Peptic Ulcer Disease

There is important evidence to document the involvement of Helicobacter pylori as a causative agent of peptic ulcer disease, antral atrophic gastritis, gastric adenocarcinoma and gastric lymphoma (Konturek et al. 2006a,b). Although these diseases are much more common in adulthood, colonization with this pathogen occurs mostly during childhood. Prevalence rates vary from almost 10 of children under the age of 10 years in industrialized countries to 56.8 -83.1 of children in the poorest Brazilian...

Disorders of Swallowing

Feeding difficulty is not an uncommon symptom in children, reportedly occurring in 25 of children (Miller and Willging 2003). The causes of pediatric dysphagia are varied and complex, and may be physiologic or behavioral. The majority of children with dysphagia have a neurological cause, and may be due to cranial nerve palsies, cerebral palsy and meningomyelocele. Structural craniofa-cial anomalies predispose to dysphagia (Lifschitz 2001 Miller and Willging 2003). Swallowing dysfunction with...

References

Addiss DG, Shaffer N, Fowler BS et al (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132 910-25 Albanese CT, Rowe MI (1998) necrotising enterocolitis. In O'Neil JA, Rowe MI, Grosfeld JL, et al (eds.) Paediat-ric Surgery, 5th ed, vol 2. St. Louis, Mosby-Year Book, pp 1297-1320 Alessi V, Salerno G (1985) The hay-fork sign in the ultrasonographic diagnosis of intussusception. Gastrointest Radiol 10 177-179 Amodio J, Berdon WE, Abramson SJ (1986)...

Epidermolysis Bullosa

Epidermolysis bullosa is a rare inherited geno-dermatosis resulting from a mutation in COL7A1, the gene encoding type VII collagen (Horn and Tidman 2002). Clinical manifestations are caused by the extreme vulnerability of squamous epithelium of the skin and mucous membranes to minor trauma. The most affected subtype is the recessive epidermolysis bullosa dystrophica, in which the most severely affected individuals will develop blisters within the first 24 h of life (HorN and Tidman 2002). Most...

Neonatal Intestinal Obstruction

Intestinal obstruction is the most common abdominal emergency in the neonatal period. It is almost always the result of a congenital anomaly of the gastrointestinal tract, which must be rectified surgically if the infant is to survive. Mortality in surgically untreated patients is close to 100 , and the rate of survival is closely related to the time of surgical intervention (Hajivassiliou 2003). The most common clinical findings are abdominal distension, vomiting, and sometimes failure to pass...

Renal Causes of Acute Abdominal Pain

Acute Abdomen Pain Ureter

The most common renal causes of an apparent acute abdomen are upper urinary tract infection, especially pyelonephritis, renal colic due to a stone in the urinary tract, and acute presentation of a pelvi-ureteric junction obstruction. Children may localize the pain to the abdomen, not the loin. Urinary tract infections, usually related to vesicoureteral reflux, may cause similar symptoms to those of intussusception, mostly in young children. In most of these cases US is normal and only in...

Info

Many etiologies for protein-losing enteropathies (celiac disease, intestinal lymphangiectasis, allergic gastroenteritis, cow milk protein allergy, Crohn disease, cystic fibrosis, collagen vascular disease, short bowel, intestinal transplants and others) have been identified. Celiac disease is the commonest cause of intestinal malabsorption in childhood. The etiology is an intolerance to the gliadin component of gluten. Most patients present early in childhood with failure to thrive, abdominal...

Acute Pancreatitis

Acute pancreatitis is an uncommon clinical entity in children that is caused by a wide variety of etio-logical agents, the most common of which is blunt abdominal trauma. Other causes include viral infections, drugs, and hereditary abnormalities. Clinical presentation depends on the severity of the disease, but abdominal pain is invariable. Other symptoms are vomiting, fever, jaundice, and an abdominal mass if a pseudocyst is present. When pancreatitis is suspected in a child, US should be the...

