classification
 Dynamic(Mechanical obstruction)/Adynamic(Paralytic
Ileus)
 Small bowel obstruction/Large bowel
obstruction/both(generalized ileus).
 Acute/Chronic
 Simple/Strangulated
 Closed loop obstruction
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21. Classi…
Dynamic : where peristalsis is working against a
mechanical obstruction.
Adynamic (paralytic ileus):Ineffective motility
without any physical obstruction.
Acute obstruction: sudden onset of severe colicky
central abdominal pain, distention and early vomiting
&then, constipation
Usually occur in small bowel obstruction)
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22. Clasi…
Chronic obstruction :lower abdominal colic &
absolute constipation, followed by distention.
Usually seen in large bowel obstruction with
Simple mechanical obstruction:
In which there is obstruction but blood supply to
intestine remains intact.
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23. Cont …
 Strangulated obstruction : Mesentric blood vessel are
blocked besides the usual mechanical obstruction.
 Closed loop obstruction:Specific type of obstruction in
which two points along the course of a bowel are
obstructed at a single location & forming a closed loop.
 Usually this is due to adhesions.
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24. Common causes of IO in children
Intussusception
Hirschsprung’s disease
Band of adhesions
Necrotizing enterocolitis
Pyloric stenosis
Hernia
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25. Intusisupation
 An intussusceptions is a medical
condition in which a part of the
intestine has invaginated into another
section of intestine.
 Usually proximal loop invaginate in to
the distal bowel.
 Rarely distal loop may invaginate into
the proximal loop( retrograde
intussusceptions)
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26. Epidemiology
Most common cause of intestinal obstruction in
infants between 6 and 36 months of age.
Approximately 60% < 1 year &
80 to 90% <2 years old
 Intussusception is less common before three
months and after six years of age
 Male: female ratio of approximately 4:1
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27. Clinical presentation
 The first sign of intussusception may be sudden, loud
crying caused by abdominal pain.
 Infants who have abdominal pain may pull their knees to
their chests when they cry.
 The pain of intussusception comes and goes, usually every
15 to 20 minutes
 Vomiting
 Lethargic
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28. Con…
 Stool mixed with blood
and mucus (also known
as “redcurrant jelly"
because of its appearance
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29. Diagnosis
U/S of the abdomen identify target sign.
Longitudinal scan reveal tubular mass
 Barium enema reveal coiled spring sign
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30. Cont ...
tubular mass/target sign on
u/s
Coil spring sign
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31. Management
 Air or hydrostatic enema reduction
 Surgical reduction if enema fails
 Surgical resection and anastmosis in late
presentation
Antibiotics in case of surgical intervention
Adequate fluid resuscitation to correct the often severe
dehydration caused by vomiting
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32. HIRSCHSPRUNG’S DISEASE
 It is a blockage of the large intestine due to improper muscle
movement in the bowel
• CAUSES:
 Muscle contractions in the gut help digested materials move through
the intestine.
 Nerves in between the muscle layers trigger the contractions.
 Areas without such nerves cannot push material through.
 This causes a blockage.
 Intestinal contents build up behind the blockage, causing the
bowel and abdomen to become swollen

33. Symptoms
.
 Difficulty with bowel movements
 Failure to pass meconium shortly after birth
 Poor feeding
 Poor weight gain
 Vomiting
 Constipation
 Fecal impaction
 Malnutrition

34. Dx
 During a physical examination, the doctor may be able to
feel loops of bowel in the swollen belly.
 A rectal examination may reveal a loss of muscle tone in the
rectal muscles.
 tests
 Abdominal x—ray
 Barium enema
 Rectal biopsy

35. TREATMENT
 Colostomy
 A variety of subsequent corrective operations
Are carried out at approximately 1 year of age
,

36. Pyloric Stenosis
 Is hypertrophy & spasm of the pyloric
muscle, resulting in narrowing of the
pyloric sphincter
 Causing partial obstruction of the
gastric oulet.
– It is common in male (m :F= 6:1)
– Onset: b/n 2- 6 wks.
Etiology: The exact cause is unknown.
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37. Pyloric stenos …
C/M
 Vomiting(after feeding)(postprandial), non-bilious, often
projectile & demands to be re-fed soon afterwards (a
"hungry vomiter"). (classic presentation)
 Excessive hunger
 Crying with out tear (sign of dehydration)
 Loss of Wt. or failure to gain wt.
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38. DX
 Usually based on clinical manifestations
-projectile vomiting(non bilious)
-Palpation of pyloric mass can be felt.
 Abdominal U/S (the enlarged thickened pylorus is seen on U/S monitor)
confirms the diagnosis
 pyloric thickness >4 mm or an overall pyloric length >14 mm.
 X-ray examination with barium meal.
-Narrowing of pyloric canal.
-Enlarged stomach
RX-
 RX may be surgical or medical.
- Surgical(pyloromyotomy) is the best management.
- Medical Rx :like gastric lavage 38
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39. Preventive Strategies
• Promotion of Exclusive Breastfeeding
• Improved Complementary Feeding Practices
• Immunization(measles , cholera, rotavirus)
• Improved Water and Sanitary Facilities
• Promotion of Personal and Domestic Hygiene
• Improved Case Management of Diarrhea
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40. Acute appendicitis
 It refers to inflammation of the
appendix.
Epidemiology
 The leading acute abdomen in
children : 4/1000
 Peak age between 12-18
age(adolescent )
 But rare below 5 years (5%) and
extreme rare below 3 year.
• .
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41. Cause
 An obstruction: Food waste or a hard piece of stool
(fecal stone),tumor etc can block the opening of the
cavity
 An infection: May also follow an infection, such as a
gastrointestinal infections, or it may result from other
types of inflammation.
 In both cases, bacteria inside the appendix multiply
rapidly, causing the appendix to become inflamed,
swollen and filled with pus.
 If not treated promptly, the appendix can rupture.
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42. Pathophysiology
Appendix become obstructed
Increase intra-luminal pressure
Decrease venous drainage, thrombosis, edema,
and bacterial invasion of bowel wall.
Appendix become increasingly hyperemic, warm
and covered with exudate.
Perforation and gangrene of appendix
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43. Con…
Appendiceal
obstruction/early
appendicitis – visceral
peritoneal irritation
Appendiceal distension Irritation of parietal
peritoneum (localised)
Perforation,
localised/generalised
peritonitis, mass
obstruction
Distention
mucus
Distention causing
Ischemia
Gangrene

