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Oral cavity - Diseases of digestive organs at children

Table of contents
Diseases of digestive organs at children
Oral cavity
Diseases of teeth
Malformations of the sky and soft tissues of an oral cavity
Diseases of a mucous membrane of an oral cavity and gums
Diseases of lips and language
Sialadens
Digestive tract
Basic reasons of gastrointestinal frustration
Gullet
Atresia and esophageal and tracheal fistula
Guttural and tracheal and esophageal crevice, inborn stenosis of a gullet
Other diseases of a gullet
Stomach and intestines
Peptic ulcer
Inborn hypertrophic pyloric stenosis
Inborn impassability of intestines
Inborn impassability of a duodenum
Disturbances of turn of intestines
Inborn impassability of a small bowel
Inborn megacolon
Diverticulums and duplikatura
The acquired impassability of intestines
Intestines invagination
Foreign bodys of a stomach and intestines
Motive frustration. stomach and intestines
Anomalies of a structure of anorectal area
Infectious diseases of intestines
Nonspecific ulcer colitis
Illness Krone
Necrotic coloenteritis of newborns
The coloenteritis connected with treatment by antibiotics
Gastrointestinal symptoms of anaphylactoid purpura, gemolitiko-uraemic syndrome
Intolerance of food proteins
Eosinophilic gastroenteritis
Absorption disturbance syndromes
Malabsorption
Immunodeficiency and intestines
Syndrome of "a congestive loop"
Syndrome of a short small bowel
Gee's disease
Sprue after acute enteritis
Tropical to a spr
Whipple's illness, intestines lymphangiectasia, Uolmap's illness, idiopathic diffusion defeat of mucous
Enzymopathies and disturbances of mechanisms of transport of nutrients
Irritable colon
Acute appendicitis
Diseases of an anus, direct and large intestine
Tumors of a digestive tract at children
Hernias of a digestive tract at children
Exocrine part of a pancreas
Pancreatitis
Embryonic development of structure and function of a liver
Diagnosis of diseases of a liver
Cholestatic states at babies
Parenchymatous jaundices at children of chest age
Disturbances of a metabolism of a liver and zhelchevydelitelny system
Anomalies of a structure of bilious ways
Cysts of bilious channels
Cholestasia and diseases of a liver connected with completely parenteral food
Medicinal damage of a liver
Ray's syndrome
Chronic hepatitis
Wilson's illness — Konovalova
Indian juvenile cirrhosis
Damages of a liver at chronic colitis
Cirrhosis and chronic liver failure
Portal hypertensia and varicosity of a gullet
Fatty infiltration of a liver
Cholecystitis
Peritoneum diseases
Peritonitis
Peritoneum hernias

DIGESTIVE
SYSTEM
ORAL CAVITY
Physical and mental development of the child, and also his overall health in many respects depends on a condition of an oral cavity. Joint efforts of the therapist and stomatologist are necessary for timely establishment of the diagnosis and the correct treatment of the patient. Most of children of advanced age are regularly inspected by stomatologists, at children of early age of an illness of an oral cavity, as a rule, pediatricians who then direct the child to the stomatologist for the first time reveal.
Examination of an oral cavity at children is recommended to be conducted before achievement of 2-year age by them, it is the best of all in the period of a prorezyvaniye of the first teeth. It gives the chance to discuss stomatologic problems with parents when their interest in them is especially big to warn about danger of some habits and to timely begin actions for prevention of caries of teeth. As at this age of an illness of teeth meet seldom, each revealed symptom indicates existence of an unusual situation which should be analyzed carefully. The advice given to parents can sharply reduce probability of development of diseases of an oral cavity further. Stomatologic inspections of children should be performed regularly as diseases of an oral cavity can unexpectedly arise. Untimely identification can lead them to emergence of discomfort, and also permanent disturbances.

ANOMALIES OF DEVELOPMENT OF JAWS AND TEETH

Development of jaws

Skull bones quickly form in the early childhood, however the lower part of the person, including jaws, the skeleton in general develops more slowly, than. Thereof teeth and the structures supporting them pass a long line of consecutive stages of forming.
The upper jaw is formed by in utero at an union of lateral maxillary shoots with an incisal bone and front part of a palatal bone. In a junction of an upper jaw with malar, frontal and palatal bones seams form. Their course corresponds to the direction of expansion of an upper jaw. Thanks to growth of a share and existence of seams the verkhpy jaw is displaced to the relation to a base of skull forward and down. Transformation and accretion of bones lead to formation of maxillary sine and alveolar shoots, at the same time face contours form. Growth in a frontal projection happens due to proliferation of a bone in the field of an average palatal seam and an outside surface of an upper jaw. Growth of a bone stops at teenage age.