Duodenal Obstruction

Pictures Duodenal Obstruction

Complete duodenal obstruction is much more frequent than congenital gastric obstruction. Persistent vomiting is the cardinal sign, but abdominal distension may not be a conspicuous feature. The vomiting is bile-stained when the obstruction is below the ampulla of Vater (70 of cases), and clear but persistent in supra-ampullary lesions. The classic plain radiographic finding is the so-called double bubble image (Rathaus et al. 1992) (Fig. 1.3). The higher, more leftward and larger bubble is the...

Inflammatory Bowel Disease

Crohn's disease may affect any part of the gastrointestinal tract, being the commonest site in the ileo-cecal region. In children, 20 of cases of Crohn's disease present with acute abdominal pain mimicking acute appendicitis (Hayes 2004). In fact, Crohn's disease may cause, though rarely, appendicitis. Parietal involvement is often discontinuous in Crohn's disease with intervals of apparently normal bowel, producing skip lesions. Another specificity of the disease is the transmural inflammation...

Radiological Techniques of Examination

An empty esophagus is not visible on plain radiographs or CT. However, the esophagus is not uncommonly outlined by air in a child that is crying and swallowing large amounts of air (Fig. 2.1). An air-filled esophagus is also frequently seen in neonates ventilated with continuous positive airway pressure (CPAP), as well as in those with tracheo-esophageal fistula, esophageal stricture and achalasia (Fig. 2.2). In children with developmental delay, air in the esophagus is a common finding, and is...

Hepatobiliary Causes of Acute Abdominal Pain

Hepatitis, space occupying hepatic lesions, and biliary pathology such as cholecystitis or those char acteristics of the childhood (hydrops, choledochal cyst) may also cause abdominal pain. Acute cholecystitis in children is relatively rare, but certain pediatric patients are prone to these diseases. Acute cholecystitis may be calculous or acalculous. The triad of right upper quadrant pain, vomiting, and fever is the usual clinical presentation (TsakayaNNiS et al. 1996). Jaundice occurs in 25...

C

Campylobacter 61 Candida 153, 154, 214 - esophagitis 105 candidiasis 153 Caroli disease 66, 137 Castleman syndrome 129 catheter drainage 233 caudal regression syndrome 211 caustic ingestion 100, 121, 122 - alkali granules 100 CBD, see common bile duct cecostomy 228 CGDC, see chronic granulomatous disease of childhood - excision 139 choledocholithiasis 67 cholestasis 135, 137 cholithiasis 232 chronic granulomatous disease of childhood (CGDC) 122 - volvulus 215 colonoscopy 217 common bile duct...

Gynecological Causes of Acute Abdominal Pain

Adnexal Mass

The main gynecological conditions causing acute abdominal pain are functional ovarian cysts, ovarian torsion, and hydrometrocolpos. Transabdominal US will commonly show the lesion. Transvaginal US should not be routinely done as a primary investigation in adolescent girls, but may supplement the abdominal examination in sexually active patients. Ovarian cysts usually result from failure of involution during the normal menstrual cycle. They may cause acute lower abdominal or pelvic pain in...

Pneumoperitoneum

Massive Insertion

Pneumoperitoneum or free intraperitoneal air in the neonatal period is usually the result of a hollow viscous perforation. In healthy neonates, the perforation is usually iatrogenic, secondary to the insertion of a tube or a rectal thermometer (Fig. 1.43). Necrotiz ing enterocolitis is the most common cause of pneumoperitoneum in the neonatal intensive care unit. Intestinal atresia is also an important cause, the perforation usually occurring in the dilated loops above the atresia. Ruptured or...

Distinction In Stomach

Stomach Collapsed

Low intestinal obstruction is defined as one occurring in the distal ileum or colon. The symptoms are vomiting, abdominal distension, and failure to pass meconium. For practical purposes, the differential diagnosis of low intestinal obstruction in the neonate consists of five conditions. Two conditions involve the distal ileum and include ileal atresia and meconium ileus, and three involve the colon, which are colonic atre-sia, Hirschsprung's disease, and functional immaturity of the colon that...

Abnormal Bowel Loop

Pink Sock Inverted Colon

Colon atresia, similar to small bowel atresia, is believed to result from an intrauterine vascular insult. The colon is the least frequent location, representing 5 -15 of all intestinal atresias (Powell and Raffensperger 1982). Multiple atresia syndromes may involve the colon in addition to the small bowel. Proximal location is more common than distal, with atresia beyond the splenic flexure being unusual. Clinical presentation may be delayed up to 48 h after birth. The abdominal scout film, in...

