Features of child digestion even if. Characteristics of intestinal microflora in children. How the newborn digestive system is arranged

Do I need to know parents about the features of digestion in young children?

Maybe it's only the theory?

Knowledge of the anatomy and physiology of digestion are necessary primarily in order to correctly and calmly respond to various problems of digestion in the child (Ikota, flashing, stomach pain caused by accumulation of gases, etc.) and make the right decisions. These knowledge will also help to understand why the newborn is worried and wakes up at night, which may develop dysbacteriosis, how to navigate when choosing a child of female milk substitutes, etc.

Parents should be understood that the child differs from an adult not only with dimensions: it is not yet sufficiently developed by many bodies involved in digestion; The newborn just begins to master the "independent" food intake and its digestion.

During the intrauterine life, the fruit received the nutrients necessary for the development of the mother through the placenta and umbilical cord. These substances entered the blood in a split form, ready for assimilation by organs and tissues.

Immediately after birth, the child begins to conduct a "independent lifestyle", and all the substances necessary for its livelihoods it receives with food. At the same time, high demands are presented to the digestive tract of the newborn in connection with the rapid growth of the organism and the intensive metabolism. That is why there are especially many problems with parents with nutrition and digestion of the child in this period.

As you know, the process of digestion begins in the oral cavity, where the reflex-salivary glands, located here, is distinguished by saliva. The newborn saliva has little, because, to assimirate the breast milk, saliva has no significant value.

This explains the dryness of the oral mucosa. In connection with a minor salivation, it has a very gentle newborn and is easily damaged. In the first months of saliva's life is characterized by a less acidic reaction, therefore, various inflammatory processes are easily developed in the oral oily cavity and mushrooms cause milk and other diseases. Salus plays an important role in the act of sucking, providing a dense contact of the nipple of the breast with the tongue and the mucous meal of the child, which facilitates the flow of milk from the chest.

From 3-4 months of age, the formation of saliva increases, but the ability to swallow it has not yet been fully developed, which leads to a permanent (physiological) salivation in children in this period. So that the resulting from the mouth of the saliva does not irritated the skin of the face, the child's mouth should be pulled out.

The intensity of the selection of saliva is influenced by the nature of food: the cow's milk is released more saliva than on the female, and the milk mixtures are more than on the cow's milk. Slyunodellation decreases with digestion disorders and temperature increase. By the year, the secretion of the salivary glands reaches 150 ml per day, which is approximately 10% of the salivary secretion of the adult.

The saliva of the newborn in a small amount is contained a digestive enzyme of amylase, which is subsequent to digesting complex carbohydrate compounds, such as starch, and bactericidal substance - lysozyme, carrying the body's protective function. The saliva desires milk in the stomach, turning it into small and gentle flakes and contributing to better digestion.

Jumping food

The mucous meal of the infant gentle, is always dry due to the underdevelopment of the mucous glazed glazed glazes and is easy to blame. The stomach in infants is located horizontally (the vertical position it takes only after the child starts to walk), which predisposes to jeep. The muscular stratum of the stomach is poorly developed, the entrance to it is wide, which also contributes to flashing food.

Jumping, manifested in the fact that immediately after eating a small amount of milk comes out of the child from the stomach, - the usual phenomenon at the kid during the first 2-3 months of life. It can be observed both occasionally and after each feeding.

The main reason for this phenomenon, in addition to the characteristics of the structure of the stomach, is abundant ingestion of the child by the air during sucking or entering the stomach of too much milk. The air can get into the stomach, if the child at the beginning of feeding eats very greedily. This also causes the wrong position of the bottle when feeding when the neck is not completely filled with milk.

To reduce tightening before eating a child, hold on the stomach, and after feeding - vertically, putting it to your shoulder, until you feel or hear how the air from the stomach came out in the form of belching.

If tightening caused by excessive milk associated with too greedy sucking, reduce breastfeeding time. With a frequent and abundant joining, it is better to consult a doctor. However, if the baby adds normally in weight, nothing to worry about. As a rule, further joining disappears by itself.

The volume of the stomach as absolute and relative (by weight of the body) in the child of the first year of life is less than in an adult: it is 30-60 ml in a newborn, in a child of three months - 100 ml, at the age of 1 year - 250 ml.

Therefore, in order not to overfect the stomach, it is necessary to give food to the child a little less than it can fit in the stomach, otherwise its walls will be stretched, which contributes to overeating with all the ensuing consequences (obesity, diabetes, etc.).

The secretion of the gastric juice and the activity of its enzymes in the first months of the child's life is low. In this regard, the baby cannot have any food, such as an adult or older child, and needs a special age diet (in breast milk, children's adapted mixtures, with a gradual transition to more "coarse" food).

The food in the stomach in the newborn is delayed for 2.5-3 hours, so the gaps between feedings must correspond to this period. It should be borne in mind that with the natural feeding of the child, the stomach is released after 2-3 hours, and with artificial - after 3-4 hours, i.e. In case of artificial feeding, the load on the digestive tract and on the body is generally higher. The child at the age of 1 and older is the time of finding food in the stomach depends on its character and composition.

A few hours after meals, the contents of the stomach enters the duodenum and the intestinal digestion begins, in which the pancreas, the biliary system and intestines are involved. In the intestines there is a further digestion and suction of foodstuffs.

The intestinal movement in children depends on the nature of feeding and happens faster than adults. The duration of digestion when feeding with maternal milk is an average of 13 hours, a cow - 15 hours. The daily number of feces with natural feeding is small (on average 20-25 g); It is characterized by egg-yellow color, cascum-like consistency, an acidic reaction, the absence of fecal smell.

When feeding cow's milk, the children's feces are characterized by a more dense consistency, light color and unpleasant odor; The daily number of feces increases to 60-100 g, i.e. With the same amount of food obtained, much more waste, which indicates that the cow's milk is worse than digested.

The emptying of the intestines in infants usually occurs 2-4 times a day, and by the end of the first year of life - 1-2 times.

The intestinal tract in newborns is sterile, but in the first days of life it is populated by microorganisms. With breastfeeding in the intestine of children of the first half of the year, lactic acid bacteria predominate, bifidoflore (which prevent the reproduction of other microbes and protect the child from intestinal infections), and only in small quantities contain intestinal wand, acidophilic and other bacteria.

Normal intestinal microflora performs three functions: digestive, synthetic and protective. The digestive function lies in help when digesting the residues of non-solid food. As for the second, it was proved that the intestinal microflora carries out the synthesis of Vitamins B1, B2, B6, B12, RR, K and Biotin.

The synthetic function of the intestinal microflora is most vulnerable, declining or completely terminated under the influence of adverse factors (antibiotics, intestinal infections, etc.). The intestinal microflora is also a kind of barrier, protecting the body from the invasion of pathogenic microorganisms and not allowing their reproduction.

With a deficiency of bifidobacteria in the intestine, the immunobiological forces of the body occurs, the absorption of calcium is reduced, vitamin K, the vitamosinteresting function of intestinal microflora suffers. Changing the normal composition and function of the intestinal microflora, i.e. dysbacteriosis, is most often evolving with the irrational use of antibiotics and other chemotherapeutic drugs.

With the transfer of a child to artificial feeding into the gastrointestinal tract, various bacteria fall, some of which may be conditionally pathogenic, for example, some types of colibacteria. With a worsening of the general condition of the body, these microbes can cause digestive and illness disorders. This is another argument against artificial feeding of children.

Thus, the age-related features of the gastrointestinal tract often underlie digestive disorders in children of the first year of life, provoked by insignificant malnutrition, nutrition and care.

V.G. Liflyandsky, V.V. Zvarevsky

Doctors and scientists for many decades examine the characteristics of the digestion of children and the impact on it of various factors. Recommendations for nutrition from year to year undergo changes, revised in accordance with modern data and are improved. So how does the digestion work crumbs? And how correctly, from the point of view of physiology, feed babies? Let's talk about it.

1. Catch the moment.

While the baby is in the tummy at Mom, it gets food through a cord and placenta. At this time, his digestive system works not so actively as those who have already born. But nevertheless, the baby swallows the accumulative water, and, therefore, its glands are gradually involved in the work. By the time of birth in the intestine, the crumbs accumulates a sufficient amount of semination, which consists of residual water and particles of the solid epithelium. After circumcision cord, the baby begins to eat mouth, and its digestion is activated.
The first days of life are the most important to normalize the work of the digestion, so you need to know some features of the organism of newborns to properly organize their nutrition. The oral cavity in the kids is relatively small, but the chewing muscles are well developed in it. In addition to this, there are special lumps of fat in the cheeks and the lip mucosa and language are in a special way. All these anatomical features are aimed at being effectively sucking her mother's chest from birth. Due to such a structure of the mouth, the baby captures the nipple with a nearby circle, the lingering tongue along the lower sponge and turning the sponge out - this allows you to create a vacuum and suck effectively.
A sucking reflex in a healthy duddy kid is from birth, but in order to run and fasten it, you need to start to put small to your chest as early as possible (preferably in the first half hour of life). If at this time you can tell the baby with my mother, and instead of the chest give a nipple, then the congenital program will betray. And "reappection" will not give effect - the baby will still become sucking the chest is incorrectly. It will injury the nipples of the mother, and maybe even abandon his chest.

2. The first days.

One of the features of the digestion of the crumbs is the weak development of the salivary glands, which are in the oral cavity. Therefore, the first 1.5-2 months there is some dryness in the mouth, the saliva stands out of little, and the moisturization is insufficient. Because of these features, the mucosa becomes vulnerable and sensitive to infection. In addition, in the first months, protective immunoglobulin Class A is practically not produced on the mucous membrane - special antibodies that are responsible for protection against penetration of microbes and viruses. That is why the kids often develop thrush - fungal disease of the oral cavity. The thrush creates unpleasant sensations in the mouth, discomfort during sucking, and the child can cry, refuse to take the chest. If you have discovered cotton raids on cheeks, gums and language (signs of thrush), it is necessary to process the chest and the mouth of the baby with a solution of soda and a special means of fungus, which the doctor will advise. With proper treatment, the thrush will be held in 4-5 days.
The toddler's stomach, unlike our, is almost horizontally located. In addition, its sphincters, circular muscle fibers at the entrance and outlet of the stomach, have features. Cardial sphincter - that is, the entrance, it works weakly, but the pyloric, that is, the day off is already well developed. Therefore, if the stomach is too stretched, the entrance to it will remain open, and filling or vomiting will be closed and possible. If the stomach falls in the stomach, then when changing the position of the body through a linked top, it will be released in the esophagus and then in the mouth - a burden will occur.
Knowing these features of the building of the sphincters, you will understand why it is so important to ensure that the baby is properly applied to the chest and not "sucking" the air (this is evidenced by any sounds during sucking, except for sinks). If the kid is "artificial", it is necessary to follow the amount of portions. The fact is that the baby simply will not be able to move, because the milk is not pouring from the chest with a stream, and the baby is able to adjust its volume sucking. Favoring, he will just let go of the chest. When feeding from the bottle, milk is poured continuously, and the baby does not remain anything but to swallow, swallow and swallow again. And, as a result, - to overeat. Holding out the volume of nutrition for the "artificial", remember: the volume of the stomach during the newborn period is 25-30 ml, by the month it is up to 100 ml, by 3 months
up to 150 ml, by half to 200, by year to 250-300. And it should be filled with no more than 2/3!

