Gastrointestinal tract

1
Gastrointestinal tract

• Examination of the newborn

2
Functions of the Gastrointestinal tract

• Ingestion
• Digestion
• Absorption
• Elimination

3
Development of the gut
4
Embryology

• Week 4 Gut forms from a blind ended single tube.
  From part of the yolk sac being incorporated into
  the embryo during folding. The endoderm forms
  the secretary lining.
• Week 5 The tube is fixed at pits stomatodaeum
  proctodaeum. 3 distinct parts foregut, midget and
  hindgut
• Foregut Oesophagus, stomach , duodenum and liver
• Midgut Jejunum, ileum ascending and transverse
  gut
• Hindgut Descending gut, rectum

5
Embryology

• Week 6 Rapid growth convolution and rotation.
  Mid gut is too big for abdominal cavity and
  herniates through the yolk sac. Endodermal
  epithelium proliferates to occlude the canal.
• Mouth lip closes
• Week 7 Intestinal villi

6
Fetal development

• Week 8 Recanalization complete
• Week 10 Intestines return to the abdominal canal.
  The palate in the mouth fuses
• Week 10 14 Swallowing present
• Week 14 -16 Bile acids produced
• Week 16 Meconium present stomach cells secreting
  enzymes, acid intrinsic factor. 20 weeks gut in
  final position, non nutritive sucking present
• 32-34 weeks nutritive sucking

7
Assessment of the gastrointestinal tract

• History Antenatal, sibling,
• Observation skin opaque, smooth, shape- round,
  symmetric, muscle tone, movement
• Palpation Each quadrant should be palpated.
  Liver edge can be palpated 1-2cm below costal
  edge should be sharp. Abdomen depressed 1-2
  cm. Spleen is not normally palpated

8
Factors to remember the baby at birth

• Stomach holds 15-30ml
• Gastric emptying time 2-3 hours
• Presence of mucus in the stomach delays emptying
  further
• Cardiac sphincter
• Enzymes are less effective than an adults
• HCl at birth 10 of adults
• Initiation of feeding stimulates growth of the
  intestinal mucosa

9
Mouth

• Ankyloglossia inferior, short frenulum does not
  cause a problem, lengthens during the postnatal
  period
• Epsteins pearls 80 of infants, disappear within
  1 month

10
Cleft lip and palate

• 1700 Cleft lip with or without cleft palate.
  70 with cleft lips have cleft palates
• Teratogenic and or genetic factors
• 10 associated with other congenital
  malformations
• Timing of operative repair Lip 3 Months, palate
  6 months. Treatment continues until child is 18
  years old

11
Complications of cleft Lip and Palate

• Problems bonding
• Problems feeding
• Difficulties with hearing
• Formation of teeth
• Difficulties with speech

12
Oesophageal atresia Trachea-oesophageal fistula

• Incidence of OA 1 3 -4,000 births 85 have a
  fistula
• Incidence of TOF 125,000
• 50 have other congenital abnormalities cardiac,
  urogenital Downs syndrome 0.9
• Associated with polyhydramnios

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Treatment

• Excessive saliva
• Choking
• Nursed in an upright position
• Feeding withheld
• Surgical repair oesophageal anastomosis
• Prognosis Without respiratory complications 95
• Prognosis Severe respiratory complications 75

14
Umbilical hernia

• Usually close spontaneously by 2 years of age
• Not usually a cause for concern

15
Exomphalos

• Incidence 15-6, 000
• Defect through the umbilicus
• Diagnosis in the antenatal period by ultrasound
• Associated with other abnormalities such as
  cardiac GU

16
Diaphragmatic Hernia

• 12000 births
• Usually left side
• Associated with polyhydramnios
• Respiratory distress
• Shift of heart sounds
• Emptiness of abdomen

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Gastroschisis

• Defect through the abdominal wall
• Contents not covered by peritoneal sac
• Difficult surgery depends on the extent of
  herniation
• Associates with jejunoileal atresia

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Atresia

• Incidence 1 15000 births, represent 1/3 of all
  intestinal obstructions
• Associated with Downs syndrome, oesophageal
  atresia, cardiovascular disease Intrauterine
  growth restriction
• 30 Duodenal (110,000)
• Vomiting of bile
• Duodenal atresia Abdominal distension absent

19
Jejunoileal

• 50 of intestinal atresias
• Associated with gastroschisis
• Late intrauterine mesenteric vascular incident
• Polyhydramnios
• Bilious vomiting
• Abdominal distension
• 20-40 pass meconium
• Jaundice

20
Meconium Ileus

• 80-90 have Cystic Fibrosis
• Abdomen feels doughy
• Often has other complications such as atresias /
  volvulus

21
Volvulus

• 16000
• Sudden vomiting
• Abdominal distension

22
Hirschsprungs disease

• Incidence 15000
• Absence of ganglion cells, peristalsis in
  co-ordinated
• Associated Downs syndome
• Delay in passing meconium, not passed by 36 hours
• Retention of gas and faeces
• Poor feeder

23
Imperforate anus

• Incidence 15,000
• More common in boys than girls
• Patency not confirmed until passage of meconium
• Passage of meconium normally occurs within 24
  hours

24
Pyloric Stenosis

• 21000 births
• 5 times more common in boys
• Manifests week 2
• Projectile vomiting
• Stools become infrequent