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Physiologic anatomical features of the digestive system in children. Semiotics of digestive disorders and main diseases (gastritis, ulcer diseases, cholecystitis, functional disorders of bile ducts By S.Nykytyuk . The main functions of the digestive system 1. To process and absorb nutrients 2. The excretory function 3. Detoxification 4. Maintain fluid and electrolyte balance 5. The mechanical function Morphology peculiarities of all parts of digestive system in infant 1. The mucous membrane is thin, soft, dry and easy damage 2. The cubmucosal layer is well vascularitied 3. The cubmucosal layer consist of loose connective tissue 4. Underdevelopment (immaturity) of muscular and elastic tissue Physiological peculiarities of digestive system in infant 1. The secretory function of digestive system is impaired 2. Digestive system produces only small amounts of digestive juice 3. Digestion is worsen when the food doesn’t adequate of age of child Peculiarities of oral cavity in infant 1. It is relatively small 2. Teeth are absent 3. The palate is flat 4. The tongue is relatively thick and wide. 5. The sucking fat in the cheeks fill the mouth and help maintain negative pressure. Peculiarities of pharynx in infant 1. It is relatively wide and short 2. The oral part is on the same level as oral cavity 3. The way which the food passage is lateral of larynx 4. The baby can to breath and swallow the food at once Peculiarities of the esophagus in infant 1. Average length of the esophagus in newborn is 10 cm 2. It is relatively narrow 3. The entrance into the esophagus is: in newborn -- between the III-IV cervical vertebra 2 years of live - IV-V cervical vertebra 12 years of live - VI-VII cervical vertebra 4. The localization of lower esophagusХ sphincter is the same in children of different age groups (X-XI thoracic vertebra) 5. Ratio between the length of the esophagus and the length of the body is the same in children of different age groups (1:5) Length of the esophagus in children of different age groups in newborn is 11-16 cm in 1.5-2 years - 22-24.5 cm in 15-17 years - 48-50 cm The constriction of the esophagus Anatomical 1. Upper constriction - in place of entrance into the esophagus is 2. Middle constriction - in place of adjacent the trachea to esophagus 3. Lower constriction - in place of entrance through the diaphragm Physiological constrictions 1. Upper constriction - at the begining of the esophagus is 2. Middle constriction - in place of adjacent the aorta to esophagus 3. Lower constriction - in place of entrance into the cardial part of the stomach. Peculiarities of the stomach in infant 1. The stomach lying horizontally, is round until approximately 2 year of age. 2. In horizontally lying of baby the gastric fundus is lower as the antral part of the stomach. 3. Gasroesophageal reflux is frequent. 4. Cardial sphincter has a poor development of mucous membrane and muscular coat 5. Pyloric part is developed well 6. The fundus of stomach is under the left dome of diaphragm 7. The weight of the stomach is 6-7 g in newborn, in a year 18-21 g The anatomical capacity of the stomach, cm3 Newborn - 30-35 4 days - 45 14 days - 90 In next months the anatomical capacity of the stomach increase for 25 cm3 2 years - 500 4 years - 700 8 years - 1000 An adult- 1200-1600 The physiological capacity of the stomach, cm3 In newborn - 7 a year - 250-350 3 years - 400-600 10 years - 1300-1500 Peculiarities of the stomach in infant 1. The protheolytic function of the stomach juice in baby is in 1/3 less than in adult 2. Figures of common gastric acidity is in 2,5-3 times lower than in adult 3. The fats of cow’s milk arenХt digestion in baby younger 3-5 months 4. The fats of humanХs milk is easy digestion by enzyme lipase of humanХs milk, saliva and stomach juice 5. Highly saturated fats is digestion only in a small intestine Peculiarities of the bowels in infant 1. The length is relatively longer then in adult 2. Ratio of bowels length and body length are: in newborn - 8.3:1 a year - 6.6:1 16 years - 7.6 1 an adult - 5.4:1 3. The increasing of bowels length is slower than the increasing of length of the body 4. The bowels are more mobile in infant Peculiarities of the small intestine in infant 1. The length is in two time less than in adult 2. The length of small intestine mesentery is relatively longer 3. The membrane is thin, is well vascularitied. 