American Medical Association Family Medical Guide - American Medical Association [184]
Esophageal atresia
In esophageal atresia, the esophagus (which moves food from the mouth to the stomach) is not fully developed, and there is no passageway into the stomach. Surgery is performed as soon as possible to join the separated sections of the esophagus.
Symptoms
The main symptom of esophageal atresia is continuous bubbling noises from the infant’s throat. Sometimes, if the airways are obstructed, the baby’s skin turns blue from lack of oxygen. When a doctor removes the secretions with a suction tube, the symptoms disappear temporarily, but return as soon as the secretions build up again. When the baby eats, he or she may cough, gag, choke, or vomit. If your child has any of these symptoms, talk to your doctor.
Diagnosis and Treatment
A diagnosis of esophageal atresia is based on the baby’s symptoms and a physical examination. The doctor may look for esophageal atresia by trying to pass a soft tube down the baby’s esophagus. The diagnosis is confirmed with X-rays. An infant with this disorder cannot be given food or liquids by mouth and is fed intravenously (through a vein) until the condition is corrected. Surgery is performed in one or more stages to open and join the two separate sections of the esophagus, which usually eliminates the problem. After surgery, a tube may be inserted temporarily into the repaired portion of the esophagus to dilate (widen) the esophagus and hold it open.
Biliary Atresia
Biliary atresia (also called bile duct atresia) is a rare congenital (present from birth) disorder in which parts of the bile ducts (the tubes that carry a digestive fluid called bile from the liver to the small intestine) are either malformed or absent. As a result, bile becomes trapped in the liver and damages it. If not treated promptly, the disorder can be fatal before a child is 2 years old.
Symptoms and Diagnosis
The main symptom of biliary atresia is prolonged jaundice (yellowing of the skin and the whites of the eyes), which usually starts during the second week after birth. The infant may also have pale or white stool and dark-colored urine.
A diagnosis of biliary atresia is based on the child’s symptoms, a physical examination, and the results of blood tests. The doctor may order an ultrasound scan (see page 111) or a radionuclide scan (see page 114) of the liver to confirm the diagnosis.
Treatment
To treat biliary atresia, doctors usually recommend surgery to bypass the defective or absent bile ducts by connecting the liver to the small intestine. The procedure, which is usually performed when a child is about 2 to 3 months old, enables bile to flow directly from the liver into the small intestine. In other cases, doctors may recommend a liver transplant (see page 790).
Encopresis
Encopresis is a condition in which a child who is toilet trained and has no underlying disease involuntarily passes stool into his or her underpants. In encopresis, large amounts of stool accumulate and harden in the rectum and the lower part of the large intestine, and the child passes liquid stool past the blockage. Possible causes of encopresis include chronic constipation, painful bowel movements, resistance to using the toilet, impaired ability to sense the presence of stool in the rectum, or not taking enough time to use the toilet.
A child may also have involuntary bowel movements because of stress. Parents may (mistakenly) believe that the child is soiling his or her clothing purposely, and react with anger, possibly making the problem worse.
Symptoms
The symptoms of encopresis are usually similar to those of constipation. Bowel movements may be painful, and the child may have only a few bowel movements per week. He or she may strain to move his or her bowels, and some stool may remain in the rectum after a bowel movement. The child may have abdominal pain and bloating and may resist using the toilet. He or she may have no appetite and may be