Anatomical and physiological

features of the digestive system in

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 Functions of Digestive System:
1. Ingestion
2. Propulsion
3. Mechanical processing: chewing, churning, mixing,
compacting
4. Chemical digestion: enzymatic breakdown of large
molecules into building blocks
5. Secretion: enzymes, acids, mucus, water, cell wastes
6. Absorption: move organic molecules, electrolytes,
vitamins, water from gut to interstitial fluid, lymph, blood
7. Excretion: cell waste, secretions, indigestible foodstuffs
ejected from body

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 Esophagus
• Usually collapsed (closed)
• 3 constrictions
– Aortic arch
– Left primary bronchus
– Diaphragm
• Surrounded by
– SNS plexus
– Blood vessels
• Functions
– Secrete mucous
– Transport food
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 Peculiarities of the esophagus in
children of different age
1. Average length of the esophagus in newborn is 10 cm
2. It is relatively narrow
3. Ratio between the length of the esophagus and the
length of the body is the same in children of different
age groups (1:5)
4. Length of the esophagus:
• in newborn is 11-16 cm
• in 1.5-2 years - 22-24.5 cm
• in 15-17 years - 48-50 cm

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 The constriction of the esophagus
• Anatomical
1. Upper constriction - in place of entrance into the
esophagus
2. Middle constriction - in place of adjacent the trachea to
esophagus
3. Lower constriction - in place of entrance through the
diaphragm

• Physiological
1. Upper constriction - at the begining of the esophagus
2. Middle constriction - in place of adjacent the aorta to
esophagus
3. Lower constriction - in place of entrance into the
cardial part of the stomach.
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 Capacities of the stomach
 Anatomical, cm3
• Newborn - 30-35
• 4 days – 45
• 14 days – 90
• In next months increase for 25 cm3
• 2 years – 500
• 4 years – 700
• 8 years – 1000
• An adult- 1200-1600

 Physiological , cm3
• In newborn - 7
• 1 year - 250-350
• 3 years - 400-600
• 10 years - 1300-1500
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 Peculiarities of the small intestine
in infant
1. The length is in two time less than in adult
2. The length of small intestine mesentery is
relatively longer
3. The membrane is thin, is well vascularitied.
4. The intestinal glands are more bigger then in
adult
5. The lymph cells are in each little parts of
small intestine

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 Peculiarities of the large intestine
in infant
1. The large intestine is not completely developed
2. The length of the large intestine is the same as
the body length (in any age of a child)
3. Haustrumes appear after 6 month of life
4. In schoolchildren the rectum is in the small
pelvis
5. In newborn ampulla is absent

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Peculiarities of the liver in infant
• Before the birth the liver is the largest
organ of the body
• The left lobes before the birth is very great
• In newborn is functionally undeveloped
• Normally the lower edge of the liver till 7
years is palpated below the edge of the
right costal margin

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 Gathering complains
(Pain in the abdomen)
It is necessary to distinguish the following signs:
1. Is it constant or colicky.
2. Location of pain.
3. Character of pain.
4. Intensity.
5. The connection with the time of eating.
6. The connection with the kind of intakes food.
7. The connection with the time of day.
8. The connection with the act of defecation.

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 Inspection
 Common physical examination:
• Color of integuments
• The condition of physical development
• The position of the child
• Expression of fair on the child's face
• Moving by legs (children of early age)

 Physical examination of abdomen:

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 Palpation (General rules)
The front abdominal
wall is divided into 9
arias by lines:
1-3 – epigastria arias
4-6 – mesogastria arias
7-9 – hypogastria arias

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Palpation
Points for palpation
А – Сhauffard’s zone
Б – Kehr’s point
B – Desgandin’s point
Г – Mayo-Robson’s
point
Д – Mc-Burney’s point
E – Lants’s point

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 Superficial palpation
 Signs determined during superficial palpation:
• Sensitivity
• Painfulness
• The tension of abdominal wall
• Relaxation of abdominal wall
• The sizes of the internal organs
• At abdominal distension

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Deep palpation according to
Obrazcov-Stragesko’s
Sigmoid colon
in normal case it is:
• Painless
• With a smooth surface
• 1-2 cm
• Soft
• Mobile
• Grumbling is absent

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Deep palpation according to
Obrazcov-Stragesko’s
The cecum
in normal case it is:
• Painless
• With a smooth surface
• 3-3,5 cm
• Rather dense
• Mobile
• Grumbling can be heard

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Deep palpation according to
Obrazcov-Stragesko’s
• Shchotkin-Blumberg’s
symptom
The pain is increased at fast
taking away hand
(peritonitis, acute
apendicitis)

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Deep palpation according to
Obrazcov-Stragesko’s
Mc-Burney’s symptom
The pain is increased at
pressing (peritonitis,
acute apendicitis)

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Deep palpation according to
Obrazcov-Stragesko’s
Lants’s symptom
The pain is increased at
pressing in point
(peritonitis, acute
apendicitis)

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Deep palpation according to
Obrazcov-Stragesko’s
The ascending part of
the large intestine
Is palpated according to
the rules
Often is not palpable

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Deep palpation according to
Obrazcov-Stragesko’s
Transverse colon
in normal case it is:
• Painless
• With a smooth surface
• 2-4 cm
• Soft
• Mobile
• Grumbling is absent

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Deep palpation according to
Obrazcov-Stragesko’s
The descending part of
the large intestine
Is palpated according to
the rules
Often is not palpable

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Grott’s method of palpation
(pancreas)
The fist of the left hand
is placed under the
join. Palpation is
carried out the right
hand when child
exhales.

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Palpation of pancreas
Desgandin’s point
Painfulness in this point
arises at diseases of
the head of pancreas

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Palpation of pancreas
Mayo-Robson’s point
Painfulness in this point
arises in children with
the pathology of the
pancreatic tail.

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Palpation of the liver (bimanual)
In normal case the inferior
margin of the liver is:
• 0.5-3 cm lower than
inferior margin of the
costal rib
• Painless
• The margin is sharpened
• Soft
• Smooth

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Auscultation
It is possible to
determine:
• Grambling
• Lower margin of the
stomach

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Additional methods of investigation
Instrumental diagnostic:
• Computed tomography scan (CT or CAT scan)
• Lower GI (gastrointestinal) series (also called barium enema)
• Magnetic resonance imaging (MRI)
• Magnetic resonance cholangiopancreatography (MRCP)
• Oropharyngeal motility (swallowing) study
• Ultrasound
• Upper GI (gastrointestinal) series
• Endoscopic procedures:
− Colonoscopy
− Endoscopic retrograde cholangiopancreatography (ERCP)
− Esophagogastroduodenoscopy (EGD)

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