4. The intestinal glands are more bigger then in adult 5. The lymph cells are in each little parts of small intestine Peculiarities of the large intestine in infant 1. The large intestine is not completely developed 2. The length of the large intestine is the same as the body length (in any age of a child) 3. Haustrumes appear after 6 month of life Peculiarities of the sigmoid colon in infant 1. Is longer 2. Is mobile 3. Increasing in size during the life 4. In children younger 5 years is upper then in schoolchildren (in schoolchildren is in the pelvic cavity) Peculiarities of the rectum in infant 1. The localization is under the entrance into the small pelvis in preschoolchildren 2. In schoolchildren the rectum is in the small pelvis 3. Is longer 3. Is mobile 4. In newborn is absent ampulla Peculiarities of the liver in infant Before the birth the liver is the largest organ of the body It is in the upper quadrant of the abdomen and one part of the left and epigastrium The left lobes before the birth is very great Liver functions Bile salts emulsify fats making them aviable to intestinal lipases Help make and products soluble and aviable for absorption by the intestinal mucosa ,aid peristalis, fluid on enzyme ,bile ,sodium glucoholate sodium taurocholate, cholesterol ,biliverdin, mucus, fat, lecitin, cells and cell debris. Detoxification Glucose exchanges Hepatocytes functions Synthesis of bile Storage (glicogen,fat,vitamis,copper,iron biotransformation Synthesis of blood components Regulation of the digestive system Cephalic phase Hypotalamus Hypophisis Endocrine regulation Vagus nerves of the stomach Regulation of the digestive system Local reflexes,secretin,cholecystokinin stimulate intestinal secretion Secretin stimulates the pancreas to secrete waters solution and the liver to secrete bile .Cholecystokinin stimulates the pancreas to secrete an enzyme rich solution and stimulates the gallbladder to contract,releasing large amounts of stored bile into the intestinae neuronal stimulation from the medulla also causes pancreatic ,hepatic,and intestinal secretion Disorder of peritoneum and abdominal cavity Dispeptic disturbances Appetite(poor,excessive,moderate0 Heartburn Hiccup belching Vomiting Diarrhea Constipation Nausea Special methods of investigation Gastroscopy Duodenal intubation Esophageal intubation Colonoscopy Scanning of the liver Laparoscopy esophagoscopy Peculiarities of the esophagus in infant 1. Average length of the oesophagus in newborn is 10 cm. 2. It is relatively narrow. 3. The entrance into the oesophagus is: in newborn - between the III-IV cervical vertebra; 2 years old - IV-V cervical vertebra; 12 years old - VI-VII cervical vertebra. 4. The localization of lower oesophagus' sphincter is the same in children of different age groups (X-XI thoracic vertebra). 5. Ratio between the length of the oesophagus and the length of the body is the same in children of different age groups (1:5). The anatomical constriction of the oesophagus 1. Upper constriction - at the place of entrance into the oesophagus. 2. Middle constriction - at the place of adjacent the trachea to oesophagus. 3. Lower constriction - at the place of entrance through the diaphragm. Physiological constriction of the oesophagus 1. Upper constriction - at the begining of the oesophagus. 2. Middle constriction - at the place of adjacent the aorta to esophagus. 3. Lower constriction - at the place of entrance into the cardial part of the stomach. Peculiarities of the stomach in infant 1. The stomach lies horizontally, is round until approximately 2 year of age. 2. In horizontally lying baby, the gastric fundus is lower as the antral part of the stomach. 3. Gastroesophageal reflux is frequent. 4. Cardial sphincter has a poor development of mucous membrane and muscular tunic. 5. Pyloric part is developed well. 6. The fundus of stomach is -under the left dome of diaphragm. 7. The weight of the stomach is 6-7 g in newborn, in 1 year old 18-21 g. The anatomical capacity of the stomach, cm3 Newborn - 30-35. 4 days - 45. 14 days - 90. 6 months - 200. 1 year - 250-350. 2 years - 500. 4 years - 700. 8 years - 1000. An adult - 1200-1600. The physiological capacity of the stomach, cm2 Newborn - 7. 1 year - 250-350. 3 years - 400-600. 10 years - 1300-1500. Peculiarities of the stomach secretion in infant 1. The proteolytic function of the stomach juice in baby is 1/3 less than in adult. 2. Figures of common gastric acidity is in 2.5-3 times lower than in adult. 3. The fats of human's milk are easy digested by enzyme lipase of human's milk, saliva and stomach juice. 4. Highly saturated fats are digested only in a small intestine. Peculiarities of the bowels in infant 1. The length is relatively longer than in adult. 2. Ratio of bowels length and body length are: in newborn - 8.3:1; 1 year - 6.6:1; 16 years - 7.6:1; in adult - 5.4:1. 3. The increasing of bowels length is slower than the increasing of length of the body. 4. The bowels are more mobile in infant. Peculiarities of the small intestine in infant 1. The length is two times less than in adult. 2. The length of small intestine mesentery is relatively longer. 3. The membrane is thin and well vascularisied. 4. The intestinal glands are bigger than in adult. 5. The lymph cells are located in each little part of small intestine. Peculiarities of the large intestine in infant 1. The large intestine is not completely developed. 2. The length of the large intestine is the same as the body length (in any age of a child). 3. Haustrume appear after 6 months of life. Peculiarities of the sigmoid colon in infant 1. It is longer. 2. It is mobile. 