3. Often and grind.

In the tummy at Mom, the baby received food continuously. And therefore, immediately after birth, rebuild on the portion "biting food" he cannot. Because of this baby and feed on demand, getting milk through short periods of time and gradually. Usually, milk in the stomach is located 15-20 minutes and gradually minor portions enters the intestine. It was for this reason that regime feedings were not justified. In addition, frequent applying to the chest effectively empties and stimulates the chest, giving a tide of even large volumes. Children- "artificials" to feed with small volumes is constantly extremely difficult, so it was chosen for feeding on the clock. However, recently, this method is revised towards a more free feeding mode, with variation of the volume of the mixture. Approximately half a year, the digestive glands of the stomach are not active enough to produce gastric juice, so the child should not receive any other food besides milk or mixture. The intestines of the baby is longer than our, but the motor activity is still insufficient - there is not enough coordinated work of muscles to promote food from the stomach to the rectum. Therefore, the kids are frequent constipation and bloating, people referred to as "colic". Approximately 3-4 months muscle activity is normalized, and everything becomes in its place. In the first months, it is possible to help the peristaltics to activate the peristaltics, laid out it on the tummy or massaging the front abdominal wall.

By the way, the features of the child's chair are also due to the work of the intestine and the reduction of muscles, as well as the type of feeding - chest or artificial. During the first two days after birth, the intestine should empty from the megonia. If during this period the kid receives a colostrum that has a relaxing property and activates the liver operation, the MECONIAN is output faster. And therefore, the likelihood of the development of jaundice decreases, and even if it arises, the degree of severity will not be so bright. At the time of birth, the intestine of the baby is sterile, and in the first hours its microbial settlement begins. Therefore, it is extremely important, with which microflora of the ventricle will get acquainted - from the skin of mom and its breasts (with a joint stay and breastfeeding) or from the air of the maternity hospital and from the hands of the staff in the children's office. And this is another argument in favor of applying to the chest directly after birth and in favor of early joint stay. On the mother of the mother there is a mass of microbes, but they are not dangerous for the baby - with milk it receives factors contributing to the settlement of beneficial bacteria (they form lactate bifidoflora) and the destruction of harmful.
In the first 6-10 weeks, the baby's chair often scares his parents, as all the time changes its character. But if a child is solely on breastfeeding, his chair "has the right" to such impermanence. This is the so-called physiological dysbacteriosis - a state when the operation of microflora is configured. Under the action of immune protection of milk, useful microbes are littered and tested by brown neighbors (UPB condition and pathogenic flora). At the same time, the mother (through milk) transmits this Flora formed immunity. Therefore, the baby staphylococcus detected in the fear, Klebsiella or intestinal wand do not require special treatment. All therapy is breastfeeding. At the time of birth, the intestines of the baby sterile, and in the first hours its microbial settlement begins.
Greens is alarming in a chair? It is due to the cleavage products of Bilirubin, which the baby in the first months of life is usually elevated (which is sometimes manifested by the jaundice). But the foamy and watery chair is due to the excess of the front milk, which is formed between feeding. The first months of life, the kid is experiencing a relative lack of a lactase enzyme, which splits the dairy sugar of the front milk (lactose). As a result, with an excess of the front milk, not all lactose is split, enters the thick intestine, where the microbes are fermented. Hence the formation of carbon dioxide and excess water - foam and water in a chair. In this case, more frequent and prolonged feedings will help.
White lumps in a chair usually talk about oversaturation by milk when a small part does not have time to digest and falls into a large intestine in the form of sink-free lumps. Separately, it is worth saying about the frequency of the child's chairs. It may be different: from several times a day to once a few days, but more. This applies primarily to the baby - the milk is as well as a child that almost no waste remains, and the chair occurs when there is a sufficient amount of content in the reinforcement to cause defecation reflex. With normal well-being, a soft tummy and the disheem of gases, stooling stool is not necessary, even if it was not for several days - the child will cope. At the "artificials" with the adequate selection of the mixture and the correct dispensing it is permissible to wait for the chair not more than 2-3 days. Alas, the mixture is not so well digested and duppliness to the constation.

5. New dishes.

When can I start luch? From the point of view of the physiology of digestion, the majority of the enzymes of the stomach, liver and pancreas are ripened by 6-8 months, and the intestinal wall becomes less permeable for allergens and harmful substances to 4-6 months. Therefore, it is correct for children of all types of feeding is the introduction of lines in half a year, if, according to special testimony, the doctor will not prescribe it before (for example, the introduction of porridge in the diet with a poor weight set).

The material is taken from the Journal of Young Family for November 2011.

The digestive system of the newborn baby has a number of differences from the digestive tract of an adult. It is also about the degree of development of the gastrointestinal bodies and their functionality. The most visual example is to join, which always happens in babies, and never in healthy adults. Another functional difference between the digestion in newborns from such a process in adults is the number of feces: Breasts Cal leaves several times more often.

Baby digestive system

The oral cavity in newborns and young children is relatively small, its mucous membrane is easy to view, the tongue is short and wide.

This newborn digestive organ is fully adapted for sucking, which is facilitated by:

1) fat lumps that are located in the thicker of the cheek;

2) rolic-shaped cheek thickening;

3) transverse allure of the lip mucosa.

Such organs of the digestive system of newborns, like salivary glands, in the first months of life are not developed enough, saliva is distinguished by little. But by 4 months, they begin to function actively, physiological salivation appears, associated with the fact that the child does not know how to swallow saliva.

The child of the first months of life takes food only by sucking. With sucking, the child covers her mother's nipple lips and a nearby circle. The reflex muscles of the nipple are cut, the nipple is lengthened. Between the language and lower jaw in the oral cavity, a discharged space with negative pressure is created. At this time, the child squeezes the jaw and squeezes milk from output ducts. One swallowing movement is preceded by several sucks. Sometimes, together with milk, the child swallows the air, which leads to joining. To prevent this after breastfeeding, the child must be moved to a vertical position.

The activity of sucking movements is not only an indicator of the maturity of a baby, but more by the indicator of his health, since in case of illness, the baby sluggishly takes her chest. If the child is immediately after childbirth, do not attach to the chest, after 12 hours, the sucking reflex begins to weaken.

Esophagus in the newborn It has a length of 10 cm, a width of 5-8 mm, in 1 year its length is 12 cm. This digestion organ in infants is wide and short, physiological narrowings are not developed, they are formed at an older age. The peculiarities of the esophagus are weak development of muscle and elastic fabric, no glazed glance.

The stomach is located in the left hypochondrium. Up to 1 year, it is horizontal. When a child begins to walk, this organ of the digestive system of the newborn takes a vertical position. The sphincter in the input part of the stomach is not developed sufficiently, which contributes to shinking. The volume of the stomach of the intricate newborn is 30-35 ml, the child has 3 months - 100 ml, in 1 year - 500 ml, by 8 years - 700-800 ml.

Already in the period of the newborn, the components of the gastric juice are the same as in adults. It contains hydrochloric acid, pepsin, lipase, etc. By 4 months, these enzymes are contained in sufficient amounts and have greater activity than in the newborn period.

The peculiarity of the digestive system of newborns is also that the intestines of the infant is relatively longer than in an adult. Its mucous membrane is developed, is abundantly equipped with blood vessels. The characteristic feature of the intestine at the breast is an increased permeability of its walls, which contributes to the development of toxicosis in various diseases.

In children, the blind intestine and a worm-shaped process are movable, the latter occupies an atypical position behind the blind intestine or in a small pelvis.

The dates of evacuation of food from the stomach depends on the type of feeding. Breast milk is in the stomach of 2- 3 hours, and the milk mixtures of cow's milk - 3-4 hours.

In a breast child, the digestive system is developed in such a way that suction takes place more active than in adults, but the barrier function due to high permeability and other factors is insufficient, therefore, toxins, microbes and other pathogenic agents are easily passing through the intestinal wall.

The duration of food through the intestines during the digestion in the newborn baby is different, it depends on age: in 1-6 months of age, it ranges from 4 to 20 hours; more older children - about 1 day; In case of artificial feeding, the digestion lasts up to 2 days.

Features of the digestion of newborn children of early age

The chair of the child is poured into different age periods and depends on the nature of feeding, the nature of the functioning of the digestive glands.

A characteristic feature of the digestion of newborns is the presence of selection (feces generated in the intestine of the fetus). It consists of secrets of various departments of the digestive tract, epithelium, swallowed octoped waters. Immediately after birth, it is dark green, from the first to the fourth day - brownish, and then becomes golden yellow. The frequency of feces of a healthy child - from 1 to 4 times a day. Some children have a chair once every 2-3 days.

The feces of a breast child, which is on artificial feeding, brighter color, has a more dense consistency and a sharper grinding smell.

As the child grows, the stool frequency decreases, it becomes dense. After 1 year, it happens 1-2 times a day.

In the intrauterine period, the gastrointestinal tract of the child is sterile. Microorganisms fall into it during the passage through the generic pathways of the mother, then through the mouth and at the contact of the baby with the objects of the environment.

In such organs of the infant digestive system, such as the stomach and duodenum, microflora are scanty. In a thin and tolstish intestine, it is more diverse and depends on the type of feeding. When feeding breast milk, the main flora is bifidobacteria, beta-lactose of female milk contributes to its growth. After the introduction of lures and when transferring to artificial feeding in the intestine, an intestinal wand begins to prevail, relating to conditionally and pathogenic bacteria.

Features of the digestion of young children's children are that the basic functions of intestinal microflora are concentrated on creating an immunological barrier, the synthesis of vitamins and enzymes, the final digestion of food residues.

