Ebook Practical paediatric problems: Part 2
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Ebook Practical paediatric problems: Part 2
Chapter 10Gastrointestinal system, hepatic and biliary problemsPeter GillettEMBRYOLOGY OF THE GASTROINTESTINAL TRACTThe gastrointestinal tract compris Ebook Practical paediatric problems: Part 2ses all components from mouth to anus. In the fourth week of gestation the primitive yolk sac divides into the primitive gut and yolk sac. These are in continuity until (he seventh week when the vitelline duel is obliterated. The gut comes from the dorsal aspect of tire yolk sac. The primitive gut h Ebook Practical paediatric problems: Part 2as three parts: foregut. midgut and hindgut.The mouth is derived from stomodcum. which is lined wilh ectoderm, and the proximal portion of (he forrgulEbook Practical paediatric problems: Part 2
, which is endodermal in origin. The Ibregul gives rise Io I he pharynx, oesophagus, stomach and duodenum down to the ampulla of Vater and the liver aChapter 10Gastrointestinal system, hepatic and biliary problemsPeter GillettEMBRYOLOGY OF THE GASTROINTESTINAL TRACTThe gastrointestinal tract compris Ebook Practical paediatric problems: Part 2 the classic C-loop forms with the ligament of Trcitz fixing the terminal duodenum (fourth part). The liver buds off the distal foregut (second part of the duodenum). The pancreas develops from two buds: a dorsal and a ventral hud of endodermal cells from the foregut. Gut rotation causes the buds an Ebook Practical paediatric problems: Part 2d ducts to fuse, forming the main pancreatic duct that joins the common bile duct and enters the second part of the duodenum.The midgut comprises theEbook Practical paediatric problems: Part 2
distal duodenum, small bowel and colon to the proximal third of the transverse colon. The growing abdominal organs squeeze the gut out of the abdominaChapter 10Gastrointestinal system, hepatic and biliary problemsPeter GillettEMBRYOLOGY OF THE GASTROINTESTINAL TRACTThe gastrointestinal tract compris Ebook Practical paediatric problems: Part 2ome small bowel. The caudal limb forms the caecum and colon. A diverticulum forms, which will become the caecum and appendix. The cephalic limb of the midgut forms the jejunum and ileum. The caudal part becomes the distal ileum, caecum, ascending colon and proximal two-thirds of the transverse colon Ebook Practical paediatric problems: Part 2. When outside the embryoniccavity, the gut rotates counterclockwise through 90’ (viewer! from the anterior aspect of the embryo). In the third month,Ebook Practical paediatric problems: Part 2
the cavity is able Io accommodate the bowel again and the gut returns Io the abdomen. The head end returns with the jejunum first, ending high on theChapter 10Gastrointestinal system, hepatic and biliary problemsPeter GillettEMBRYOLOGY OF THE GASTROINTESTINAL TRACTThe gastrointestinal tract compris Ebook Practical paediatric problems: Part 2future jejunum and ileum. During (his return, the gut loop rotates another 1 BO” counterclockwise. again looking from the anterior position. Rotation is a total of 27O:. leaving the caecum and appendix in initial close proximity Io the liver, but later descending into the right iliac fossa.The hindg Ebook Practical paediatric problems: Part 2ut structures are the distal transverse colon, descending, sigmoid colon rectum and tire upper half of the anal canal. The hindgut terminates as a bliEbook Practical paediatric problems: Part 2
nd-ending sac. in contact with the proctodeum, an ectodermal depression. These apposed layers comprise thecloacal membrane, rhe bladder forms anteriorChapter 10Gastrointestinal system, hepatic and biliary problemsPeter GillettEMBRYOLOGY OF THE GASTROINTESTINAL TRACTThe gastrointestinal tract compris Ebook Practical paediatric problems: Part 2he lower canal is formed from the ectodermal tissue of the proctodeum and this posterior part of the cloacal membrane breaks down to form the anal opening. Many congenital anatomical abnormalities arc explained by the failure of proper development (particularly malrotation).INVESTIGATIVE PROCEDURES Ebook Practical paediatric problems: Part 2FORGASTROINTESTINAL DISEASERelevant blood and stool investigations for specific conditions are discussed in the appropriate sections.Percutaneous liveEbook Practical paediatric problems: Part 2
r biopsyChildren who have acute or chronic liver disease may need to undergo a biopsy. Platelets should be over 60000,310 Gastrointestinal system, hepChapter 10Gastrointestinal system, hepatic and biliary problemsPeter GillettEMBRYOLOGY OF THE GASTROINTESTINAL TRACTThe gastrointestinal tract compris Ebook Practical paediatric problems: Part 2d/or platelet cover may be required. Ultrasound examination is carried out to exclude grossly dilated ducts, vascular malformations, cysts or abscesses, which are contraindications and many use real-time ultrasound guidance. Complications include bleeding, perforation, pneumothorax, hacmopncumothora Ebook Practical paediatric problems: Part 2x and local infection. The children may Iw kept overnight for observation, nursed on their right side for the first four hours, but after four to sixEbook Practical paediatric problems: Part 2