3. Increasing in size during the life. 4. The localization of sigmoid colon is upper in children who are younger 5 years than in schoolchildren (in schoolchildren it is in the pelvic cavity). Peculiarities of the rectum in infant 1. The localization is under the entrance into the small pelvis in preschoolchildren. 2. In schoolchildren the rectum is in the small pelvis. 3. It is longer. 3. It is mobile. 4. The ampulla of rectum is absent in newborn. Peculiarities of the liver in infant 1. Before the birth the liver is the largest organ of the body. 2. It is in the upper quadrant of the abdomen and one part of the right epigastrium. 3. The left lobe is very large before the birth. Liver functions 1. Bile salts emulsify fats making them available to intestinal lipases. 2. Bile helps make the products soluble and available for absorption by the intestinal mucosa; it stimulates peristals. 3. Detoxification. 4. Glucose metabolism. Hepatocytes functions 1. Synthesis of bile. 2. Storage (glycogen, fat, vitamins, copper, iron). 3. Biotransformation. 4. Synthesis of blood components. Diagnostic Procedures Laboratory tests: albumin level Below-normal levels of albumin, a protein made by the liver, found in the bloodstream are associated with many chronic liver disorders. bilirubin level Bilirubin is produced by the liver and is excreted in the bile. Elevated levels of bilirubin may indicate an obstruction of bile flow or a defect in the processing of bile by the liver. Diagnostic Procedures fecal fat test child is asked to eat a high-fat diet for several days. You collect small samples of stool in sealed containers for 3 days. The amount of fat contained in child's stool is measured. If the digestive tract is working properly, only small amounts of fat will be present in the stool; the rest of the fat that was in the diet will have been digested and reabsorbed by the body. If child has a condition known as malabsorption, then the intestinal tract cannot digest fats as well as it should, and elevated amounts of fat will pass through into the stool. fecal occult blood test A fecal occult blood test checks for hidden (occult) blood in the stool. It involves placing a very small amount of stool on a special card, which is then tested Diagnostic Procedures complete blood count (CBC) Red blood cells will be present in smaller amounts than normal if blood has been lost, if the diet has been inadequate, or with certain diseases. electrolyte tests Up to 22 electrolytes can be measured, including sodium, potassium, calcium, and glucose. These minerals are important for the body to function properly. Children who have lost large amounts of fluid due to vomiting or diarrhea often lose large amounts of the various electrolytes as well. Diagnostic Procedures lactose tolerance test This test helps determine if a child has trouble digesting lactose properly. child is given a liquid containing lactose to drink. Several blood samples are taken over a 2 hour period to measure the amount of glucose (sugar) present in the bloodstream. If lactose is digested normally, blood glucose rises. If lactose is not digested as it should be, then the blood glucose level does not change throughout the test. liver enzymes Elevated levels of liver enzymes can alert physicians to liver damage or injury, since the enzymes leak from the liver into the bloodstream under these circumstances. prothrombin time (PT) test This test measures the time it takes for blood to clot. Blood clotting requires vitamin K and a protein made by the liver. Liver cell damage and bile flow obstruction can both interfere with proper blood clotting. Diagnostic Procedures stool culture A stool culture checks for the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems. urea breath test This test helps diagnose the presence of Helicobacter pylori (H.pylori) in the digestive tract. Child swallows a capsule containing urea. If H.pylori is present in the stomach, then the urea will be converted into nitrogen and carbon. The carbon changes to carbon dioxide and moves into the bloodstream, and then into the lungs where it is exhaled. Child breathes into a balloon, and the amount of carbon in the breath is measured. A positive test, meaning carbon is present, indicates the presence of H.pylori. Diagnostic Procedures Imaging tests: computed tomography scan (CT or CAT scan) A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. lower GI (gastrointestinal) series (also called barium enema) A procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is given into the rectum as an enema. An xray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems. Diagnostic Procedures (magnetic resonance imaging) MRI A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. child lies on a bed that moves into the cylindrical CT scanner. The machine takes a series of pictures of the inside of the body using a magnetic field and radiowaves. The computer enhances the pictures produced. The test is painless, and does not involve exposure to radiation. Diagnostic Procedures upper GI (gastrointestinal) series A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium is