Guide Derangements, Primary and Reflex, of the Organs of Digestion

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Derangements, Primary and Reflex, of the Organs of Digestion

Email address subscribed successfully. A activation email has been sent to you. Storage glycogen, fat, vitamins, copper, iron. Synthesis of blood components. Control signs:. Painful syndrome. Pain intensive, paroxysmal, after the meal, more often at night and on empty stomach. The pain is localized in epigastrium, umbilicus, right subcostal area, sometimes irradiates to waist or has spread character.

Tenderness on palpation in pyloroduodenal area, muscular defence, and hyperesthesia of skin in tender zones Zakhariev-Ged , positive sign of Mendel. Dyspeptic syndrome: vomiting, nausea, heartburn, vomiting frequently causes relief, removing pain, decrease of appetite. Tendency to constipation in patients with increased gastric acidity or unstable stool in patient with low gastric acidity. Intoxication syndrome: weakness, lucidity, bad sleep, headaches, irritability, tearfulness, increased disposition to perspiration, blue shadows under the eyes.

Major symptoms and signs of digestive tract disorders. Disorders of organs outside the gastrointestinal GI tract can produce symptoms and signs that mimic digestive tract disorders and should be considered in the differential diagnosis Table 1. Table 1. Some nondigestive tract causes of gastrointestinal symptoms in children.

Nondigestive tract causes. Systemic disease: inflammatory, neoplastic. Cardiorespiratory compromise. Iatrogenic: drug therapy, unpalatable therapeutic diets.

Anorexia nervosa. Inborn errors of metabolism. Medications: erythromycin, chemotherapy, nonsteroidal anti-inflammatory drugs. Increased intracranial pressure. Brain tumor. Infection of the urinary tract. Adrenal insufficiency. Abdominal migraine. Renal disease.

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Infection: otitis media, urinary. Medications: antibiotics, cisapride. Tumors: neuroblastoma. Spina bifida. Psychomotor retardation. Dehydration: diabetes insipidus, renal tubular lesions. Medications: narcotics. Lead poisoning. Infant botulism. Abdominal pain. Pyelonephritis, hydronephrosis, renal colic.

Pelvic inflammatory disease. Familial Mediterranean fever. Sexual or physical abuse. Systemic lupus erythematosus. School phobia.

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Sickle cell crisis. Vertebral disk inflammation. Psoas abscess. Pelvic osteomyelitis. Abdominal distention.

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Ascites: nephrotic syndrome, neoplasm, heart failure. Discrete mass: Wilms tumor, hydronephrosis, neuroblastoma, mesenteric cyst, hepatoblastoma, lymphoma. Hemolytic disease. Urinary tract infection. Poor weight gain or weight loss is often associated with a significant pathologic process and usually necessitates a more formal evaluation.

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Difficulty in swallowing is termed dysphagia. Painful swallowing is termed odynophagia. Swallowing is a complex process that starts in the mouth with mastication and lubrication of food that is formed into a bolus. The bolus is pushed to the pharynx by the tongue. The pharyngeal phase of swallowing is rapid and involves protective mechanisms to prevent food from entering the airway.

The epiglottis is lowered over the larynx while the soft palate is elevated against the nasopharyngeal wall; respiration is temporarily arrested while the upper esophageal sphincter opens to allow the bolus to enter the esophagus. In the esophagus, peristaltic coordinated muscular contractions push the food bolus toward the stomach. The lower esophageal sphincter relaxes shortly after the upper esophageal sphincter, so liquids that rapidly clear the esophagus enter the stomach without resistance.

Dysphagia is classified as oropharyngeal dysphagia and esophageal dysphagia. Oropharyngeal dysphagia occurs when the transfer of the food bolus from the mouth to the esophagus is impaired also termed transfer dysphagia. The striated muscles of the mouth, pharynx, and upper esophageal sphincter are affected in oropharyngeal dysphagia. Neurologic and muscular disorders can give rise to oropharyngeal dysphagia Table 2. The most serious complication of oropharyngeal dysphagia is life-threatening aspiration. Table 2. Causes of oropharyngeal dysphagia. Neuromuscular disorders:. Metabolic and autoimmune disorders:.

Infectious disease:. Structural lesions:. A complex sequence of neuromuscular events is involved in the transfer of foods to the upper esophagus. Abnormalities of the muscles involved in the ingestion process and their innervation, strength, or coordination are associated with transfer dysphagia in infants and children. In such cases, an oropharyngeal problem is usually part of a more generalized neurologic or muscular problem botulism, diphtheria, neuromuscular disease.

Painful oral lesions, such as acute viral stomatitis or trauma, occasionally interfere with ingestion. If the nasal air passage is seriously obstructed, the need for respiration causes severe distress when suckling. Although severe structural, dental, and salivary abnormalities would be expected to create difficulties, ingestion proceeds relatively well in most affected children if they are hungry.

Esophageal dysphagia occurs when there is difficulty in transporting the food bolus down the esophagus. Esophageal dysphagia can result from neuromuscular disorders or mechanical obstruction Table Primary motility disorders causing impaired peristaltic function and dysphagia are rare in children. Achalasia is an esophageal motility disorder with associated inability of relaxation of the lower esophageal sphincter, and it rarely occurs in children.