44. Clinical manifestation
 Peri-umblical pain
 Shift of maximal pain to right lower abdomen
 Early malaise and anorexia
 Low grade fever and vomiting
 Severe RLQ pain which limits movement
 Perforation after 36-48 hours (65%)
 High grade fever and rigid abdomen is a sign of
peritonitis due to perforation
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45. Physical examination
 Mild fever and tachycardia
 Child walks bending down
 Direct tenderness over RLQ area
 Positive psoas and obturator sign
 Positive rovsing sign (rebound tenderness)
 Point of maximal pain at McBurny’s point.
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46. Maximal point of tenderness inappendicitis
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47. Laboratory investigation
 Leukocytosis
 Raised ESR
Radiologically,
 Ultrasound often reveal swollen, distended appendix
 Appendiceal mass or abscess in few cases
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48. Differential diagnosis
 Urinary tract infections
 Acute gastroenteritis
 Pelvic inflammatory disease
 Urolithiasis
 Primary peritonitis
 Bacterial enteritis
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49. Alvarado Scale for the Diagnosis of Appendicitis
Value
Manifestations
1
Migration of pain
Symptoms
1
Anorexia
1
Nausea and/or vomiting
2
Right lower quadrant
tenderness
Signs
1
Rebound
1
Elevated temperature
2
Leukocytosis
Laboratory values
1
Left shift in leukocyte count

50. Diagnosis

51. Differential Diagnosis

52. Treatment
 Pain control and hydration
 Keep NPO for surgery
 Antibiotics to cover GIT flora
 Ceftriaxone and Metronidazole OR
 Ampicillin, Gentamycin
 Emergency operation(appendectomy )
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53. Complication
 Diffuse peritonitis
 Bacterial sepsis
 Wound infection
 Abscess collection
 Intestinal obstruction
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54. Umbilical hernia
 Hernia: Is the protrusion/projection of an organ or a part of an
organ through abnormal opening in the wall of the cavity that
normally contains it.
 Umbilical hernia: Protuberant umbilicus
Diagnosis: Soft reducible swelling at umbilicus covered with skin
Treatment
• Most close spontaneously
 Apply adhesive tape (2 inches)
• Repair if not closed by age 6 years, or if there is a history of the
hernia being difficult to reduce.
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55. Inguinal hernia
 Swelling or bulge at inguinal area.
Diagnosis
 Intermittent reducible swelling in the groin that is observed when the
child is crying or straining.
 Occurs where the spermatic cord exits the abdomen (inguinal canal).
 Distinguish from a hydrocele (fluid that collects around testicle).
 Hydrocele trans illuminates and usually do not extend up into the
inguinal canal.
 Can also occur rarely in girls.
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56. Inguinal hernia ---
Treatment
Uncomplicated inguinal hernia: elective surgical
repair to prevent incarceration.
Hydrocele: repair if not resolved by age 1 year.
Unrepaired hydroceles will turn into inguinal
hernias.
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57. Incarcerated hernias
 These occur when the bowel or other intra-abdominal structure is trapped
in the hernia.
Diagnosis
 Non-reducible tender swelling at the site of an inguinal or umbilical
hernia.
 There may be signs of intestinal obstruction (vomiting and abdominal
distension) if the bowel is trapped in the hernia.
Treatment
 Attempt to reduce by steady constant pressure.
 If the hernia does not reduce easily, an operation will be required.
 Give the child nothing orally.
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58. RX Incarcerated hernias---
 Give intravenous fluids.
 Pass a nasogastric tube if there is vomiting or
abdominal distension.
 Give antibiotics if compromised bowel is suspected:
 Ampicillin (25–50 mg/kg IM or IV four times a day),
gentamicin (7.5 mg/kg IM or IV once a day) and
metronidazole (7.5 mg/kg three times a day).
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59. 11/4/2023 By Bogale C. 59
Thank you!!!