The mandible is formed as a result of emergence of the centers of ossification and substitution of a mekkelev of a cartilage by a bone tissue. Growth of a mandible in the longitudinal direction happens thanks to development of an intersticial bone tissue in condyles. The configuration of branches of a mandible is determined by a resorption of fabrics by a first line and their growth on the rear edge. The body forms due to counter growth of alveolar shoots and bottom edge. Growth of a mandible stops in the teenage period though potentiality of further growth remains.

MANDIBLE HYPOPLASIA

Roben's syndrome. This anomaly includes a micrognatia, a pseudo-macroglossia, a glossoptosia and the dome-shaped sky (or a sky crevice). At such pathology the genioglossal muscle is attached to an underdeveloped mandible atypically that interferes with the normal provision of language in an oral cavity. By gravity language sinks down, closing a throat. A frequent, but not constant sign — a post-alveolar crevice of a hard and soft palate; in some cases the sky gets a dome-shaped form.
Language usually has the normal sizes, however the mouth floor is shortened and the cavity is reduced that aggravates a glossoptosia. There can come obstruction of respiratory tracts, especially at the time of a breath therefore it is necessary to undertake special measures to warn asthma. The child should be put facedown or sideways in order that language was displaced forward and released respiratory tracts. To sew a ventral surface of language to an under lip or to impose a tracheostoma usually it is not required as within several months the mandible, as a rule, increases so that the glossoptosia decreases. Attempts to use various tires or traction devices were unsuccessful. Feeding of children with a hypoplasia of a mandible requires attention and patience; in most cases feeding through a gastric tube manages to be avoided. Often the jaw to 4 — to 6-year age develops so that the front profile becomes normal. The accompanying anomalies of teeth demand inividualny treatment.
Maxillofacial dysostosis (Collins or Franchesketti's syndrome — Klein). At this syndrome the micrognatia is expressed much more weakly, than at Roben's syndrome. The face of the patient has characteristic signs: a "anti-Mongoloid" section of eyes a coloboma of lower eyelids, the sunk-down cheekbones; the "blind" fistular courses with outside openings between a corner of a mouth and an ear; the deformed auricles; atypical growth of hair of a pas cheeks; the cut-off chin and a big mouth. Crevices of a lip, the upper sky, and also anomaly of an inner ear and deafness are often observed. This illness is inherited on dominant type, but not always shown completely. The mandible is almost always underdeveloped, mental area expressly concave; branches of a jaw are developed insufficiently, and coronal and condylar shoots are flattened or even aplastichna. The sky arch high or split. The unilateral or bilateral macrostomia, and also incomplete accretion of maksillyarny or mandibular shoots are occasionally observed. Owing to a hypoplasia of an upper jaw and deformation of the sky malocclusion often forms. Teeth are underdeveloped, displaced, will widely defend from each other. Orthodontic Treatment is shown.
Unilateral hypoplasia of a mandible. In some cases this defect represents part of a symptom complex which includes partial paralysis of a facial nerve, a macrostomia, "blind" fistulas between a corner of a mouth and an ear and the deformed auricles. The expressed asymmetry of the person and malocclusion are caused by absence or an underdevelopment of a condylar shoot of a mandible on the struck party. Inborn deformation of this shoot over the years amplifies. Early plastic my surgery "et to reduce deformation.
Asymmetries of the person. Excessive flattening of a head of a fruit or shift of a mandible can be the frequent cause of asymmetries at the time of delivery at buttock or front presentation. These states pass without treatment. Injury of a growth cartilage, changes in the field of condyles at childbirth or at early children's age can cause resistant asymmetry of the person. The injury usually occurs when imposing obstetric nippers on this zone or at blow in a chin in the early childhood.
Injuries, acute infections, arthritis in the growing condylar cartilage can lead to a partial (fibrous) or full (bone) anchylosis of a temporal and mandibular joint and a growth inhibition of a mandible on the struck party. On the healthy party growth of a bone continues owing to what the center of a jaw is displaced in the sick party. It is especially noticeable when opening a mouth. On roentgenograms of the affected joint the increased hollow and shift of a head of a condyle are visible. Bilateral damage of a growth cartilage conducts to a mandible underdevelopment.

