Alterations in Nutrition and GI

• Intussusception


  One of the most common cause of intestinal obstruction in children (3 months to 3 years)
• Intussusception


  • Boys > girls; (+) cystic fibrosis
  • Cause: unknown
  • Idiopathic: hypertrophy of intestinal lymphoid tissue 2˚ viral infection
  • Most common site: ileocecal valve (ileocolic)
  • Ileum invaginates into cecum
• Pathophysiology of intussusception


  1. One segment of the bowel telescopes into another segment pulling the mesentery

  2. Mesentery is compressed and angled resulting in lymphatic and venous obstruction

  3. As edema from obstruction increases, pressure within the area of intussusception increases

  4. When pressure equals the arterial pressure, arterial blood flow stops resulting in ischemia and pouring of mucus into intestine

  5. Venous engorgement leads to leaking of blood and mucus into intestinal lumen forming the classic "currant jelly-like stools
• Hirschsprung disease


  • Congenital
  • Aganglionic
  • Megacolon
  • A congenital anomaly in which inadequate motility causes mechanical obstruction of the intestine
  • Incidence: 1 in 5000 live births; more common in males
  • Single anomaly or in combination with other anomalies
  • Aganglion in distal portion GIT; rectosigmoid (75%)
• Appendicitis


  • Inflammation of vermiform appendix (fluid sac at the end of cecum) resulting to visceral pain
  • Acute condition
  • Progresses to perforation to peritonitis
  • Significant pediatric problem – delayed diagnosis
  • Etiology: Obstruction of appendix - fecalish, foreign body, microorganism, parasite; Other causes: obstructive kink, lymphoid hyperplasia, fibrous stenosis, tumors, low fiber diet
• Hypertrophic pyloric stenosis (HPS)


  • Occurs when circumferential muscle of pyloric sphincter thickened resulting in elongation & narrowing of pyloric channel
  • Produces an outlet obstruction, compensatory dilation, hypertrophy, and hyperperistalsis of stomach
  • Usually develops in the 1st 2 to 5 weeks of life
  • Projectile vomiting (nonbilious), DHN, metabolic alkalosis, and growth failure