In case of diseases of the digestive tract, it may occur, in which bifidobacteria, intestinal sticks are displaced by pathogenic microbes. Very often, dysbacteriosis occurs in children when applying antibiotics.

The article read 13 982 times (a).

Propedeutic Children's Diseases: Textbook for pediatric faculties of medical universities / COST: S.J. Bokonbayev, etc. Happy, HM Sushhanlo, N.M. Aldashva, G.P. Afanasenko. - Bishkek.: Kyrgyz-Russian Slavic University (CRSA), 2008. - 259 p.

Chapter 10. Anatomy-physiological features of digestive organs in children. Research methodology. Semiotics and defeat syndromes

The period of the intrauterine formation of digestive organs

The laying of digestive organs occurs at a very early stage of embryonic development: from the 7th day to the 3rd month of the intrauterine life of the fetus. By 7-8 days from Entoderma, the organization of the primary intestine begins, and on the 12th day the primary intestine is divided into 2 parts: an intracerevous (future digestive tract) and an extraordinary (yolk bag). Initially, the primary intestine has a rotoglotter and clock membrane. At the 3rd week of intrauterine development, the melting of the rotoglotmer, on the 3rd month - a clock membrane. In the development process, the intestinal tube passes the stage of a dense "cord" when the proliferating epithelium completely closes the intestinal lumen. Then there is a vacuolation process, ending with the restoration of the lumen of the intestinal tube. With a partial or complete violation of violations, intestinal lumen remains (almost or completely) closed, which leads either to stenosis or to atresia and obstruction. By the end of 1 month. The intrauterine development is scheduled for 3 parts of the primary intestine: front, middle and rear; The primary intestine in the form of a tube occurs. From the 1st week the formation of various departments of the digestive tract begins: a throat, esophagus, stomach and part of the duodenum with recent pancreatic and liver are developing from the front of the intestine; Of the middle intestine, some of the duodenum, skinny and iliac intestine are formed, all the colors of the large intestine are developing from the rear.

In the antenatal period, the front intestine develops most intensively and gives many bends. In the third month of intrauterine development, the process of moving fine (right to left, behind the upper mesenteric artery) and the colon (from left to right from the same artery), which is called the intestinal turn.

Distinguish three intestinal rotation periods:

1) Rotate 90 °, the thick intestine is on the left, thin - right;
2) Turn to 270º, the thick and small intestine have a total mesentery;
3) Ends the bowel fixation, the small intestine acquires a separate mesentery.

If the intrauterine rotation of the intestine is stopped at the first stage, then the middle intestine can occur. The time of the harrow is different: from the intrauterine period to deep old age. In case of violation of the second period of rotation, it may occur: a failed turn of the intestine, the obstruction of the duodenum and other anomalies. If the third stage of rotation is violated, the bowel fixation changes, which leads to the formation of detects of mesenter, as well as various pockets and bags predisposing to the infringement of intestinal loops and to inner hernias.

At the same time, vessels that go to the yolk bag and the intestinal tract are formed. The arteries depart from the aorta. Vienna are directly sent to the venous sinus.

On the 10th weekthe laying of the gastric glands begins, however, their differentiation of both morphologically, and the child is not completed functionally.

Between the 10th and 22ndweeks of intrauterine development takes place of intestinal vice - most enzymes of membrane digestion appears, but the activation of some of them, for example, lactase occurs only by the 38-40 week of pregnancy.

From the 16-20th weekthe beginning of the functioning of the system as an organ of digestion: a swallowing reflex is already expressed, the gastric juice contains pepsinogen, intestinal - tripsinogen.

The fruit swallows and digested a large amount of amniotic fluid, which is close to extracellular fluid in composition and serves as an additional power supply (amniotic food) for the fetus.

Morphological and physiological features of digestive organs in childrenespecially pronounced at heart age. In this age period, the digestion apparatus is adapted, mainly for the assimilation of breast milk, the digestion of which requires the smallest amount of enzymes (lactotrophic nutrition). A child is born with a well-pronounced sucking and swallowing reflex. The act of sucking is provided by the anatomical features of the oral cavity of the newborn and child of the chest. With the sucking of a child's lips tightly capture the nipple of the mother's chest with a near-slip circle. The jaws squeeze it, and the message between the oral cavity and the outer air stops. In the mouth of the child, an cavity with negative pressure is created, which contributes to lowering the lower jaw (physiological retrognition) along with the language down and back. In the sparse space of the oral cavity comes breast milk.

Oral cavitythe child is relatively small, filled with tongue. The tongue is short, wide and thick. With closed oral cavity, it comes into contact with the cheeks and solid sky. Lips and cheeks are relatively thick, with a sufficiently developed muscles and dense fatty lumps of Bisha. On the gums there are rolic-shaped thickening, also playing a role in the sucking act.

The mucous membrane of the oral cavity is rude, richly equipped with blood vessels and relatively dry. The dryness is due to the insufficient development of the salivary glands and the deficiency of saliva in children up to 3-4 months of life. The oral mucosa is easy to raise, which should be considered when carrying out the toilet of the oral cavity. The development of the salivary glands ends to 3-4 months, and from this time the enhanced selection of saliva (physiological savory) begins. Saliva is the result of the secretion of three pairs of salivary glands (varnish, submandibular and sublingual) and small glands of the oral cavity. The response of saliva in newborns is neutral or weakly acidic. From the first days of life, it contains an amylolytic enzyme. It contributes to ease of food and foaming, its bactericidity increases from the second half of life.

Login B. larynxthe child of the breast lies high above the lower edge of the sky curtains and is connected to the oral cavity; Thanks to this, food moves around the sides of the serving larynx through the message between the oral cavity and the throat. Therefore, the child can breathe and suck at the same time. From the cavity of the mouth, food falls through the esophagus in the stomach.

Esophagus.At the beginning of development, the esophagus has a view of a tube, the lumen of which due to the proliferation of the cellular mass is filled. For 3-4 months of intrauterine development, there is a laying of glands that begin to actively secrete. This contributes to the formation of a lumen in the esophagus. Violation of the recanalization process is the cause of congenital narrowings and stricture of the esophageal development.

The newborn esophagus is a muscle tube of the spindle-shaped shape lined with an inside with a mucous membrane. The entrance to the esophagus is located at the disc level between III and IV cervical vertebrae, by 2 years - at the level of IV-V cervical vertebrae, at 12 years at the level of VI-VII vertebrae. The length of the esophagus in a newborn 10-12 cm, aged 5 years - 16 cm; Its width in a newborn 7-8 mm, by 1 year - 1 cm and by 12 years - 1.5 cm (the size of the esophagus must be considered when carrying out instrumental studies).

In the esophagus differ three anatomical narrowings- In the initial part, at the bifurcation level of the trachea and the diaphragmal. The anatomical escaps of the esophagus in newborns and the children of the first year of life are expressed relatively weakly. The features of the esophagus should include the complete absence of glands and insufficient development of muscular elastic tissue. The mucous membrane is gentle and rich in blood supply. Outside of the act of swallowing, the transition of the pharynx in the esophagus is closed. The peristalistic of the esophagus occurs when swallowing movements. The transition of the esophagus in the stomach in all periods of childhood is located at the level of x -xi breast vertebrae.

Stomachit is an elastic bag-shaped organ. Located in the left hypochondrium, his cardiac part is fixed to the left of the X of the breast vertebra, the gatekeeper is located near the middle line at the level of the XII of the breast vertebra, approximately in the middle between the navel and the mildo-shaped process. This provision varies significantly depending on the age of the child and the shape of the stomach. The variability of the shape, volume and size of the stomach depends on the degree of development of the muscular layer, the nature of nutrition, the effects of neighboring organs. In the children of breast, the stomach is located horizontally, but as soon as the child begins to walk, it takes a more vertical position.

By the birth of a child, the bottom and the cardiac diversity of the stomach is not developed enough, and the pyloric department is significantly better than the frequent tights. Jumping also contributes to the swallowing of air during sucking (aerophagia), with incorrect feeding techniques, a short bridle of a language, greedy sucking, too fast to highlight milk from the mother's chest.

The capacity of the newborn gastric is 30-35 ml, by 1 year increases to 250-300 ml, by 8 years reach 1000 ml.

The mucous membrane of the stomachgentle, rich in blood vessels, poor elastic tissue, contains little digestive glands. Muscular layer is not developed enough. There is a scarce release of gastric juice with low acidity.

Digestive glandsthe stomach is divided into the foundal (main, finish and addition), secreting hydrochloric acid, pepsin and mucus, cardiac (additional cells), isolated Muzin, and pylorial (main and additional cells). Some of them begin to function in intrauterine (bypading and main), but in general, the secretory stomach apparatus in children of the first year of life is not developed enough and the functional abilities of its low.

The stomach has two main functions– secretor and motor. The secretory activity of the stomach, consisting of two phases - neuropsychiatric and chemical-humoral, has many features and depends on the degree of development of the central nervous system and nutritional quality.

Gastric juicechild of the chest contains the same components as the gastric juice of adult: the rennet enzyme, hydrochloric acid, pepsin, lipase, but their content is lowered, especially in newborns, and increases gradually. Pepsin cleaves proteins on albumin and peptons. Lipasa splits neutral fats for fatty acids and glycerin. The renewed enzyme (the most active of the enzymes in breast-age) ensures milk.

General acidityin the first year of life 2.5-3 times lower than in adults, and is equal to 20-40. Free hydrochloric acid is determined by breastfeeding after 1-1.5 hours, and with artificial - 2.5-3 hours after feeding. The acidity of the gastric juice is subject to significant oscillations depending on the nature and mode of power, the state of the gastrointestinal tract.

An important role in the implementation of the engine function of the stomach belongs to the activities of the gatekeeper, due to the reflex periodic discovery and the closure of which the dietary masses go into small portions from the stomach into the duodenum. The first months of life The motor function of the stomach is poorly expressed, the peristalistic is sluggish, the gas bubble is increased. In breastfeeding, it is possible to increase the tone of the muscles of the stomach in the pyloric department, the maximum manifestation of which is pylorospasm. At older, sometimes cardiospasm.

Functional failure with age decreases, which is explained, first, gradually developing conditional reflexes for food irritants; secondly, the complication of the child's edible mode; Thirdly, the development of the cerebral cortex. By the 2nd year, the structural and physiological features of the stomach correspond to those in an adult.