12.3. DEVELOPMENT OF TEETH

Germinal development. Milk teeth form in tooth crypts which are formed of accumulations of epithelial cells in jaws. To calcification upper and a mandible epithelial cells a strip burgeon from a surface in the subject mesenchyma, forming tooth plates. By 12th week of pre-natal development in these tooth plates on each side of both jaws there are about 5 zones of rapid growth in the form of roundish, kolbovidny protrusions. At the same time there is an organization of adjacent sites of a mesenchyma; mesenchymal and epithelial elements together form a tooth rudiment.
Rudiments of second teeth form in two ways. After emergence of primary crypts begin to proliferate in the lingual party puchkoobrazny protrusions of a tooth plate, forming rudiments of second teeth (cutters, canines and premolar tooths). Gradually they substitute rudiments of milk teeth. This process at the central cutters begins approximately on the 5th month of pre-natal development, and at the second premolar tooths — with 10-month age. Rudiments of constant painters arise in the growing kzada to a tooth plate, being located behind a rudiment of the second milk painter. Rudiments of each of three constant painters form respectively on the 4th month of pre-natal development, on the 1st and 4 — the 5th year of life.
Histogenesis. In process of proliferation of epithelial cells the internal surface of a flask invagipirut, partially delimiting mesenchymal fabric. Epithelial cells, since a crown, take the tooth form; they form an organic matrix for the subsequent calcification of a dentine. In hollow central part of a dental germ there are nervous, vascular and lymphatic structures (a pulp of mature tooth).
Calcification. In an organic matrix the inorganic mineral salts forming enamel and a dentine are laid. In each tooth there are several centers of ossification which merge further. The inorganic part of tooth can be patholologically changed owing to: 1) disturbances of forming of a matrix, 2) deficit of one or several mineral substances, 3) existence of foreign mineral particulates. All this can influence color, texture and thickness of a blanket of teeth.
Teething. Since forming of a dental germ each tooth begins the continuous movement to a jawbone surface. The full chronology of development of teeth is provided to tab. 2-4; relative terms of a prorezyvaniye and loss of milk teeth, and also terms of secondary dentition are specified in tab. 12-1 and 12-2. On a mandible teeth appear earlier, than on upper, and at girls earlier, than at boys.

ANOMALIES OF DEVELOPMENT OF TEETH

Perhaps both insufficient, and excessive development of teeth. An edentia (lack of teeth) — a malformation at which dental germs do not form.
Table 12-1. Terms of a prorezyvaniye and loss of milk teeth

 

Prorezyvaniye

Loss

 

Upper

Lower

Upper

Lower

 

age (month)

age

(years)

Cutters are central

0

7,5

6

7,5

Cutters are lateral

7

9

7

8

Canines

16

18

9,5

11,5

Painters the first

12

14

10

10,5

Painters the second

20

24

11

10,5

Cutters

Deviation of ±2 months

Deviation of ±6 months

Painters

Deviation of ±4 months

 

 

From: Massler, Schour. "Atlas of the Mouth". Chicago, American Dental Association.

Table 12-2. Terms of secondary dentition (advanced in years)

 