hours, the risk of bleeding is very small. Tire biopsy is usually taken with the patient on their back, right arm above the head at the point of max iChapter 10Gastrointestinal system, hepatic and biliary problemsPeter GillettEMBRYOLOGY OF THE GASTROINTESTINAL TRACTThe gastrointestinal tract compris Ebook Practical paediatric problems: Part 2This can be performed under sedation and local anaesthesia or under a quick general anaesthetic depending on local preferences. The present author uses a disposable I lepafix® needle, which is a variation of the Menghini (a hollow coring needle). Ibe Trucut* needle is also used. The breath is held i Ebook Practical paediatric problems: Part 2n endexpiration and the needle quickly advanced to a predetermined depth and withdrawn. The core is flushed out of the needle into a container containEbook Practical paediatric problems: Part 2
ing formalin.Transjugular liver biopsyWhere percutaneous biopsy is contraindicated because of uneorrcctablc coagulopathy, the transjugular route (inteChapter 10Gastrointestinal system, hepatic and biliary problemsPeter GillettEMBRYOLOGY OF THE GASTROINTESTINAL TRACTThe gastrointestinal tract compris Ebook Practical paediatric problems: Part 2n coagulation results as bleeding occurs into the vascular system. Transjugular liver biopsy is taken in children with prothrombin time prolonged over 5 seconds despite vitamin K. FFP or cryoprecipitate support.Jejunal biopsyThe original Crosby-Kugler capsule in adults was modified for children, but Ebook Practical paediatric problems: Part 2 this technique has been superseded by endoscopy. It involved a metal capsule with a suction port and tubing being passed down to the jejunum and suctEbook Practical paediatric problems: Part 2
ion applied thus firing an internal cutting device and the sample retained within the port.Rectal suction biopsyThis is used in suspected HirschsprungChapter 10Gastrointestinal system, hepatic and biliary problemsPeter GillettEMBRYOLOGY OF THE GASTROINTESTINAL TRACTThe gastrointestinal tract compris Ebook Practical paediatric problems: Part 2owing deep biopsies, including muscularis. to be taken. Histological examination including acetylcholinesterase is done.Biopsies for disaccharldasesThese can hr taken endoscopically for measurement of maltase, sucrase, lactase (and trrhalase). The levels are expressed as level/g of protein or wet we Ebook Practical paediatric problems: Part 2ight of mucosa. Lactase is more sensitive to intestinal inflammatory states than the other enzymes and seems to be the last to recover. Measurement isEbook Practical paediatric problems: Part 2
usually useful in primary disorders such as congenital lactase deficiency or sucrase-isomallase deficiency.Breath testingMalabsorption of carbohydratChapter 10Gastrointestinal system, hepatic and biliary problemsPeter GillettEMBRYOLOGY OF THE GASTROINTESTINAL TRACTThe gastrointestinal tract compris Ebook Practical paediatric problems: Part 2ogen measurement is taken and then ). g/kg (maximum ',()g) of the sugar Io he tested is ingested in solution. Lactose and sucrose arc the two commonest investigations. The test is dependent on the fermentation lor not) of sugar by bacteria in the colon. Children blow into a plastic bag with a three- Ebook Practical paediatric problems: Part 2way lap for sampling and a read-out (in parts per million, PPM) is given. Baseline elevations in hydrogen can be seen in small bowel bacterial overgroEbook Practical paediatric problems: Part 2
wth. A rise of 10 20 PPM from baseline is indicative of intolerance. Glucose and lactulose breath testing has been used to look for bacterial overgrowChapter 10Gastrointestinal system, hepatic and biliary problemsPeter GillettEMBRYOLOGY OF THE GASTROINTESTINAL TRACTThe gastrointestinal tract compris Ebook Practical paediatric problems: Part 2 the most commonly utilized lest. Blood is taken for glucose estimation at half-hour intervals for two hours. An increase of 1.7 mmol/L above the pretest glucose level is considered normal. Of value is the clinical response to the load of sugar (symptoms of gassiness, pain, diarrhoea).Small intestin Ebook Practical paediatric problems: Part 2al permeability testsTwo inert sugars, usually xylose or lactulose (larger sugar) and rhamnose or cellobiose (smaller sugar) arc given orally, and theEbook Practical paediatric problems: Part 2
ratio of these sugars is measured in a timed urine collection. The differential absorption gives a measure of increased intestinal leakiness (increasChapter 10Gastrointestinal system, hepatic and biliary problemsPeter GillettEMBRYOLOGY OF THE GASTROINTESTINAL TRACTThe gastrointestinal tract compris Ebook Practical paediatric problems: Part 2luid part of a stool (the nappy should be inverted or cling film placed inside the nappy so that the whole stool can be collected and the liquid element is not wicked away). A Clinitest tablet is added to a diluted mix with water and a colour change indicates reducing substances from 0 to 2 per cent Ebook Practical paediatric problems: Part 2. One per cent or more is significant. A delay in getting the stool to the lab allows continued fermentation by bacteria and a false positive test. StEbook Practical paediatric problems: Part 2
ool chromatography is used if there are significant reducing substances present and can identify patterns of sugar malabsorption which may be helpful,Gọi ngay
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