GASTROINTESTINAL DYSFUNCTION IN CHILDREN

FAILURE TO THRIVE
Deceleration from established growth pattern or consistently below the 5th percentile for height and weight on standard growth charts; sometimes accompanied by developmental delays

Spitting up or regurgitation
Passive transfer of gastric contents into the esophagus or mouth

Vomiting
Forceful ejection of gastric contents; involves a complex process under central nervous system control that causes salivation, pallor, sweating, and tachycardia; usually accompanied by nausea

Projectile vomiting
Vomiting accompanied by vigorous peristaltic waves and typically associated with pyloric stenosis or pylorospasm

Nausea
Unpleasant sensation vaguely referred to the throat or abdomen with an inclination to vomit

Constipation
Passage of firm or hard stools or infrequent passage of stool with associated symptoms such as difficulty expelling the stools, blood streaked stools, and abdominal discomfort

Encopresis
Overflow of incontinent stool causing soiling; often caused by fecal retention or impaction

Diarrhea
Increase in the number of stools with increased water content as a result of alterations of water and electrolyte transport by the gastrointestinal(GI) tract; may be acute or chronic

Hypoactive, hyperactive, or absent bowel sounds

Evidence of intestinal motility problems that may be caused by inflammation or obstruction

Abdominal distension
Protuberant contour of the abdomen that may be caused by delayed gastric emptying, accumulation of gas or stool, inflammation, or obstruction

Abdominal pain
Pain associated with the abdomen that may be localized or diffuse, acute or chronic; often caused by inflammation, obstruction or haemorrhage

Gastrointestinal bleeding
Bleeding from an upper or lower GI source; may be acute or chronic

Hematemesis
Vomiting of bright red blood or denatured blood that results from bleeding in the upper GI tract or from swallowed blood from the nose or oropharynx

Melena
Passage of dark-colored, tarry stools caused by denatured blood, suggesting upper GI tract bleeding or bleeding from the right colon

Hematochezia
Passage of bright red blood per rectum, usually indicating lower GI tract bleeding

Jaundice
Yellow coloration of the skin and sclerae associated with liver dysfunction

Dysphagia
Difficulty swallowing caused by abnormalities in the neuromuscular function of the pharynx or upper esophageal sphincter or by disorders of the esophagus

Dysfunctional swallowing
Impaired swallowing resulting from central nervous system defects or structural defects of the oral cavity, pharynx or esophagus; can cause feeding problems or aspiration

Fever
Common manifestations of illness in children with GI disorders; usually associated with dehydration, infection or inflammation

GASTROINTESTINAL DIAGNOSTIC PROCEDURES

Stool examination
Gross, microscopic, and chemical examination of stool specimen to detect normal and abnormal constituents

Ova and parasites (O&P)

Microscopic examination of stool contents for parasites of their eggs To aid in diagnosis of parasitic infection

Bacterial Culture
Sample contents grown on culture medium Detect bacterial pathogens in stool

Stool assay for viral pathogens

ELISA(enzyme-linked immunosorbent assay) Detect viral pathogens in stool

Quantitative fat
Detection of abnormal quantities of fat in stool Diagnosis of pancreatic insufficiency or malabsorption by measuring stool-reducing substances

Reducing substances
unabsorbed sugars measured in stool To detect elevated levels of reducing substances in stool, which are abnormal and suggest carbohydrate malabsorption

pH
Stool pH <5 suggestive of carbohydrate malabsorption; colonic bacterial fermentation produces short-chain fatty acids, which lower stool pH

Occult blood guaiac test

Stool smeared on guaiac-impregnated paper, and 2 drops of developing solution added to reverse side; blue color indicates hemoglobin detect presence of blood in stool

Serology test
Blood test for antibody to H.pylori assess for exposure to H. pylori

Urea breath test

Collection of breath after ingestion of isotopic urea with either carbon 14 or carbon 13; measures labelled carbon dioxide in expired air Determine if there is active infection with H.pylori in the stomach

Urease test

Biopsy of stomach, which is stained and placed in Christensen urea medium which turns color in presence of H.pylori

Pancreatic function

pancreatic secretions collected via duodenal tube under stimulated conditions and analyzed for water, ions and enzymes determine functional secretory capacity of pancreas

D-Xylose absorption test

D-xylose solution administered orally; serum levels of D-xylose measured at 30, 60, 90, and 120 min urine collected for total of 5 hr. to measure Dxylose excretion Evaluate absorptive capacity of small intestinal mucosa diagnose small-bowel malabsorption caused by celiac disease

Hepatobiliary scintigraphy
Nuclear medicine study Radiopharmaceutical administered intravenously, then sequential images of liver, biliary system, and bowel obtained evaluate conditions of liver and biliary tract abnormalities and gallbladder disease diagnosis and monitoring of these conditions, such as biliary atresia

Breath hydrogen test

non-invasive study to asses for carbohydrate intolerance Hydrogen is generated in colon by bacterial fermentation of undigested carbohydrates and is then absorbed into blood, where it diffuses into expired air via lungs evaluate bacterial overgrowth, lactase or sucraseisomaltase deficiency evaluate malabsorption or bacterial overgrowth by detecting rise in expired hydrogen after oral loading with specific carbohydrate

Esophageal pH monitoring
probe that measures pH placed through nose into distal esophagus and records pH over time determine frequency and duration of gastric acid reflux into the esophagus establish association between patient symptoms(pain, apnea, failure to thrive, asthma, wheezing) and acid reflux

Upper GI, colonoscopy; flexible sigmoidoscopy, anoscopy

Endoscope introduced into area to be examined Endoscope has flexible-tip light source and aspiration and instrument channel directly visualize GI tract to evaluate abnormalities, detect lesions, obtain biopsies perform therapeutic procedures

Ultrasonography
To locate, measure and delineate abdominal organs

Computed tomography (CT)

to visualize horizontal and vertical cross section of abdomen at any axis To distinguish density of various tissue structure or organs To detect blunt trauma to internal organs and masses

Magnetic resonance imaging (MRI)

to visualize internal body structures in any plane; permits soft tissue discrimination unavailable with many technique