Upper

Lower

Cutters are central

6 — 7

7 — 8

Cutters are lateral

7 — 8

8 — 9

Canines

9 — 10

11 — 12

Premolar tooths the first

10-12

10 — 11

Premolar tooths the second

11 — 12

10 — 12

Painters the first

6 — 7

6 — 7

Painters the second

11 — 13

12 — 13

Painters the third

17 — 21

17 — 21

It is borrowed from: Massler and Schour. "Atlas of the Mouth". Chicago, American Dental Association.
The full edentia arises at an ectoderm dysplasia, and partial — at disturbance of a zone of localization of dental germs, for example when splitting the sky, and also as a result of genetic defect (quite often hereditary). Most often pe the third painters, upper lateral cutters and the second lower premolar tooths develop. If the quantity of rudiments in a tooth plate are more than norm, then accessory teeth, mainly in the field of upper central cutters appear. As such teeth violate situation and a prorezyvaniye of adjacent normal teeth, it is important to reveal timely them by means of a X-ray analysis. Inborn teeth already exist at the birth or are cut through soon after it. It can be option of normal process of formation of milk teeth; such teeth should be distinguished from accessory which need to be removed.
In development also other anomalies which are shown disturbance of structure of teeth, in particular a makrodontiya (big teeth) and a mikrodontiya (small teeth) are possible. Upper lateral
cutters sometimes take the cone-shaped form (klykovidny teeth).
"Twin teeth". At this pathology teeth are connected in pairs (mainly the lower milk cutters). It arises owing to doubling, merge or an union of teeth. Doubling results from division of a dental germ. At the same time the dual crown at one root and the general cavity of a pulp is formed; additional tooth is located in a tooth arch. Merge — connection of two pe completely developed teeth as a result of their prelum at an injury or a close arrangement which conducts to the fact that they grow as one tooth. In one cases teeth merge on all length, in others — only crowns, and roots remain separate. An union — connection of roots of very close located teeth owing to excessive adjournment of cement. Unlike other anomalies this type of connection of teeth is observed mainly in the field of upper painters.
"Tooth in tooth" — a radiological find at which in externally not changed tooth contours of another are visible. Such anomaly — result of invagination of a lingual surface of a dental germ (most often upper cutters) during merge of zones of calcification; at the same time there is an enameled internal cavity.
Imperfect enamelogenesis — the state inherited on dominant type; it is caused by the wrong forming of an organic matrix. Teeth are covered with so thin layer of enamel that through it illuminates a yellow dentine, giving to teeth dark coloring. Usually both milk, and second teeth are surprised. Enamel is easily erased though predisposition to caries is not increased.
For protection of enamel and improvement of outward of teeth use artificial crowns.
Imperfect formation of a dentine — a hereditary disease which main symptom is opalescence of a dentine. At the same time the differentiation of fibrilloblasts is broken owing to what process of calcification of a dentine suffers. Communication between enamel and a dentine fragile, enamel exfoliates, and the bared dentine is exposed to destruction. Surface of teeth dim, granular; the cavity of a pulp is obliterated owing to calcification. Both milk, and second teeth are surprised. If timely not to protect a crown of such teeth, then when chewing they are erased to the level of alveolar holes.
Often the limited disturbances of process of calcification connected with any illness or insufficiency of food meet. (They are similar to lines of a growth disorder which it is possible to see in tubular bones.) The neonatal furrow on all milk teeth, on constant central cutters and on tops of canines can be an example; it is located at the level of crowns and corresponds to a calcification stage at the time of the birth. Also 2 main types of pathology of enamel are known. Dark-white spots on a buccal surface of teeth are result of hypocalcification. More severe defeat — a hypoplasia — is shown in the form of deepenings on a tooth surface in those places where enamel is absent. The hypoplasia almost does not affect milk teeth as pre-natal stresses arise rather seldom; at early children's age when diseases or insufficiency of food influence an enamelogenesis of constant cutters, canines and the first painters, such defeats meet quite often. To lower sensitivity of a naked dentine, to warn caries and to improve outward of teeth, special treatment is required.
Speckled enamel is observed at people whose early childhood passed in the district where the content of fluorides in drinking water exceeded 2 mg/l that led to dysfunction of ameloblasts. Changes fluctuate from small hardly noticeable white specks to the expressed brown spots and a hypoplasia (such disturbance arises if concentration of fluorides exceeds 5 mg/l).
The disturbances caused by deficit of mineral salts are observed seldom; vitamin-B-resistant rickets leads to uneven adjournment of a dentine and expansion of a cavity of a pulp, and vitamino-dependent rickets — to a hypoplasia.
Disturbance of coloring of teeth — result of hit of foreign substances in the developing enamel. Eritroblastoz of a fruit is followed by hemolysis that leads to blue-black coloring of milk teeth, since a neonatal furrow; the same coloring can be observed on tops of constant first painters. All drugs of a tetracycline row actively get into bones and teeth, giving them brownish-yellow color and even causing an enamel hypoplasia if they are appointed during its development. For milk teeth this period begins approximately from 4th month of pre-natal development and comes to an end on the 10th month of life, and for second teeth — from 4th month of life to 16-year age. On average forming of enamel comes to the end at 8-year age (except for the third painters). Therefore, younger it is undesirable to pregnant women and children to appoint 8 flying tetracyclines. Damage of teeth as a result of influence of these antibiotics is revealed on fluorescence when lighting by ultra-violet light.
Sometimes the teething proceeds with pains and an inflammation of gums. The child becomes irritable, salivation sharply amplifies. Penetration of bacteria into tissue of a gum or under gingival edge through defect of a mucous membrane can be the cause of an inflammation. To the child an opportunity to bite some blunt dense object gives relief; the cut of a gingiva is shown in rare instances. Convincing data that the teething is connected with such general temporary frustration as subfebrile temperature, rash on a face or slight diarrhea are not received.
The delay of a prorezyvaniye of all teeth testifies to a general disease or disorder of food. It can be observed at a hypopituitarism, a hypothyroidism, a clavicular and cranial dysostosis and rickets. It is necessary to carry to the local reasons the wrong provision of dental germs, accessory teeth of a cyst, a delay of loss of milk teeth; at the same time it is broken prorezyvany one or several second teeth. Early loss of their milk predecessors is the most frequent reason of premature secondary dentition. If all development of teeth goes more intensively, than has to be at the child of this age and a floor, it is necessary to think of a hyperpituitarism.
Inborn teeth are observed at 1 of 2000 newborns; usually it is the lower central cutters. They are attached generally to edge of a gum, roots are developed badly and poorly connected with a bone tissue. It is possible to distinguish inborn teeth from accessory only by means of a X-ray analysis. Existence at least of one inborn tooth causes to anticipate a premature prorezyvaniye of other teeth.
Shaking of inborn teeth can cause pain. Mother also feels discomfort because the child when feeding bites and scratches a nipple. There is a danger of a separation of tooth and its aspiration. As at the time of delivery language lies between alveolar shoots, at inborn teeth its anguish or even a nibble is possible (Righi's illness — Fedya). The issue of removal of prematurely developed teeth is resolved in each case individually. Before its odontectomy it is necessary to otseparovat accurately from gingival edge to warn a rupture of fabrics and severe bleeding.
Disturbance of exfoliation of teeth is expressed that milk teeth do not drop out at secondary dentition. Such milk teeth should be extracted. This phenomenon is more often observed in the field of the lower cutters.