Intestinesit starts from the gastric gatekeeper and ends with a posterior hole. Distinguish the thin and colon. The first is divided into short duodenal, skinny and iliac. The second is on the blind, hatch (ascending, transverse, descending, sigmoid) and the rectum.

Duodenumthe newborn is located at the level of the i-th lumbar vertebra and has a rounded form. By 12 years, it descends to the III-IV lumbar vertebra. The length of the duodenum under 4 years is 7-13 cm (in adults up to 24-30 cm). In early age, she is very mobile, but by 7 years there is a fatty tissue, which fixes the intestine and reduces its mobility.

In the upper part of the duodenum, the oxide of acidic gastric chimus occurs, preparations for the action of enzymes that come from the pancreas and are formed in the intestine, and mixing with bile (bile comes from the liver through the bile ducts).

The skinny gauge takes 2/5, and the iliac 3/5 of the small intestinal length without a duodenal intestine. There is no clear boundary between them.

The ileum ends with an ileocecular valve. In early age children, its relative weakness is noted, and therefore the contents of the blind intestine, the richest bacterial flora, can throw into the ileum. In older children, this condition is considered pathological.

Small intestinein children occupies a non-permanent position, which depends on the degree of its filling, body position, tone of the intestine and muscles of the peritoneum. Compared with adults, it has a relatively big length, and intestinal loops lie more compactly due to a relatively large liver and underdevelopment of a small pelvis. After the first year of life, with the development of a small pelvis, the location of the loop of the small intestine becomes more permanent.

In the small intestine of the breast child, there is relatively many gases, which gradually decrease in the amount and disappear by 7 years (in adults in the norm of gases in the small intestine there is no).

To others particularities of the intestinechildren in breast and early age include:

• large permeability of intestinal epithelium;
• the weak development of the muscular layer and elastic fibers of the intestinal wall;
• tenderness of the mucous membrane and the large content of blood vessels in it;
• good development of villus and folding of the mucous membrane in case of insufficiency of the secretory apparatus and the incompleteness of the development of nerve paths.

This contributes to the light occurrence of functional disorders and favors the penetration into the blood of non-absolute components of food, toxico-allergic substances and microorganisms.

After 5-7 years, the histological structure of the mucous membrane is no longer different from its structure in adults.

The mesentery, very thin in newborns, is significantly increased in length during the first year of life and sinks together with the intestine. This seems to necessarily causes the child with respect to frequent worsens of intestines and invagination.

Lymph, leaking from the small intestine, does not pass through the liver, so suction products together with lymph through the chest duct fall directly into circulating blood.

Colonit has a length equal to the growth of the child. Parts of the colon are developed to varying degrees. The newborn has no surp processions, the ribbons of the colon are barely outlined, the Gaustra is missing to six months of age. The anatomical structure of the colon after 3-4 years of age is the same as in an adult.

Cecum,having a funnel shape, is the higher than the younger child. The newborn is located directly under the biscuits. The higher the blind intestine is located, the greater the upward is underdeveloped. The final formation of the blind intestine ends by year.

Appendixthe newborn has a cone-shaped form, wide open entry and a length of 4-5 cm, by the end of 1 year - 7 cm (in adults 9-12 cm). It has greater mobility due to a long mesentery and can be provided in any part of the cavity of the abdomen, but most often occupies a retrocecal position.

Colonthe rim surrounds the loop of the small intestine. The ascending part of the colon in the newborn is very short (2-9 cm), begins to increase after a year.

Transverse partthe semicircuit in the newborn is in the epigastric region, has a horseshoe-shaped form, a length from 4 to 27 cm; By the 2nd year, it approaches horizontal position. The mesentery of the transverse part of the colon is thin and relatively long, so that the intestine is easily moved when the stomach and the small intestine is filling.

Downward partcolon in newborns already than the other parts of the colon; Its length doubles by 1 year, and by 5 years it reaches 15 cm. It is weakly moving and rarely has a mesentery.

Sigmoid colon- The most mobile and relatively long part of the colon (12-29 cm). Up to 5 years, it is usually located in the abdominal cavity due to the underdeveloped small pelvis, and then falls into a small pelvis. It mobility is due to a long mesentery. By 7 years, the intestine loses its mobility as a result of shortening the mesentery and clusters around her adipose tissue.

Rectumthe children of the first months are relatively long and when filling can take a small pelvis. The newborn ampoule of the rectum is weakly differentiated, the fatty fiber is not developed, as a result of which the ampoule is poorly fixed. The rectum takes its final position to the 2nd year. Thanks to a well-developed submucosal layer and weak fixation of the mucous membrane in young children, its loss is often observed.

Anuschildren are located more expensively than in adults, at a distance of 20 mm from the tailbone.

The process of digestion, starting in the oral cavity and in the stomach, continues in the small intestine under the influence of the pancreatic juice and bile standing out in the duodenum, as well as intestinal juice. The secretory intestinal apparatus in general is formed. Even in the smallest in intestinal sectors, the same enzymes are determined, as in adults (enterocinate, alkaline phosphatase, Erepsin, lipase, amylase, maltase, nuclease), but their activity is low.

The duodenum is a hormonal digestive center and carries out a regulatory effect on the entire digestive system by means of hormones secreted by the glazale of the mucous membrane.

In the small intestine, the main stages of the complex process of splitting and suction of food substances under the joint action of intestinal juice, bile and secrets of the pancreas are carried out.

Food cleavage occurs with the help of enzymes both in the cavity of the small intestine (strip digestion) and directly on the surface of its mucous membrane (cloth or membrane digestion). A breast child has a special honey intracellular digestion, adapted to lactotropic nutrition, and intracellular, made by pinotoxet. Food cleavage occurs mainly under the influence of the secrets of the pancreas containing trypsin (acting proteolytic), amylase (splits polysaccharides and turns them into monosaccharides) and lipase (breaks fats). Due to the low activity of the lipolytic enzyme, the digestion of fats is especially intense.

Suction is closely connected with the ribbon digestion and depends on the structure and function of the cells of the surface layer of the mucous membrane of the small intestine; It is the main function of the small intestine. Proteins are absorbed in the form of amino acids, but in the children of the first months of life it is possible to partially sucking them unchanged. Carbohydrates are absorbed in the form of monosaccharides, fats - in the form of fatty acids.

Features of the structure of the intestinal wall and relatively large its area are determined in young children are higher than in adults, absorption capacity, and at the same time, due to high permeability, the insufficient barrier function of the mucous membrane. The components of the female milk, whose proteins and fats are partially absorbed by unreptic.

In the colon, the absorption of digested food and mainly water, and the remaining substances under the influence of both enzymes from the small intestine and bacteria inhabiting the colon are cleaved. The coat of colon is insignificant; However, it increases sharply with mechanical irritation of the mucous membrane. In the colon is formed by hiding masses.

The intestinal motor function (Motorika) consists of pendulum movements arising in the small intestine, due to which its contents, and peristaltic movements that contribute to the promotion of chimus towards the colon is stirred. Antiperistaltic movements, thickening and forming caliper masses, are characteristic of the colon.

Motoric in childrenan early age is very energetic, which causes freaky intestinal emptying. In breast children, defecation occurs reflexively; In the first 2 weeks of life up to 3-6 times a day, then less often; By the end of the first year of life, it becomes an arbitrary act. In the first 2-3 days after birth, the child allocates Mekonia (original feces) of greenish-black. It consists of bile, epithelial cells, mucus, enzymes, swallowed oily water. For 4-5 days, Cal acquires a normal view. Focusing healthy newborn, which are natural feeding, have a cascidious consistency, golden yellow or yellow-greenish color, an acidic smell. The golden-yellow color of the feces in the first months of the child's life is explained by the presence of bilirubin, greenish - biliveridine. More older children are decorated chair, 1-2 times a day.

The intestines of the fetus and the newborn first 10-20 hours are free from bacteria. The formation of the microbial biocenosis of the intestine begins from the first days of life, by the 7-9th day in healthy donated children gaining breastfeeding, the normal level of intestinal microflora with a predominance of b. bifidus, with artificial feeding - B. Coli, B. Acidophilus, B . Bifidus and Enterococci.

Pancreas- Parenchimato body of the external and internal secretion. The newborn is located deeply in the abdominal cavity, at the level of the X-th thoracic vertebra, the length of it is 5-6 cm. In children of early and older age, pancreas is at the level of the I-th lumbar vertebra. The most intense iron is growing in the first 3 years and in the pubertal period. By birth and in the first months of life, it is not differentized enough, is richly vascularized and poor connective tissue. The newborn is the most developed head of the pancreas. At an early age, the surface of the pancreas is smooth, and by 10-12 years there appears the bugs caused by the release of the boundaries of the lobes.

Liver- the largest digestive gland. In children, it has relatively large sizes: in newborns - 4% of body weight, while adults are 2%. In the postnatal period, the liver continues to grow, but slower than the body weight.

Due to the different pace of increasing the mass of the liver and body in children from 1 year to 3 years of life, the edge of the liver comes out from under the right hypochondrium and easily persuaded with 1-2 cm below the rib arc on the mid-clearable line. From 7 years in the position lying down the lower edge of the liver is not palpable, and on the median line does not go beyond the upper third distance from the navel to the sword-shaped process.

The liver parenchyma is little differentiated, the valley structure is detected only by the end of the first year of life. The liver is full, as a result of which rapidly increases with infection and intoxication, circulatory disorders and is easily reborn under the influence of adverse factors. By 8 years, the morphological and histological structure of the liver is the same as adults.

The role of liver in the body is diverse. First of all, this is the production of bile, participating in the intestinal digestion, stimulating the intestinal motor function and its sanitudes. The bore is noted already at a 3-month fetus, but the borter at an early age is still not enough.

Bilerelatively poor with bile acids. A characteristic and favorable feature of the bile of the child is the predominance of tautrocholic acid over the glycohole, since Taurocholic acid enhances the bactericidal effect of bile and accelerates the separation of pancreatic juice.

The liver deposit nutrients, mainly glycogen, as well as fats and proteins. As necessary, these substances come to blood. Separate cellular elements of the liver (star reticulosendoteliocytes, or kipper cells, endotheliums of the portal vein) are part of the reticulinendothelial apparatus, which has phagocytic functions and actively participating in the exchange of iron and cholesterol.

The liver carries out a barrier function, neutralizes a series of endogenous and exogenous harmful substances, including toxins coming from the intestine, and takes part in the metabolism of medicinal substances.

Thus, the liver plays an important role in carbohydrate, protein, bile, fat, water, vitamin (A, D, K, B, C) metabolism, and during the period of intrauterine development is also a hematome body.

