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Peptic ulcer is an erosion of the mucosal wall of the stomach pylorus, or duodenum. Gastric Ulcer affects the lining of the stomach, whereas a duodenal ulcer involves the pylorus or duodenum, Although peptic ulcers are more common in adults, they are also a significant pediatric problem, occurring most frequently between 12 and 18 years. Males are affected more than three times as often as females.
Clinical manifestations
Signs and symptoms of peptic ulcers vary according to the age of the child and the location of the ulcer.
� The typical pain-food-relief syndrome
� Chronic abdominal pain, especially when the stomach is empty during the night or early morning
� Recurrent vomiting after meals
� Chronic anemia with occult blood in the stools
� Vague gastrointestinal complaints with a positive family history for peptic ulcer.
� Children with chronic illness and especially those undergoing steroid therapy are prone to develop peptic ulcers.
Acute appendicitis
Appendicitis, inflammation of the vermiform appendix, or blind sac, at the end of the cecum, is the most common reason for abdominal surgery during childhood. It is rare in children younger than 2 years of age group. Progressive peritoneal inflammation results in functional intestinal obstruction of the small bowel, since intense gastrointestinal reflexes severely inhibit bowel motility
Clinical manifestations
1. Abdominal pain, initially the pain generalized or periumbilical
2. localized tenderness, usually descends to the lower right quadrant
3. fever
4. shchotkin’s symptom is positive, The intense site of pain may be at McBurney’s point, which is located about 3.75cm (1.5 inches) above the anterior superior iliac crest along a straight line drawn from this process to the umbilicus
5. Rebound tenderness
6. A rigid abdomen, and decreased or absent bowel sounds are important signs of appendicitis.
7. vomiting is a common early sign
8. constipation may be present, diarrhea can also occur
Low grade fever is typically seen early in the disease but can rise sharply once peritonitis has begun. Other signs of peritonitis include sudden relief from pain after perforation, subsequent increase in pain, which is usually diffused and accompanied by rigid guarding of the abdomen, progressive abdominal distention, tachycardia, rapid shallow breathing as the child refrains from using abdominal muscles, pallor, chills, irritability and restlessness.
� A change in the child’s behaviour
� A characteristic side-lying position with the knees flexed to the abdomen
� A rigid, motionless posture should alert one to abdominal pain
The older child may exhibit all of these behaviours, while complaining of abdominal pain.
Diagnostic evaluation
� Diagnosis is based primarily on history and examination
� The chief clues that should alert the practitioner to appendicitis are the progression of abdominal pain
� Location of abdominal tenderness
� Decreased peristalsis
� Pain on rectal examination
� Absence of any other symptoms or findings suggesting another disorder, such as pneumonia
Laboratory evaluation
� White blood cell count, which is usually elevated but is seldom higher than 15,000 to 20,000.mm3
� Roengenographic studies of the abdomen
Therapeutic management
� Surgical removal of the appendix (appendectomy).
For child with peritonitis
� Medical management for shock
� Dehydration (this includes intravenous administration of fluid and electrolytes, blood volume replacement with plasma or albumin)
� Systemic antibiotics
� Oxygen,
� Nasogastric suctioning, and positioning in Fowler’s position to facilitate drainage into the pelvic area.
� Antibiotic therapy
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Source by Funom Makama