swallowed. X-rays are then taken to evaluate the digestive organs. Diagnostic Procedures oropharyngeal motility (swallowing) study child is given small amounts of a liquid containing barium to drink with a bottle, spoon, or cup. Barium shows up well on x-ray. A series of x-rays are taken to evaluate what happens as your child swallows the liquid. ultrasound A diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Diagnostic Procedures Endoscopic procedures: Colonoscopy is a procedure that allows the physician to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible lighted tube, in through the rectum up into the colon. Diagnostic Procedures esophagogastroduodenoscopy (EGD) (also called upper endoscopy) is a procedure that allows the physician to look at the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube called an endoscope is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary). Diagnostic Procedures esophageal pH monitoring An esophageal pH monitor measures the acidity inside of the esophagus. It is helpful in evaluating gastroesophageal reflux disease (GERD). A thin plastic tube is placed into a nostril, guided down the throat and then into the esophagus. The tube stops just above the lower esophageal sphincter, which is at the connection between the esophagus and the stomach. At the end of the tube inside the esophagus is a sensor that measures pH, or acidity. The other end of the tube outside the body is connected to a monitor that records the pH levels for a 12 to 24 hour period. liver biopsy A liver biopsy helps diagnose liver diseases. A small sample of liver tissue is obtained with a special biopsy needle and examined for abnormalities. Children are sometimes given medication to minimize their anxiety during the procedure. A small area of skin over the liver is numbed with a local anesthetic. The anesthetic is then injected deeper under the skin to numb the area that the biopsy needle will pass through and reduce the discomfort of the test. Diagnostic Procedures anorectal manometry This test helps determine the strength of the muscles in the rectum and anus. These muscles normally tighten to hold in a bowel movement and relax when a bowel movement is passed. Anorectal manometry is helpful in evaluating anorectal malformations and Hirschsprung's disease, among other problems. A small tube is placed into the rectum, and the pressures inside the anus and rectum are measured. esophageal manometry This test helps determine the strength of the muscles in the esophagus. It is useful in evaluating gastroesophageal reflux and swallowing abnormalities. A small tube is guided into the nostril, then passed into the throat and finally into the esophagus. The pressure the esophageal muscles produce at rest is then measured. Appendicitis Appendicitis is acute inflammation and infection of the vermiform appendix, which is usually referred to as the appendix. The appendix is a blind-ending structure that arises from the cecum. Acute appendicitis is one of the most common causes of abdominal pain and is the most frequent condition that leads to emergent abdominal surgery in children. Age: Appendicitis occurs in all age groups. The mean age in the pediatric population is 6-10 years. Appendicitis is rare in the neonate, and the diagnosis is typically made after perforation for the reasons discussed above .Younger children have a higher rate of perforation (50-85% reported). What are the symptoms of appendicitis? pain in the abdomen which: – may start in the area around the belly button, and move over to the lower right-hand side of the abdomen, but may also start in the lower right-hand side of the abdomen. – usually increases in severity as time passes. – may be worse with moving, taking deep breaths, being touched, and coughing or sneezing. – may spread throughout the abdomen if the appendix ruptures. nausea and vomiting loss of appetite fever and chills changes in behavior diarrhea or constipation How is appendicitis diagnosed? Pain: The initial symptom is poorly defined periumbilical pain. Acute onset of severe pain is not typical in acute appendicitis but is seen with acute ischemic conditions such as volvulus, testicular torsion, ovarian torsion, or intussusception. If the pain is initially located in the right lower quadrant, severe constipation should be considered. Nausea and vomiting: Generally, vomiting that occurs prior to pain is unusual. However, in retrocecal appendices, particularly those that extend cephalad along the posterior surface of the right colon, inflammation of the appendix irritates the nearby duodenum, resulting in nausea and vomiting prior to the onset of right lower quadrant pain. How is appendicitis diagnosed? Diarrhea: Likewise, significant diarrhea is atypical in appendicitis, and the physician should consider other diagnoses while not ruling out appendicitis. In patients with an appendix in a pelvic location, inflammation of the appendix occasionally results in an irritative stimulation of the rectum. These patients often report diarrhea. Shift to right lower quadrant