In young children, the liver is in a state of functional failure, its enzymatic system is particularly insolvent, the result of which is the transient jaundice of newborns due to incomplete metabolism of free bilirubin, formed during the hemolysis of red blood cells.

Spleen- lymphoid organ. The structure of it is similar to the fork iron and lymph nodes. It is located in the abdominal cavity (in the left hypochondrium). The spleen pulp is based on the reticular tissue, forming it strom.

Features of the examination of the digestive organs. Basic symptoms of defeat

Features of the collection of anamnesis. The carefully assembled history is the basis for the diagnosis of diseases of the gastrointestinal tract.

Among the complaintsdominance abdominal pain, dyspeptic syndrome, symptoms of intoxication.

Stomach achechildren are a frequent symptom, they often have a recurrent character, occur about 20% of children over 5 years old. Most localization of painin preschool and younger school age - the area of \u200b\u200bthe navel, which can be marked with different diseases. This is due to the age characteristics of the central and vegetative nervous system of the child.

With the appearance of children in the abdomen, each time you should spend differential diagnosisbetween the following groups of diseases:

• surgical diseases (acute appendicitis, peritonitis, diverticulitis, intestinal obstruction - invagination, hernia, etc.);
• infectious pathology (enterocolites, hepatitis, yersiniosis, pseudotuberculosis, infectious mononucleosis, etc.);
• diseases of the digestive organs (at an early age are common so-called "infantile colic", in an older age - diseases of the gastroduodenal zone, the pathology of the hepatobiliary system and the pancreas, the disease of the intestine, etc.);
• somatic diseases (pneumonia, myocarditis, urinary tract diseases, manifestations of nervous arthritic diathesis, Shenlein-genuch disease, neurocirculatory dysfunction, etc.).

With abdominal pains find out:

The time of appearance, duration, frequency. Early pains - during eating or within 30 minutes after meals are characteristic of esophagitis and gastritis. Late pains that arise an empty stomach in the afternoon 30-60 minutes after eating or at night, characterized by gastritis of the anthral gastric department, duodenitis, gastroduodenitis, duodenal ulcerative disease;

Communication with meals and its character. The intensity of pain can be influenced by the meal itself. In antral gastritis, gastroduodenitis, ulcerative diseases of the duodenal bulb after taking food, the intensity of pain decreases. But after some time, pain is reinforced. These are the so-called Moisinganovsky Pain. Pains often arise or enhanced when taking acute, fried, oily, acidic, with the use of concentrated, extracted broths, spices, etc.

Place localization of pain. Pain in the opposite region is characteristic of eosophagitis and gastritis. In pylorododenal - antral gastritis, gastroduodenitis, ulcerative duodenal disease. The pain in the right hypochondrium is characteristic of the diseases of biliary tract (Discinesia, Cholecystocholangitis). Watching pain with predominant localization on the left, above the navel is marked with pancreatitis. Pains all over the stomach are usually observed with enterocolites. Pain in the right iliac area is characteristic of appendicitis, proximal colitis, ileit.

Characteristic of pain. They distinguish pariety, stitching, constant, stupid, nunning and night (with ulcerative disease) pain. In the first year of life, abdominal pain is manifested by common concern, crying. As a rule, children are lying with legs, which happens often with meteorism, and after fatting gases - calm down.

Communication with physical, emotional loads and other factors.

Among the dyspeptic phenomena, the gastric and intestinal form of disorders is distinguished.

• For gastrointestinal dyspepsia Children are celebrated: belching, nausea, heartburn, vomiting, tightening. They reflect the violation of the motility of the gastrointestinal tract and are not strictly specific symptom of any disease.
• Belching It is a consequence of increasing intragastric pressure during the insufficiency of the cardiac sphincter. It occurs in esophagite, hernia of the esophageal hole of the diaphragm, cardius failure, chronic gastritis, gastroduodenitis, ulcerative disease. On the 1st year of life in children, due to the weakness of the cardiac sphincter, the burden of air (Aerophagia) is often observed, this may be due to both infringement of feeding technology.
• Nausea In children, more often is the result of increasing intrapend pressure. It occurs with duodenal diseases (duodenitis, gastroduodenitis, ulcerative sickness of the duodenal bulb). Precedes vomiting.
• Heartburn It is observed during gastroesophaginal reflux, esophagite, due to the cast in the esophagus of the acidic content of the stomach.
• Vomot - A complex reflex act, during which there is an involuntary ejection of the contents of the stomach through the esophagus, a throat, mouth outward. Vomiting may be nervous origin (with damage to the central nervous system, meningitis, intoxications, irritation of the correspondence center with various infections), and during the damage to the gastro-duodenal zone (acute and chronic gastritis, gastroduodenites, ulcerative disease, intestinal infections, food toxicoin intake). With violent feeding, "familiar vomiting" can be formed. A variety of vomiting in children of the first year of life is jeeping, which arise without effort, i.e. Without the tension of the abdominal press. Often flashing there are practically healthy children for 1 year of life, but they can be a sign of a starting intestinal infection. There are also a "short" esophagus and Cardia's Ahalasia. Rarely in children with disruption of intellect arises a ruminance - a gum, characterized by the fact that the dumping masses are dug in the cavity again swallowed by the child. Vomiting fountain -a typical sign of pylorostenosis, while in the vomit's masses is not an impurity of bile. Intestinal dyspepsiamanifested by diarrhea, less often - constipation, flatulence, ration.

In the first 1-2 days of life, healthy newborn stands out mekonia -a chair representing a thick viscous mass of dark olive color, without smell, accumulated in the intestine to childbirth, before first applying it to the chest. The absence of epithelial cells in the composition of meconium can be a sign of intestinal obstruction in a newborn. Acceptance of meconium to the oily waters at the beginning of the birth indicates intrauterine asphyxia. The type of feces in children of the first year of life on natural feeding is a casciarscent golden yellow color with a weakly acidic smell. The number of feces - up to 7 times a day in the first half, and 2-3 times a day - in the second.

In case of artificial feeding, the carte masses are more dense, magnificent consistency, light yellow, with an unpleasant smell, the number of feces 3-4 times a day to 6 months and 1-2 times a day before a year. In older children, the chair decorated (species of sausages), dark brown, does not contain pathological impurities (mucus, blood). Chair is 1-2 times a day. With different diseases, the character of the chair changes, distinguish:

• dyspeptic chair, liquid with admixture of mucus, greenery, white lumps, frothy, acid odor (happens with simple dyspepsia - "ferotous dyspepsia");
• "Hungry" chair, meager, resembles dyspeptic, but thick, darker (happens during hypotrophies);
• chair for toxic dyspepsia is watery, light yellow color with admixture of mucus;
• with a colidentity, the chair is liquid, hidden yellow (less often greenish) with admixture of mucus and white lumps;
• under salmonellosis - a liquid chair, green (such as swamp green), the mucus is a small amount, blood does not happen;
• in the dysentery, the chair is rapidly (up to 15 times), contains a large number of mucus, pus and streams of blood, the feet masses are almost no, the defecation is accompanied by tenezms;
• in the abdominal title, the chair is rapidly (up to 10 times) liquid, slicer, in the form of peas, occasionally contains an admixture of bile;
• when cholera, a chair is almost continuous (up to 100 times a day), abundant, in the form of a rice brave, never contains blood;
• in the food toxicoinfection, the chair is liquid, frequent, rich, greenish yellow color with admixture of mucus (rarely with strengths of blood);
• at Amebiaz, the chair is rapidly, the colors of raspberry jelly;
• with giardiasis Chair 3-4 times a day, yellow-green color, soft consistency;
• with viral hepatitis, a acher, gray-clay color, without pathological impurities;
• for Malabsorption syndromes, polyfexalia is characterized (when the number of feces exceeds 2% of the eaten food and drinking liquid). This syndrome is observed in disaccharide insufficiency (lactose and sucrose), celiac disease (gluten intolerance, glyiadin), intolerance to the protein of cow's milk, with chronic pancreatitis;
• melena (black homogeneous chair) occurs during bleeding in the upper gastrointestinal tract (esophagus, stomach, duodenum, delicious intestine);
• alay blood in a chair appears during bleeding in the terminal deposits of the iliac and colon (with half ateposes of the intestine, invagination, crown disease, on the 2-3rd week of the abdominal disease, with the cracks of the rear passage (where blood is separate from the carts);
• publishers (stool delay over 48 hours) are organic and functional origin. If the chair is not 1-3 days in a newborn baby since birth, it is necessary to think about congenital intestinal developmental anomalies (Megacolon, Girshprung disease, megasigm, the atresia of the anal hole, etc.). At the older age, constipation is observed with colitis, hypothyroidism and other states.

Flatulence- The bloating, like a rumbling, arises due to the impaired absorption of gases and liquid content in the terminal department of the ileum and the proximal division of thick, is marked more often with enterocolites, intestinal dysbacteriosis.

Receive signs of intoxication:

• the presence of lethargy, fatigue, decline in appetite;
• increasing body temperature;
• changes in the leukocyte formula, acute blood reactions.

It is extremely important to establish the relationship between the syndromes specified above. An important role in the development of diseases is played and clarified when collection of anamnesis:

Inspection. In older children, the inspection starts with the oral cavity, and in young children, this procedure is carried out at the end of the inspection, in order to avoid a negative reaction and anxiety. Pay attention to the color of the oral mucosa, zea and almonds. Healthy children are mucously pale pink, shiny. With stomatitis, the mucosa is locally hyperemic, the gloss (catarrhal stomatitis) disappears, and defects of the mucous membrane can be detected in the form of AFT or ulcers (aphthous or ulcerative stomatitis). Determine the symptom of Filatov - Sokilka (the mucous membrane of the cheeks against small indigenous teeth, less often the gums, coated in the form of semolina), which testifies to the area of \u200b\u200bmeasles. You can detect inflammatory changes in the gingules - gingivitis, or language damage - glossitis (from catarrhal to ulcerative-necrotic). When examining the language, it is detected by its purity (normally) or the design (in diseases of the organs of the gastrointestinal tract). The collapse in the language can be located over the entire surface or only at the root of the language. Have a different color: white, gray or dirty, and density: be thick or superficial. It is peculiar to the type of language under various diseases: under anemia there is an atrophicity of the papillars, and it resembles a "polished" language; with scarletin - raspberry color, especially the tip; With acute intestinal and other infections, the language is dry, taxed; With exudative-catarial diathesis, the geographical language. With a strong cough, accompanied by reprises, ulcers appear on the mucous membrane of the tongue of the language, as it occurs on the lower front cutters. Find out the condition of the teeth (formula, caries, defects, enamels, bite anomalies).

