Chapter 39 – Pediatric Digestive Disorders

Cleft Lip & Cleft Palate

Caused by failure of facial structures to fuse during development

Key problems:

• Feeding difficulty

• Speech problems

👉 Treatment:

• Surgery

• Speech therapy

• Dental/orthodontic care

Cleft lip

split in upper lip

Cleft palate

opening in roof of mouth

Esophageal Atresia

• Esophagus ends in a blind pouch (food can’t reach stomach)

• Often with tracheoesophageal fistula (TEF)

Clues:

• Excess amniotic fluid (polyhydramnios) before birth

• Baby chokes/coughs when feeding

👉 Diagnosis:

• Cannot pass feeding tube

Pyloric Stenosis

• Thickened pylorus → blocks food leaving stomach

Key sign:

• Projectile, non-bilious vomiting (2–3 weeks old)

Effects:

• Weight loss

• Dehydration

👉 Treatment:

• Pyloromyotomy (surgery)

Duodenal Obstruction

• Early blockage in intestine

Signs:

• Vomiting

• Abdominal swelling

• “Double bubble” sign on X-ray

Jejunal/Ileal Obstruction

Causes:

• Atresia (missing part)

• Hernia

• Intussusception

• Meckel diverticulum

Meckel Diverticulum

• Outpouching of small intestine

“Rule of 2s”:

• Age 2

• 2 inches long

• 2 feet from ileocecal valve

• 2% of population

Key sign:

• Painless rectal bleeding

Intestinal Malrotation

• Intestines not properly positioned → twisting (volvulus)

Symptoms:

• Bilious (green) vomiting

• Pain, diarrhea

👉 Emergency → surgery needed

Meconium

first stool

Meconium Ileus

• Thick stool blocks intestine

• Often linked to cystic fibrosis

Meconium Plug Syndrome

• Temporary delay in passing stool

Hirschsprung Disease

• Missing nerve cells in colon → no movement

Results:

• Severe constipation

• Colon enlargement

👉 Treatment:

• Surgery

Anorectal Malformations

• Examples:

  • Imperforate anus

  • Narrow anus

👉 Treatment:

• Surgery or dilation

GERD in Infants

• Reflux is normal in babies, but becomes GERD if severe

Symptoms:

• Vomiting

• Crying

• Choking

Complications:

• Esophagitis

• Bleeding

Intussusception

• Intestine folds into itself (telescoping)

Classic signs:

• Severe abdominal pain

• Vomiting

• “Currant jelly” stool (blood + mucus)

👉 Treatment:

• Enema or surgery

Cystic Fibrosis

• Genetic disease → thick mucus

Effects on GI:

• Blocks pancreas → no enzymes

Symptoms:

• Poor digestion

• Fatty stools (steatorrhea)

• Malnutrition

Celiac Disease

• Autoimmune reaction to gluten

Causes damage to:

• Villi in small intestine → poor absorption

Symptoms:

• Diarrhea

• Weight loss

• Malnutrition

👉 Treatment:

• Gluten-free diet for life

Necrotizing Enterocolitis (NEC)

• Serious disease in premature infants

What happens:

• Intestine becomes inflamed → dies

Symptoms:

• Abdominal swelling

• Bloody stools

👉 Treatment:

• Stop feeding

• Antibiotics

• Surgery if severe

Neonatal Jaundice

• Yellow skin from high bilirubin

Types:

• Physiologic (normal) → immature liver

• Pathologic → appears early, more serious

👉 Treatment:

• Fluids

• Phototherapy

Biliary Atresia

• Blocked or missing bile ducts

Key sign:

• Persistent jaundice

👉 Treatment:

• Often needs liver transplant

Hepatitis in Children

• Viral infection of liver

Types:

• Hep A → common in kids

• Hep B & C → can become chronic

Hepatitis A virus

30% to 50% of hepatitis A infections occur in children

Hepatitis B virus

Many newborns with HBV are infected by their mother

Hepatitis C virus

Transmission through exposure to infected blood or contaminated materials