Necrotizing Enterocolitis

Necrotizing Enterocolitis Xray

Necrotizing enterocolitis NEC is the leading gastrointestinal emergency of the premature infant. In many cases, it happens in apparently healthy premature infants who have no other medical problems. Although it affects mostly premature infants, 10 of affected infants are born at term. Its incidence varies between 0.3 and 2.4 infants 1000 births and between 3.9 and 22.4 amongst infants of less than 1500 g. Males and females are equally affected. Most infants develop NEC within the first 2 weeks...

Enteritis

Gastroenteritis is the most frequent cause of abdominal pain in children. Several organism may cause this usually self-limited disease in developed coun tries. Diarrhea, vomiting, and abdominal pain are common symptoms. There is overlap of symptoms with some cases of appendicitis for this reason imaging is required in cases of atypical course. Plain film may show diffuse small and large bowel distension, with air-fluid levels on positional views the pattern of an ileus Fig. 1.71a . US may...

Scrotum Air Inflation

Scrotal Air Inflation

Ileal atresia is an important cause for low intestinal obstruction. It represents approximately 50 of small bowel atresias and the etiology is similar to that of jejunal atresia. As jejunal atresias, they are believed to result from an intrauterine vascular injury. Approximately 25 have a history of polyhydramnios Sweeney et al. 2001 . Plain film shows numerous dilated loops of bowel occupying the entire abdominal cavity, including the pelvic portion, and multiple air-fluid levels in upright...

Intussusception

Meniscus Sign Intussusception

Intussusception is one of the most common causes of acute abdomen in infancy. Intussusception occurs when a portion of the digestive tract becomes telescoped into the adjacent bowel segment. This condition usually occurs in children between 3 months and 2 years of age. In almost all cases intussusceptions are idiopathic, that is, they do not have a demonstrated anatomic abnormality that functions as a lead point except for hypertrophied lymphoid tissue. The vast majority of childhood cases of...

Lucent Proximal Pouch Bowel

Enlarged Stomach Duodenal Atresia

The radiological appearance varies with the type of lesion, whether there is esophageal atresia, fistula or both. The initial radiograph must include the entire abdomen to assess for the presence of bowel gas Figs. 2.5 and 2.6 . The abdomen is characteristically gasless in the absence of a fistula, whereas in the presence of a distal fistula, the abdomen has a normal bowel gas pattern. Features of esophageal atresia are characteristic. The proximal blind-ending pouch is lucent and distended...

Small Bowel Obstruction

Axr Bowel Obstruction Transition Point

Besides perforated appendicitis and intussusception, the most common causes of small bowel obstruction are incarcerated hernias and adhesions. Other causes of small bowel obstruction comprise a miscellaneous group of rare conditions, such as midgut volvulus, Meckel's diverticulum, advanced stages of Crohn's disease, and bezoars. Adhesions usually result from prior surgery and are often multiple. There is an increasing tendency for initial conservative management rather than immediate operative...

Normal Embryology and Anatomy

In the normal embryo, the abdominal portion of the foregut is visibly divided into the esophagus, stomach and proximal duodenum by the fifth week Larsen 2001 . During the fifth week, the stomach starts out as a straight tube but since there is differential growth of its dorsal and ventral wall, the greater curvature will become more elongated than the lesser curvature. Continued differential expansion of the superior part of the greater curvature gives rise to the fundus and cardiac incisure by...

Omental Torsion and Epiploic Appendagitis

Epiploic appendagitis and omental infarction are benign self-limiting conditions that are more frequent than generally assumed. Both disorders fre- Fig. 1.75a,b. Mesenteric lymphadenitis. a US image shows enlarged mesenteric lymph nodes in the region to right of the umbilicus arrows . b Color Doppler image shows increased flow reflecting hyperemia. Appendix was normal Fig. 1.75a,b. Mesenteric lymphadenitis. a US image shows enlarged mesenteric lymph nodes in the region to right of the umbilicus...