Inspection of the belly . First of all, attention should be paid to participation in the act of breathing the abdominal wall. Under the local peritonitis (acute appendicitis, cholecystitis) of the movement is limited, and with a spilled peritonitis, the front abdominal wall does not take part in the breath, it is tense. In children of the first months in pylorostenosis, you can mark the peristaltics of the stomach in the epigastric area in the form of an hourglass. Intestic peristalsis is observed with intestinal obstruction.

Normally, the front abdominal wall does not go beyond the plane, which, as it were, the continuation of the chest.

Increase abdomenin volume, it is observed in obesity, meteorism, ascite, pseudo-acid, chronic tuberculous peritonitis, a significant increase in liver and spleen, abdominal tumors, intestinal development anomalies (megalolon). With hepatosplegaly, the stomach increases in the upper departments. In tumors, the asymmetry of the abdomen is observed. The bore of the abdominal wall is characteristic of acute peritonitis, it happens with sharp exhaustion, dysentery, tuberculous meningitis.

The pronounced venous network on the front abdominal wall in newborns can be a sign of the umbilical sepsis. In children older than the year, a pronounced venous network often testifies to portal hypertension (intrahephenate - under the cirrhosis of the liver, extrahepatic - with V.Portae thrombosis), while there is a difficult course of blood outflow over the v.Portae system and the lower hollow vein. The edema of the anterior abdominal wall in newborns is marked with a poucher sepsis, sometimes septic enterocolite, and in children older than the year - during ascite and tuberculous peritonitis.

Palpation of belly. When studying the abdominal organs, their topography is important in the projection on the front wall of the abdomen. To this end, it is customary to distinguish between different areas of the abdomen. Two horizontal lines, the abdominal cavity is divided conditionally into three departments: epigastrine, mesogstra and hypocheastics. The first division line connects the X-E ribs, and the second is the ileal bone. Two vertical, walking along the outer edge of the abdominal muscles, additionally divide the abdominal cavity in the 9-pieces: left and right hypochondrium; Actually, the nasty department (epigastrine), the left and right side departments (flanks), the umbilical, left and right iliac departments, guessing. Conditionally produce the separation of belly on departments : epigastric, mesogastric and hypogastral. Epigastric Areait is divided into the central zone - epigastrium, as well as the left and right hypochondrium. Mesogstria -on the umbilical zone, left and right flanks. Hyporates- on the supoclative zone, left and right iliac areas.

For the correct palpation, the doctor sits down to the right of the patient, face to him. The child must lie on his back with a slightly bent in the hip and knee joints. Hands should be elongated along the body, head on the same level with the torso, it is desirable to distract the child.

Surface or indicative palpation is carried out by easy pressure on the front abdominal wall, and all the abdominal departments are examined, moving clockwise or against it depending on the presence and localization of stomach pain. Starting palpation follows from the area that does not hurt. Both or one hand places the palm surface on the abdominal wall, pressure is carried out 2-3-4-5 fingers of the palpant hand. This method identifies the tension of the abdominal wall, tumor formation, soreness.

The voltage of the anterior abdominal wall can be active and passive. To exclude active voltage, you need to distract the child's attention. You can use as receiving diverting change poses, translation of the child to the sitting position. The active voltage at the same time with palpation disappears, passive - persists. In children during the period of newborn, you should palpate a poucher ring and an okoloppy vessels.

Great importance for surveying pain areas have skin sensitivity zones - zone Zakharin - Ging. When examining hyperesthesia zones, older children should slide on the skin, slightly stroking the skin with two hands in symmetrically located areas on the right and to the left of the white line of the abdomen.

Distinguish the following hyperesthesia zones :

• Weldowed zone- The right upper square (region bounded by the right edge arc, the white linen of the abdomen and the line passing through the navel perpendicular to the white lines of the abdomen).
• Epigastral zone- occupies epigastrium (abdominal area above the line connecting the right and left edge arcs).
• Zone Shoffarawhich is located between the white linen of the abdomen and the bisector of the right upper square.
• Pancreatic zone- zone in the form of a strip that occupies a mesogastium from the navel to the spine.
• Pained body zone and pancreatic tail- It takes the entire left upper square.
• Appendicular zone- Right bottom square.
• Sigmal zone- Left Lower Square.

With the help of surface palpation, the asymmetry of the subcutaneous tissue thickness is also determined, for which at the level of the navel on both sides, the skin and subcutaneous fiber are collected first and second fingers into the folds. After surface estimated palpation, they go to deep sliding, topographic methodical palpation on samples and storage.

Deep palpationit is carried out in a certain order: the sigmoid intestine and the descending division of the colon, the blind, the upstream of the colon, the ultimate part of the ileum, a worm-shaped process, cross-colon. The deep palpation of the pancreas, liver and spleen is completed.

Palpation of a fat intestine. Palpation of the sigmoid intestine - the right hand of the investigative is put on the plafhmy with a few bent fingers on the left iliac region so that the end phalanges of the fingers are located perpendicular to the length of the sigmoid gut. During the breath of the surface movement of the fingers, the skin shifts slowly, forming a fold, in the direction of the outside inside and bottom up. During the exhalation, the fingers are immersed as deep as possible, and then the movement of the brush from the inside of the dodder and from top to bottom, along with the skin of the front abdominal wall, they are rolled through the intestine. Usually sigma is located on the bisector of the left lower quadrant.

Determine the consistency, mobility, elasticity, sigmoid soreness. The limited mobility of the sigma may be due to the inflammatory process (perisigmoiditis), as well as a short mesentery. A dense, thin, painful intestine is torn in spastic colitis, dysentery. Thirdly than normal, the S-shaped intestine occurs when it is filling out by the carte masses; In atony, when developing pericolitical process. A very dense sigmoid intestine is observed with tuberculosis, ulcerative colitis.

Palpation of blind gut- Palpation technique is the same as during a sigmoid intestine, but is produced in the right iliac region. The direction of the blind intestine to the top from top to bottom left. At the same time, the rising intestine is palpable with a blind intestine.

The shift rate of the blind intestine is several centimeters. Restriction of displaceability can be caused by an inflammatory process (peritiflite) or a congenital short mesentery. Palpation disease testifies to the inflammatory process and occurs at various pathologies (flu, dysentery, abdominal typhoid tuberculosis, etc.). The dense blind intestine is tested with the delay in the roaming masses (feather stones), with a peptic inflammatory process.

Palpation of the final segment of the ileumconducted after the feeling of the blind intestine. Palpation of other small intestine departments are predicted due to the abdominal press resistance. The explore puts the hand under a stupid angle and tested from the inside the duck and from top to bottom. A feature of the finite department's palpation is its peristalistic under the palpable hand.

In the spastic reduction, the iliac is dense, thin. Inteitis, pain and rumbling are observed (because there are gases and liquid). With terminal iley (Crohn's disease), the terminal cut is painful and thickened. The bug, the uneven surface of the ileum can be observed in patients with abdominal typhoid, lymphogranulomatosis, lymphosarcoma. To distinguish the lesion of the blind intestine from the terminal ileet or meso-adenit, it is necessary to palpate the blind intestine with the right hand, and the left to face the ileum medially shifted by the blind intestine. If the greatest pain is noted in the lateral region, you can think about the damage to the blind intestine or appendix. When mesoadenitis, the greatest pain is manifested by medial (under the left hand).

Palpation of the transverse colonproduced by two hands. The fingers are set parallel to the goal of the intestine by 2-3 cm above the navel on both sides in the area of \u200b\u200bthe outer edge of the direct muscles, slightly shifting them to the center and immersing your fingers into the abdominal cavity. Then the moving movement of the hands from above is performed.

When palpation of any of the divisions of the large intestineit is necessary to note the following properties of the palpable department: Localization, shape, consistency, size, surface condition, mobility, presence of uriccy and pain.

In healthy children, the intestine is torn in the form of a soft cylinder. The rumbling indicates the presence of gas and liquid.

A dense and crowded gut occurs when the delay in the feces (constipation), painful - when colitis. The presence of spastically abbreviated, with separate seals, the transverse colon testifies to ulcerative colitis. In atony, the intestine is torn in the form of a soft cylinder with sluggish walls. In the megacolon, the cross-colon is greatly increased and can take almost all the abdominal cavity.

Palpation of stomachit is possible only at deep palpation, but not always. A large curvature is palpable slightly above the navel. The correctness of the palpation of the stomach and its location is estimated by the phenomenon of the splash, as well as percussion.

The omission of large curvature of the stomach is observed during gastropththosis, expansion and atony of the stomach, during the stenosis of the gatekeeper. Palpation of the gatekeeper is of particular importance for the diagnosis of pylorostenosis. Breastfish gives empty milk or tea, and at this time they produce palpation of the gatekeeper on the right - at the edge of the liver and the outer edge of the right muscle of the abdomen, trying to penetrate the tips of the fingers to the back of the abdominal wall. In the early periods of pilor-possession, a thickened gatekeeper is detected under the straight abdominal muscle on the right. With a significant increase in the stomach, it shifts laterally and down. Palparatory is detected by a dense serrated shape rolling formation up to 2-4 cm long.

Palpation of the pancreasaccording to the method of grotto, it is held in the position of the child lying. A progress of the doctor's right hand is supplied under the patient's flaw. The feet of the patient bent in the knees. The fingers of the study penetrate into the abdominal cavity between the navel and the left hypochiest (the outer edge of the leftmost abdominal muscle in the left upper quadrant). Palpation is carried out on exhalation (abdominal muscles are relaxed) towards the spinal column. Pancreas is tested in the form of a heavy diameter with a diameter of about 1 cm of an overlapping vertex pillar. With its inflammation, the patient is pain, irradiating in the back, spine. The diagnostic value, as already mentioned, has the definition of the pain zone of Shoffara, where the body of the pancreas is projected, as well as pain points.

Dezharden's point- pain of the pancreas head, located on the border of the middle and lower third of the bisector of the right upper quadrant.

Maine - Robson- pain of the town of the pancreas, located on the border of the upper and middle third bisector of the left upper quadrant.

Point Kacha- painful pancreas, located along the left edge of the abdominal muscle by 4-6 cm above the navel.

Symptom of exemplary- soreness and rumbling during palpation in the right iliac area.