THE DISEASES OF TEETH WHICH ARE COMBINED WITH OTHER DISEASES

Imperfect bone formation usually is followed by opalescence of a dentine. This state is called sometimes an imperfect dentinogenesis. Treatment, as a rule, is not required.
At a clavicular and cranial dysostosis various disturbances of a structure of the person and an oral cavity are possible. It is possible to observe a convex forehead, protrusion of a mandible, a saddle nose. The teething delay is characteristic: loss of milk teeth is late, and second teeth are not cut through. Often accessory teeth, especially premolar tooths meet. The cut-through teeth have no hypoplasia signs, but often differ by the sizes and a form. The milk and cut-through second teeth which underwent carious destruction it is necessary to treat. Removal of milk teeth only in rare instances promotes normal development of constants. Extraction of not cut through second teeth is also contraindicated. Their roots are usually fragile and twisted that quite often conducts to changes at the time of extraction.
The dysplasia of an ectoderm is accompanied by total or partial absence of teeth. As the alveolar bone does not develop in the absence of teeth, alveolar shoots also in whole or in part are absent; as a result the mandible is displaced, and lips are given forward. Other anomalies of development of facial bones usually are not observed. Teeth (if they are) the small size, conical shape. Also the aplasia of slizeprodutsiruyushchy glands of a pas of a buccal and lip surface of an oral cavity is noted that causes dryness and irritation of a mucous membrane. Such patients need denture treatment. It recovers normal distance between jaws thanks to what lips adopt the correct provision, face contours improve. Besides, there is a chewing function correction that promotes development of the correct eating habits.
Inborn syphilis breaks process of a differentiation of second teeth owing to what cutters get a screw-driver form, is frequent with a rough edge (Getchinson's teeth), and painters — a form of mulberry berries, with a lobular chewing surface and the narrow thinned crowns.

DISEASES OF JAWS

Illness of Kaffi (children's cortical hyperostosis)

Osteomyelitis. At newborns osteomyelitis affects mainly area of a premaksillyarny seam, but at the advanced children's age process is more often localized in a mandible. The center of an infection is shown by hypostasis, erubescence or a mucous membrane of an oral cavity, pain, fever and lymphadenitis. In each case it is necessary to create a drainage for outflow of pus and to conduct its bacteriological research with the purpose to choose a suitable antibiotic. Big sequesters delete in the surgical way.
Reticuloendotheliosis (histiocytosis of X). Damage of jaws can be one of precursory symptoms of this syndrome. It is shown by pain, hypostasis, dedentition, a putrefactive smell from a mouth. After an odontectomy the wound long does not heal.
New growths. Benign tumors. Ossifying fibroma — the most often found benign tumor of jaws. It quickly grows in the prepubertatny period, but then its growth is slowed down or stops. As the tumor is painless, the first symptom is the unilateral swelling of soft tissues; In most cases treatment is not required, however, if the tumor grows very quickly, there can be a need for a curettage or other surgical correction.
Cysts of jaws, a multiple bazalnokletochny nevusny syndrome see in appropriate section.
Malignant tumors. At children Berkitt's sarcoma, an osteosarcoma, a lymphosarcoma and, more rare, a fibrosarcoma occur among malignant tumors of jaws.



 
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