pain: After a few hours, pain shifts to the right lower quadrant because of inflammation of the parietal peritoneum. This pain is more intense, continuous, and localized than in the initial pain. Fever: Most children with appendicitis are afebrile or have a lowgrade fever and characteristic flushness of their cheeks. Severe fever is not a common presenting feature unless perforation has occurred, in which case it may still be a rare finding. How is appendicitis diagnosed? Abdominal examination – The child's abdomen should be examined in the same way an adult's abdomen is examined. Full exposure of the abdomen is key. Localization of the pain is also key but may depend on the position of the appendix. – Observing the patient cough and asking them to localize their pain with one finger often localizes their discomfort to the right lower quadrant. Typically, maximal tenderness can be found at the McBurney point in the right lower quadrant. However, the appendix may lie in many positions. A medially positioned appendix may present as suprapubic tenderness. A laterally positioned appendix often presents as flank tenderness. A retrocecal appendix may not have any tenderness until it is advanced or perforated. – Rovsing sign is pain in the right lower quadrant in response to left-sided palpation or percussion and strongly suggests peritoneal irritation. – The cough sign (ie, sharp pain in the right lower quadrant after a voluntary cough) suggests peritoneal irritation. How is appendicitis diagnosed? Rectal examination – A rectal examination is important and should be performed in all – – – – patients who are evaluated for appendicitis. The rectal examination in a young child may be completely objective, as they may not be able to communicate variations in tenderness or may have general discomfort from the examination. Objective information to ascertain includes impacted stool or an inflammatory mass. A patient who is able to communicate during a subjective examination should be asked if any tenderness is present in different areas of the rectum. Right-sided tenderness of the rectum is the classic finding in pelvis appendicitis or in pus that pools in the pelvis from an inflamed appendix elsewhere in the abdomen. How is appendicitis diagnosed? abdominal ultrasound - Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. computed tomography scan of the abdomen, with or without barium (Also called a CT or CAT scan.) - A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. barium enema - An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems. Laboratory analysys blood tests - to evaluate the infection, or to determine if there are any problems with other abdominal organs, such as the liver or pancreas. urinalysis - to detect a bladder or kidney infection, which may mimic the symptoms of appendicitis. After surgery, children are not allowed to eat or drink anything for a specified period of time so the intestine can heal. Fluids are given into the bloodstream through small plastic tubes called IVs until child is allowed to begin drinking liquids. child will also receive antibiotics and medications to help him/her feel comfortable through the IV. Eventually, children will be allowed to drink clear liquids and then gradually advance to solid foods. A child whose appendix ruptured will have to stay in the hospital longer than the child whose appendix was removed before it ruptured. Some children will need to take antibiotics by mouth for a period of time specified by the physician after they go home. Medical Care: Making a timely diagnosis is a difficult challenge when evaluating children with abdominal pain. Classifying patients with abdominal pain into the following 3 major categories may be helpful: Diagnosis not consistent with appendicitis – This group includes patients whose history and physical examination findings are not consistent with appendicitis or any significant abdominal process. – Performing a complete physical examination, including rectal palpation and urinalysis, before discharge is important. – Few patients require sophisticated radiological evaluation. However, as discussed above radiographic evaluation of the kidney, ureters, bladder, and chest may lead to the correct diagnosis (constipation or pneumonia) and treatment. Classic history for appendicitis Patients with a classic history require prompt surgical consultation. Maintain nothing-by-mouth status in patients with suspected appendicitis and start intravenous fluids to restore intravascular volume. Ensure adequate hydration for patients who present with suspected appendicitis. Even in early acute appendicitis, children frequently have not had sufficient oral intake and present with some degree of intravascular dehydration. Antibiotic therapy is an important aspect of the preoperative treatment of appendicitis but should not be administered until consulting with a surgeon. Direct antibiotic therapy against gram-negative and anaerobic organisms (eg, Escherichia coli, Bacteroides species). Most of these patients do not require radiological