Palpation of the liver. Until the three-year-old, the liver in children in a calm position protrudes from under the edge of the edge arc on the mid-heartful line by 2-3 cm, and under the age of 5-7 years - by 1-2 cm. At the height of the breath, you can try to face the lower edge of the liver in children And at an older age. But usually healthy children over 7 years old liver is not palpable. There are two main types of palpation of the liver: a sliding (sprinkling) palpation of the liver in the storage and the second - on the storage sample. The position of the patient lying on the back with a slightly bent legs, the pillow is cleaned. Hands or stretched along the body or lie on the chest. The doctor's fingent fingers form one line - parallel to the lower border of the liver and produce a light sliding movement from top to bottom. Sliding movements should be compete with all the available palpation of the liver surface. Especially often the moving method of palpation of the liver is used in breast and younger children.

After that go to palpation of liver according to the method of exemplary. The right (palpable) hand is placed on the region of the right half of the abdominal wall at the navel level or below. The left hand covers the right half of the chest in the lower section. Leaving the right hand, deeply entered on the exhale in the abdominal cavity, in place they ask the child to breathe deeply. When inhaling, the palpable hand is derived from the abdominal cavity in the direction forward and up. At the same time, the lower edge of the liver, gliding down, seeks to bypass the palpming fingers. At this moment, the shape and outlines of the edge of the liver are determined, its consistency and soreness.

In a healthy child, the bottom edge of the liver is painless, sharp and gently elastic. With different diseases, the density of the lower edge of the liver may increase, its pain appears.

Redcover liverit is characteristic of its acute dystrophy (with viral hepatitis B), the upper dome of the liver is compact, and then the lower edge. With the predominance of dystrophic processes in a cirrotic liver, it can also decrease in size and not palpable. The disappearance of hepatic stupidity occurs when the duodenal ulcer or stomach is spinning.

The dense solid edge of the liver, up to the stony, is observed in cirrhosis, with congenital fibrocholgangocystosis, leukemia, lymphogranulomatosis, while in many cases the surface of the liver is uneven. Smooth, smooth, gentle liver surface with a rounded edge, rarely painful when palpation occurs in acute blood, due to cardiovascular insufficiency, with hepatitis, cholantitis, cholecystocholangitis. Radically emerging pain in touching the surface of the liver is characteristic of perigepatitis (when involving the inflammatory process of the liver capsule).

Gall-bubblechildren are not palpable. In the diseases of the gallbladder (cholecystitis), soreness is determined in the field of its projection (T. KERA).

During palpation, a number of symptoms are determined, indirectly indicating the defeat of biliary tract or other organs:

• the pain in the breath at the point of the ker or the bubble point (in the pathology of the gallbladder) is the intersection of the outer edge of the abdominal muscle with the right edge arc;
• cymptom Murphy - the appearance of a sharp pain during palpation at the moment of inhalation in the area of \u200b\u200bthe gallbladder (the place of intersection of the outer edge of the abdominal muscle with the rib arc);
• arñenius-symptom (symptom of Mussy) is painfulness when pressed between the legs of the right breast-elder muscle;
• cympt Boas - soreness when pressing in the field of transverse processes of the 8th breast vertebra on the right on the back;
• symptom of Openhovsky - pressure in the field of ostic processes 10-11-12 breast vertebrae on the back, soreness is characteristic of peptic ulcer of the stomach and duodenum.

In differential diagnosis, the symptoms of the "acute abdomen" are determined to eliminate surgical pathology:

• symptom of Brush-Blumberg- the emergence of acute abdominal pain at the time of the rapid palm palm from his surface after soft pressing - it means about the irritation of the peritoneum in the area under study;
• the symptom of the rivxing- amplification of pain in the area of \u200b\u200bthe blind intestine (in the case of appendicitis) with a bell-shaped pressure in the left ileal region;
• sytkovsky symptom- Strengthening pain in the right iliac region (at appendicitis) when the patient is rotated on the left side.

Percussion methodit is used to determine the boundaries of the liver, which is carried out in three lines: anteriorless, secondary heartless and front median. The upper limit of the liver is determined by performing from top to bottom along Linea Axillaris Anterior Dextra before the transition of clear pulmonary sound in a stupid (liver), normal on the IV-VII edge. According to Linea Medioclavicularis Dextra on the V-VI edge. The upper limit of the liver over the anterior median line is determined approximately - it is located at the level of continuation along the corresponding intercreicity of the upper boundary of the liver, determined by the mid-heartful line. The lower boundary of the liver is determined by the same lines. The polesimeter's finger is parallel to the boundaries of the liver, peculiar in the direction from the clear sound to stupid, from the bottom up. Measure the distance between the upper and lower boundaries of the liver on all 3rd lines.

In early age children, the top edge of the liver is determined by the method quiet percussionand the bottom is better to determine palpation methodby specified lines. And if the bottom edge does not fit, then it is determined by percussion. As it was already noted, depending on the age, the lower edge of the liver in children can perform on the midcurbicular line of 1-2 cm below the edge of the rib arc, and on the front median line does not go beyond the upper third of the line connecting the mamosoid process with the navel.

For more accurate control of the change in the size of the liver in the dynamics, in children from 5-7-year-old age, the method of determining the size of the liver size in the crusure is used.

Percussion of the liver boundaries and the measurement of its sizes in the crusure is carried out in three lines:

• in the middle-heartless top to the upper boundary of the liver, which in children is on the V-VI edge, from the bottom from the navel level (or below) towards the rib arc;
• on the front median line - on top to the upper boundary of the liver, which is located at the beginning of the sword-shaped process and from the bottom from the navel up to the upper third of the distance from the end of the sword-shaped process to the navel;
• under the oblique line - the left edge arc, performing the bottom from the left midcoluchic line towards the sternum.

Recording the results of the liver measurement looks like this: 9x8x7 ± 1cm. Depending on the age of the child, the liver dimensions can be less and main benchmarks should be the upper limit - 5-6 edge and lower boundary - rib arc.

With different diseases, the dynamics of the size of the liver changes. So, with a right-sided exudative pleurite, the lower edge of the liver is shifted down, and with meteorism, ascite - up.

Percussively can identify the following pathological symptoms:

• symptom of Ortner-Grekova -poland's fingering on the right edge arc painfully with damage to the gallbladder or liver;
• symptom Mendel -picking over the front surface of the belly in the area of \u200b\u200bthe epigastria. The patient should take a deep breath in the abdominal type in order to bring the stomach to bring close and make it more affordable survey. Mendel's symptom allows you to topographically determine the location of the stomach ulcers in the event that there is such;
• symptom of Frankel -nausea and back pain at percussion along the breast-shaped process (positive in acute cholecystitis, gastritis, ulcerative disease).

It is also necessary to study to identify the presence of free fluid in the abdominal cavity. Palparatory determine the free liquid in the abdominal cavity using the edge. For this, the left hand is placed on the side surface of the abdominal wall on the right, and the right hand is applied with the fingers of the right hand on the abdominal wall on the other side. This blow causes fluid oscillations that are transmitted to the other side and perceived with an left hand in the form of a so-called wave. In order to make sure that the wave is transmitted in a liquid, and not on the abdominal wall or bowel hinges, it is recommended that the doctor's assistant put the palm to the edge to the middle of the abdomen and slightly pressed, this technique eliminates the transmission of the wave along the abdominal wall or intestinal.

The percussion method can also determine the presence of fluid in the abdominal cavity. For this, the sick child is placed on the back. Percussion is carried out on the front abdominal wall in the direction of the navel to the side departments of the abdomen (flanges). The study is conducted using mediocre percussion. The Polsimeter's finger is located parallel to the white lines of the abdomen in the navel area and gradually moves to flanges, first right, then to the left, and the middle finger of the right hand is applied to the left of the plaster. The presence of bilateral shortening in the field of flanks can talk about the presence of a free fluid in the abdominal cavity.

For the differential diagnosis of ascites and dull in the abdominal cavity, due to other reasons (filled intestines, tumor, etc.), you need to turn the child on the side and spend the abdomen in the same sequence. If the dullness in the above flange disappears, you can think about the liquid in the abdominal cavity, if it remains, shortening is due to another reason.

With auscultation of the abdomena healthy child can hear the intestinal peristalsis, the intensity of these sound phenomena is small. In pathology, sound phenomena can enhance or relax and disappear.

With help mixed methodstudies - auscultation and percussions (auctofaction) can be determined borders of the stomach. The stethoscope is placed in the epigastric area - the area of \u200b\u200bthe stomach and stroking with one finger from top to bottom along the white line of the abdomen from the sword-shaped process to the navel. In the area of \u200b\u200bthe stomach, audio audio in the stethoscope is sharply enhanced. The best listening zone corresponds to the boundaries of the stomach.

Diagnostic significance is the method of studying the stomach, called "The noise of the splash."Its essence is that when concussing the stomach, where air and liquid are at the same time, a peculiar noise occurs. When the blows are applied in the area where there is no stomach, the noise of the splash will stop. This reception to X-ray examination allows you to diagnose gastroptosis.

Features of the laboratory and instrumental examination of the gastrointestinal tract.The volume of the necessary laboratory and instrumental examination is determined individually, taking into account the nature of the intended disease. When studying the esophagastrodenal zone, various methods apply.

Stomach fractional sounding - continuous aspiration of tusschko, basal and stimulated (histamine 0.008 mg / kg, pentagastrine 6 μg / kg) of gastric secrets with an assessment of volume, titration acidity and calculation of the flow rate. Fractional study of the gastric juice is conducted on an empty stomach. Take the probe (size depends on the age of the child), measure the length from the angler of the mouth to the navel (plus 1 cm), make a mark. The child helps to swallow the probe. Immediately after swallowing, gastric juice is beginning to suck. First, sucking all the contents of the stomach - Touchy or "O" portion. Then slowly suck juice for one hour: 4 portions every 15 minutes. This is basal secretion. At the end of the hour, a 0.1% hystamine solution or a 0.25% solution of Pethastrin (as an irritant) is subcutaneously introduced. After 5 minutes again, 4 servings are sucking for 1 hour every 15 minutes and get stimulated secretion. They are sent to the laboratory, thus, 9 servings, where they are filtered and titrated by a 0.1% solution of caustic soda in the presence of indicators for determining the concentration of hydrogen ions and the acid-forming function of the stomach. The method of studying the farming-forming function of the stomach is based on determining the proteolytic activity of gastric content with respect to the protein substrate. Gastric secretion indicators are given in Table. 24.

