Pediatric GI Pathology

Vomiting, or emesis, is the forceful oral expulsion of gastric contents. Vomiting is a common presenting symptom in pediatrics. The frequency and characteristics of vomiting may point toward a specific pathology, just as its presence can be another symptom of a greater clinical situation. The majority of vomiting symptoms are benign and self-limited. A good history and physical examination can bring into focus the underlying cause and workup. Management is with antiemetics and treating the underlying cause, if needed. The most common complications are dehydration and malnutrition.

Acute abdomen, which is in many cases a surgical emergency, is the sudden onset of abdominal pain that may be caused by inflammation, infection, perforation, ischemia, or obstruction. The location of the pain, its characteristics, and associated symptoms (e.g., jaundice) are important tools that help narrow the differential diagnosis. Patients will typically have severe tenderness with associated rigidity and rebound tenderness. Laboratory evaluation will demonstrate leukocytosis, acidosis, and in some cases, abnormal hepatic function tests. Imaging helps narrow the differential diagnosis; first-line imaging is always an upright chest X-ray to evaluate for pneumoperitoneum. The treatment and prognosis of acute abdomen strongly depend on the underlying cause, but the vast majority of these cases constitute a surgical emergency with associated morbidity and mortality.

Intussusception occurs when a part of the intestine (intussusceptum) telescopes into another part (intussuscipiens) of the intestine. The condition can cause obstruction and, if untreated, progress to bowel ischemia. Intussusception is most common in the pediatric population, but is occasionally encountered in adults. The pediatric patient typically presents with acute cyclical abdominal pain and vomiting, while adults present with symptoms of bowel obstruction. The diagnosis in children is frequently clinical but may be supported by an abdominal ultrasound showing a classic target sign. Management options in children include contrast or pneumatic enema, with surgical options reserved for failure of the non-operative measures, complications such as gangrene or perforation, and treatment of underlying pathology. In adult patients, surgery is usually required.

Megacolon is a severe, abnormal dilatation of the colon, and is classified as acute or chronic. There are many etiologies of megacolon, including neuropathic and dysmotility conditions, severe infections, ischemia, and inflammatory bowel disease. Toxic megacolon is an acute form of megacolon with systemic toxicity, and carries the highest morbidity and mortality. Common symptoms include abdominal distention, pain, bloody diarrhea, or obstipation. Diagnosis depends on the underlying cause, and is usually established with a combination of the patient’s history, laboratory findings, and imaging studies. Patients with chronic megacolon may require laxatives, enemas, and bowel training. Management for acute megacolon includes supportive care, decompression, and potential surgery.

Constipation is a common complaint in children that is relatively defined for individual age groups based on the frequency and difficulty of defecation and stool consistency. The majority of constipation cases are functional or non-organic. Clinical presentation may vary, from insufficient evacuation noted by the parents, to complaints of abdominal pain, to secondary incontinence. Often, a combination of non-pharmacologic and pharmacologic management is needed for evacuating bowel content, eliminating pain upon defecation, and improving bowel habits.

Congenital duodenal obstructions are a group of inborn conditions that cause obstruction of the lumen of the duodenal segment of the small intestine, impeding the passage of food and gastric juices. The condition may have intrinsic etiologies, such as duodenal atresia (most common) and/or extrinsic etiologies, such as an annular pancreas. The hallmark of duodenal obstruction is bilious vomiting. The condition can be diagnosed through prenatal or postnatal ultrasound. Associated anomalies, including congenital heart disease, are common. Treatment includes fluid resuscitation and surgical duodenoduodenostomy.

Hypertrophic pyloric stenosis is hypertrophy and hyperplasia of the pyloric sphincter muscle. The condition is the most common cause of gastrointestinal obstruction in infants. Affected newborns typically present after the third to fifth week of life with progressive non-bilious vomiting and a firm, olive-like mass in the epigastrium. Ultrasound confirms the diagnosis based on the thickness and length of the pyloric muscle and channel diameter. Initial treatment consists of fluid resuscitation with correction of electrolyte imbalances, followed by either open or laparoscopic pyloromyotomy.

Pediatric colic is a very common symptom that occurs in infants during the first few months of life, and tends to disappear by the fourth month.  Its causes are poorly understood and there are various theories explaining it as a reaction to food allergies, parental stress, gastrointestinal immaturity, maternal smoking and other factors. This article gives an overview of the condition with its epidemiology, etiology, symptom, diagnosis and differential diagnosis, and treatment.

Appendicitis is considered a serious surgical emergency in medicine, therefore early diagnosis and management is important to a successful outcome and preventing serious complications as gangrene and perforation. This article will describe the incidence of appendicitis the younger children, and how can be diagnosed and managed.

Meconium originates from the Greek word “mekonion” which stands for poppy. The nomenclature attests to the tarry, black appearance of meconium which resembles raw opium preparation. Meconium ileus implies the presence of an intestinal obstruction in-utero or in neonatal period secondary to abnormally thick meconium. This article expatiates on patho-physiological aspects of meconium ileus and expounds on clinical features of the same. The article concludes with treatment, complications and prognosis of meconium ileus.

Pediatric allergic proctocolitis is considered an IgE-mediated allergic reaction to dietary proteins; most commonly is Cow’s milk protein, which represents about 50-65% of the cases. It's a frequent, significant cause of infant colitis. This article explains the main clinic-patho-physiological aspects of the disease.