evaluation if their history, physical, and laboratory evaluations are convincing. However, some surgeons still prefer ultrasonography in female patients because of the possibility of a gynecological etiology. Unclear diagnosis – In these children, the history may be consistent with appendicitis; however, the examination is not supportive. In other children, the inverse may be true. – This is the main group who benefit from doublecontrast abdominal CT scanning. Serial examinations and test results may also help to clarify the diagnosis. – Reevaluate the patient over a few hours to determine the need for surgical consultation. If uncertainty persists after a period of observation, obtain a consultation with a surgeon. Crohn's Disease What is Crohn's disease? Crohn's disease is an inflammatory bowel disease. It is a chronic condition that may recur at various times over a lifetime. It usually involves the small intestine, most often the lower part called the ileum. However, inflammation may also affect the entire digestive tract, including the mouth, esophagus, stomach, duodenum, appendix, or anus. Crohn's disease is also called ileitis or enteritis. Who is affected by Crohn's disease? While Crohn's disease may affect persons of all ages, the age group most often affected is between 15 years to 35 years. However, Crohn's disease may also be seen in young children. Males and females are affected equally. It appears to run in some families, with about 20 percent of people with Crohn's disease having a blood relative with some form of inflammatory bowel disease. In those who have a family history, it is very likely that Crohn's disease will begin in the teens and twenties. What are the symptoms of Crohn's disease? The following are the most common symptoms for Crohn's disease. However, each individual may experience symptoms differently. Symptoms may include: abdominal pain, often in the lower right area diarrhea rectal bleeding obvious blood in the stools or black, tar like stools fever weight loss failure to grow Some people have long periods of remission when they are free of symptoms, sometimes for years. There is no way to predict when a remission may occur or when symptoms will return. The symptoms of Crohn's disease may resemble other conditions or medical problems. Consult your child's physician for a diagnosis. How is Crohn's disease diagnosed? People who have experienced chronic abdominal pain, diarrhea, fever, weight loss, and anemia may be examined for signs of Crohn's disease. In addition to a complete medical history and physical examination, diagnostic procedures for Crohn's disease may include: blood tests - to determine if there is anemia resulting from blood loss, or if there is an increased number of white blood cells, suggesting an inflammatory process. stool culture - to determine if there is blood loss, or if an infection by a parasite or bacteria is causing the symptoms. How is Crohn's disease diagnosed? endoscopy - a test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination and testing. biopsy - taking a sample of tissue (from the lining of the colon) for examination in a laboratory. How is Crohn's disease diagnosed? colonoscopy - a test that uses a long, flexible tube with a light and camera lens at the end (colonoscope) to examine inside the large intestine. What is the long-term outlook for a child with Crohn's disease? Crohn's disease is a chronic condition that may recur at various times over a lifetime. Children may experience physical, emotional, social, and family problems as a result of the disease, increasing the importance for proper management and treatment of the condition. Emotional Responses Mood swings due to illness and medications Blaming self for disease Frustration with physical problems Feeling different from everyone else Anger: "Why me?“ Worry about appearance, slow growth, weight loss Feeling vulnerable; unable to rely on body to function normally like everyone else Frustration at physical limitations, being unable to keep up with friends Social Problems Coping with being teased by classmates Embarrassment over frequent bathroom use Peer pressure regarding food choices Handling other people's lack of knowledge about the disease Change in physical stamina Changes in ability to concentrate on schoolwork Effects on the Family Understanding the needs of the child with Crohn's disease, as well as the rest of the family's needs Need for mutual support of all family members Need for all family members to learn about the disease and understand its effects on the child Learning to cope with unexpected changes in family routine Trying to channel frustration when angry Respect for privacy Encouraging independence of the child with Crohn's disease Gastroesophageal Reflux Disease (GERD) / Heartburn Gastroesophageal reflux disease (GERD) is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus. Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return. Gastroesophageal reflux (GER) is the return of acidic stomach juices, or food and fluids, back up into the esophagus.