GASTROENTEROLOGY

ANAL FISSURE

An anal fissure is a small racket ulceration. Mechanical factors like constipation can favor its appearance on certain grounds. They are manifested by pain at the time of defecation which typically resumes after a free interval. Some rectal bleeding is possible. Your doctor will make the diagnosis by examining the anal margin: pain and contracture of the sphincter often prevent digital rectal examination and anoscopy. Treatment is medical and, if it fails, surgical.

In children, it is a tear in the lining of the anus, which is observed in very constipated children. This crack is revealed by pain at the time of defecation, sometimes associated with bleeding.

The treatment consists in making this tear heal either by a diet and local care, or, in the event of failure, by a surgical intervention.

Copyright photo : Par Bernardo Gui — personale work, public domain

Bibliography : Anal Fissure: Symptoms, Diagnosis and Treatment by Pierpaolo Sileri and Achille Lucio Gaspari

ANAL PRURITUS

Anal pruritus is very common. The causes can be classified into two groups:

– Local causes: if it is one of your children. Pinworm disease is very likely. The other causes will be detected during the doctor’s examination: they can be hemorrhoids, suppuration, ulceration, venereal vegetations or “cock crests” of viral origin, herpes, or even syphilis, rarely cancer, or even fungi, eczema, allergies …

– General causes are rare: diabetes, blood disease …

Bibliography : Pruritus Ani: All You Need to Know About Pruritus Ani (Itchy bottom, Anusitis) and How To Finally Get Relief From Anal Itching!  de Joel Connor 

APPENDICITIS

Appendicitis is an inflammation, then infection of the ileo-caecal appendage, leading to the formation of an abscess inside the appendix. This abscess can rupture in the abdomen, resulting in peritonitis.

The signs are very varied, it is one of the most difficult diagnoses of pediatric surgery, and it is better to operate without diagnostic certainty than to let develop the appendicular infection.

Can be associated to varying degrees:

– predominant abdominal pain in the right iliac fossa;

– fever may be high, generally 37.8 ° C to 38 ° C, a fever at 40 ° C points to peritonitis;

– vomitings.

Before any of these signs and a fortiori if they are concomitant and persistent, you must consult a doctor because the diagnosis is based on the clinical examination carried out. An elevation of the white blood cells can be observed but is not constant. Similarly, an x-ray of the abdomen can show indirect signs of appendicitis.

The clinical pictures are very varied, and we observe everything from the child who has been suffering for several days, even weeks, to the child who develops peritonitis in a few hours.

The treatment consists, by an incision of the right iliac fossa and to remove the appendix. Hospitalization lasts five to eight days.

Copyright photo : Controversies in Pediatric Appendicitis By Catherine J. Hunter 

BALL IN THE THROAT

Very frequently felt and often poorly defined, the sensation of a lump in the throat is a factor of anxiety. When this lasts, a careful examination is always necessary in order to formally rule out a local lesion.

This being ruled out, we will retain this disorder as a modification of the sensitivity of the region, also called pharyngeal paresthesia.

It may be an impression of a foreign body, a knot in the throat, sometimes accompanied by difficulty in swallowing saliva. On the other hand, a very positive element, the meals go normally, and even make the discomfort disappear. It is not a dysphagia. This discomfort is due to a contracture of the musculature of the pharynx. The progression of the food bolus forces the relaxation of these muscles and makes the contracture disappear. Such a disorder is often related to cancerophobia, to which sedatives and tranquilizers provide temporary improvement. People who complain about it do describe this kind of symptom, often for years.

Local procedures are sometimes useful, such as cryo-surgery, or electro-coagulation of certain tonsil crypts. However, psycho-therapeutic support remains the important element of treatment when the disorders are old or very troublesome, and in particular if there are cases of cancer in the family.

CANKER SORES

The consumption of certain foods (dried fruit, Gruyere for example) causes the appearance of small erosions with yellowish bottoms and on edge roge very painful at the level of the oral mucosa. These are canker sores which occur mostly by outbreaks. To treat them, there is currently no known really effective remedies, if it is to avoid consuming the foods that trigger these outbreaks.

The concomitant appearance of mouth ulcers and genital ulcers should lead to research for Behcet’s syndrome.

Canker sores should not be confused with beginning shingles or certain drug allergies with erosions of the oral cavity.

Copyright photo : Par SimonTalBal — Travail personnel, Domaine public,

Bibliography : Current Diagnosis & Treatment Gastroenterology, Hepatology & Endoscopy de Norton J. Greenberger, Richard Blumberg

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