Table 24. Normal gastric secretion indicators in children older than 5 years

Indicators	Basal	Stimulated with meat broth	Stimulated Pentagastrine
Volume (ml / h)
Free hydrochloric acid (titer units)
GENERAL Acidness (titer. Ed.)
Acid Products (HCl Debit)
pH body stomach / alkaline time (min.)
pH Antruma				Various number
Mucus, epithelium, worm eggs	Absent
Leukocytes	Single

Changes in the coprogram make it possible to distinguish a number of coprological syndromes (Table 28).

Table 28. Coprological syndromes in children

	Cala's macro- and microscopy data
Gastrogen	Unchanging muscle fibers, intracellular starch, connecting fabric
Pyloroduodenal	Unchanging muscle fibers, connecting fabric, vegetable fiber
Pancreatic insufficiency	Liquid, massevoid yellow-gray feces, neutral fat, modified muscle fibers, extracellular starch
Lack of bile	Gray feces. Soaps and crystals of fatty acids, no reaction to Sterkobilin
Enteral	Many epithelium, fatty acid crystals, extracellular starch
Ileocecal	Mucus, abundance of transshipment of fiber, starch grains, iodophilic flora
Colitious	Mucus, leukocytes, red blood cells, epithelium

Test with D-xylose - reflects the activity of suction in the intestine, assessed with urine for 5 hours through the mouth of D-xylose (norm: in children of the 1st year of life - more than 11%, in children older than a year - more than 15%).

Lactoso- (sucrose, maltose, isomaltosis) tolerant test - identification of disruptions of splitting or suction of hydrolysis products of disaccharides by studying the dynamics of glycemia after oral load by this disaccharide (at a dose of 50 g / m 2).

Hydrogen respiratory test - Identification of the violation of fermentation in the intestines of carbohydrates to increase the content of hydrogen in the exhaled air more than 0.1 ml / min.

Thin layer chromatography sahars in the urine allows you to determine the qualitative nature of mellitourism;

Entryokinase activity in the contents of the small intestine - normally 130-150 units / ml, in case of violation of the enzyme production, the indicator decreases.

Radioisotope method estimates of the excretion of albumin, labeled iodine-31, with the feces - normal excretion is no more than 5% of the amount of the received isotope, the indicator increases with impairment of suction.

Daily excretion of fat with feces (van de Camera ) - Against the background of the reception 80 - 100 g of fat per day, the excretion does not exceed 3 g; In case of violations of hydrolysis and suction, the excretion of fat increases.

Immunogistological and enzymogistological methods studies of the biopsy of the mucous membrane of the proximal departments of the small intestine.

Perfusion of the small intestine solutions of carbohydrates, protein and fat emulsions - identification of violations of the enzymatic splitting of the substrate and impaired suction of its hydrolysis products.

Colonoscopy, RectorOnososcopy. - Endoscopy of the lower intestinal departments: allows to detect inflammatory-destructive changes, pathological formations of the mucous membrane, anomalies of the structure.

Irrigography - X-ray contrast study of the colon. Allows you to estimate the relief of the mucous membrane, the intestine motorcy, to identify anomalies, tumors, etc.

Bacteriological research Cala - Evaluation of biocenosis of colon, identification of dysbiosis.

Anamnese and inspection data allow us to formulate a preliminary diagnosis. Taking into account the laboratory and instrumental results establish a clinical diagnosis of the disease.

The digestive system in children is significantly different from those in adults. That's why some products for children need to be given from a certain age, and that - dosed. For example, mushrooms. How does this system of the children's body change with age?

Age Features of the digestive system

The characteristic feature of the children's digestion system is the tenderness of the mucous membranes of the gastrointestinal organs, abundant blood supply and underdevelopment of their elasticity.

The glands of the children's intestine and the stomach before the period of school age are not fully developed and small. Therefore, in the gastric juice of the child, the low concentration of hydrochloric acid, and this reduces the bactericidal properties of the digestion and, of course, increases the sensitivity of children to gastrointestinal infections. The amount of glands in the stomach increases intensively up to 10 years, and in 14-15 years almost corresponds to the level of an adult.

And the composition of the enzymes of the gastric juice is changing in the first years of life. Thus, the enzyme Hymosine, acting on the dairy proteins, is actively produced by the glands of the stomach in the first 2 years of life, then its production is reduced. In adults, for comparison, this enzyme is almost absent. The activity of other gastric juice enzymes increases by 15-16 years and at this age already reaches an adult. The age feature of the child's digestion system is that under 10 years old is very active in the stomach, suction processes occur. In adults, these processes are carried out only in the small intestine.

That is, the development of digestive organs in children occurs in parallel with the development of the whole organism. And this development is divided into periods of the first year of life, preschool age and adolescence.

At this time, the operation of the digestive organs is controlled by the nervous system and depends on the state of the cortex of the brain. In the process of forming a digestive system in children, reflexes are easily produced at the time of food intake, its composition and quantity.

Anatomy-physiological features of the digestive organs in young children

The esophagus in young children has a form of spindle. He is short and narrow. In children in the year of life, its length is 12 cm. There are no glazes of the esophagus. Its walls are thin, but it is well supplied with blood.

The stomach in young children is located horizontally. And as the child develops, it occupies a vertical position. By 7-10 years, the stomach is already placed as in adults. The gastric mucosa is thick, and the barrier activity of the gastric juice compared to adults is low.

The main enzyme of the gastric juice is the rennet enzyme. It provides milk.

The pancreas of an early child child has small sizes. The newborn is 5-6 centimeters. Already at 10 years she will grow three times. This body is perfectly equipped with blood vessels. Pancreas produces pancreas juice.

The largest organ of the digestive system at an early age occupying a third of the abdominal cavity is the liver. At 11 months, its mass doubles, by 2-3 years it triples. Liver capabilities are quite low at that age.

The gallbladder at an early age reaches size 3 centimeters. Peer-shaped form he acquires for 7 months. Already in 2 years, a children's bubble reaches the edge of the liver.

For kids up to a year, substances coming with Mother's Milk are of great importance. With the introduction of feeding, the mechanisms of child enzyme systems are activated.

Anatomy-physiological features of digestive organs in children of preschool age

In preschool age, the children continues the growth and development of digestive organs. However, due to different rates of general growth and development, up to 3 years, the edge of the liver leaves the zone of the right hypochondrium, it is easily palpable to 1-2 cm below the rib arc.

The pancreas kid is very actively developing up to 1 year, and then jump in its development occurs in 5-7 years. In its parameters, this body reaches the level of an adult only to 16 years. The same pace of development is characterized by the liver of the child and all the intestinal departments.

In connection with the development of digestive bodies, children under 3 years need restrictions in nutrition.

It should be noted that in preschool age in children, sharp disorders of digestion are found very often. However, they occur most often easier than the first year of life. Parents of preschool children are important to feed children correctly, taking into account both the growth of their teeth, and the regime, and the balance of nutrition. Heavy products for the stomach, with which the adult stomach easily copes, are often brazed by a children's body, causing indentation of the stomach.

Digestion in adolescents and its features

In adolescence, digestion organs are already well developed. They are actively functioning, and the process of digestion itself is almost no different from adults. The intestinal emptying frequency in adolescence is 1-2 times a day.

At 12 years old on a smooth previously surface of the pancreas appears, bugger appears. These hooks are due to the separation of pancreatic robes.

The liver of children is also actively increasing. So, by 8 years, it grows 5 times compared with the birth size, by 16-17 years its mass increases 10 times. It should be noted that from 7 years old, the lower edge of this organ is not palpable in the lying position. By 8 years of life, the histological structure of the liver of the child is the same as in adults. Horse bubble by 10-12 years increases in size almost 2 times.

It is necessary to take into account the specifics of the structure of the gastrointestinal tract of adolescents when organizing their nutrition. We are talking about the daily compliance with the power regime and its organization at school. After all, nutritionists state that for the development of a healthy digestive system, children of school age should be eaten four times a day due to their energy costs.

Digestion violation in children

Problems with gastrointestinal tract in children arise quite often. This is especially characteristic of early age. Diarrhea or constipation not only spoil the well-being of children, but also force parents to adjust their nutrition. If your child has such disorders in preschool age, it is often necessary to rely on themselves, and you need to consult a good experienced pediatrician. To contact the doctor, parents should and because only the doctor can determine the beginning of a serious pathology.

The diarrhea may cause an infection, and even the stress of the child provoke the functional diarrhea. Then he has a stool is cascidious or liquid. It occurs 2-4 times a day, but without impurities in pus and blood.

Unwashed hands and dirty water, even swallowed by chance when bathing, non-baking products or insufficiently treated thermally main causes of intestinal infections in children.

Symptoms of intestinal infections are vomiting and frequent diarrhea, pain in the stomach and an increase in body temperature. When the child happens diarrhea, then only the doctor can exclude surgical pathology and infection in the intestine.

The main danger of children's intestinal infections is the dehydration of the body. The child with diarrhea loses a lot of fluid, and it cannot drink to the urgent due to vomiting.

The prevention of intestinal infections is observing simple hygiene rules:

1. Use only boiled or mineral dining water.
2. Washing hands before meals and after the toilet.
3. Taboo on the purchase of products from natural markets, especially those sold from the ground. The lack of sanitary control can provoke serious digestive problems. For example, in such markets, milk of leukemous cows is often sold.
4. Proper storage of products and control over their shelf life.
5. Careful washing of vegetables and fruits before their use.

A dietary nutrition is of great importance in the prevention of dietary disorders. Children at least before the six-month age should eat maternal milk. These are their immunity and a kind of vaccination for the gastrointestinal bodies. Kids up to three years old can not be fed with fat and sharp products, chocolate and tanning broths. Food for such babies should be prepared for a couple. Well, if you bake it, and not fry.

A no less common problem of digestion disorders in children is constipation. It also provokes an early transition to artificial feeding, the introduction of the dust before the term, lack of fluid in a child.

Parents should be aware of another feature of constipation in children. This suppression of the urge on defecation outside the house. Such a phenomenon is characteristic of shy guys and can occur, for example, during the adaptation period to the kindergarten. Over time, such a negative habit leads to harmful masses, injury to the mucosa of the rectum. The consequence of this is afraid of defecation.

And the constipation can be the result of chronic pathologies of digestive and endocrine systems, frequent use of certain drugs. Therefore, parents need to follow the chair of the baby, as amendments in his behavior and to seek help to pediatricians to avoid the development of chronic digestion aids.

Especially for - Diana Rudenko