Pediatric Pediatric Gastroenterology & Gastroenterology & Hepatology Hepatology For Undergraduate For Undergraduate Dr Hatem Hussein Dr Hatem Hussein Professor of Pediatrics Professor of Pediatrics Associate member of Royal College Of Paed.&Child Associate member of Royal College Of Paed.&Child Health-UK Health-UK Zagazig Faculty of Medicine-Egypt Zagazig Faculty of Medicine-Egypt Mar. 2008 Mar. 2008
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Pediatric Gastroenterology & Hepatology For Undergraduate Dr Hatem Hussein Professor of Pediatrics Associate member of Royal College Of Paed.&Child Health-UK.
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1-Prodroma Arthritis,Rash1-Prodroma Arthritis,RashHepatitis short preicteric stageHepatitis short preicteric stage(Fever,Abd. Pain,Tender (Fever,Abd. Pain,Tender heptomegaly,AH,M,Slpenomeg.)heptomegaly,AH,M,Slpenomeg.)
2- 1-2 wks icteric stage 2- 1-2 wks icteric stageMilder S.&S. than HAV and HBVMilder S.&S. than HAV and HBVMost patients are not jaundicedMost patients are not jaundiced
Pathology involves the portal areas.mod. Pathology involves the portal areas.mod. Enzymopathy.may resolve or procceds toEnzymopathy.may resolve or procceds to
B- B- Chronic active hepatitisChronic active hepatitis
Rec. Jaundice and enzymopathy. May Rec. Jaundice and enzymopathy. May progress to progress to
C- C- Liver failureLiver failure , ,
either fulminant OR subacuteeither fulminant OR subacute
InvestigationsInvestigations1- High ALT,which coincides with high 1- High ALT,which coincides with high direct bili.direct bili.2-AntiHCV abs appears after 1-8 2-AntiHCV abs appears after 1-8 monthsmonths3-Viral load. RNA can be detected after 3-Viral load. RNA can be detected after 2 wks of infection2 wks of infection
ManagementManagement!- supportive.!- supportive.2- Alpha interferonfor 6-12 mos.2- Alpha interferonfor 6-12 mos.Curative in 25%Curative in 25%
VOMITING IN VOMITING IN INFANTS&CHILDHOODINFANTS&CHILDHOOD
Can affect any part of the colon.Can affect any part of the colon.
1/50001/5000
High incidence in trisomy 21High incidence in trisomy 21
AetiologyAetiology: :
Failure of segmental relaxation due to Failure of segmental relaxation due to defective innervations. Leads to proximal defective innervations. Leads to proximal empty segment, hypertonic segment and empty segment, hypertonic segment and distally hugely dilated segment.distally hugely dilated segment.
Clinically:Clinically: Failure to pass meconium up to 24h.Failure to pass meconium up to 24h. Progressive constipation Progressive constipation Huge distensionHuge distension Complicated by Diarrhea, Malnutrition, ent-Complicated by Diarrhea, Malnutrition, ent- erocolitis, anaemiaerocolitis, anaemiaInvestigations:Investigations: P/RP/R Ba enema (cone shaped)Ba enema (cone shaped) Rectal biopsyRectal biopsy Treatment:Treatment: 1- manual evac.1- manual evac. 2- supportive care2- supportive care 3- surgical management3- surgical management
Chronic Abdominal Pain in Childhood: Diagnosis and
Management
Affects more than third of the childrenAffects more than third of the children..
Becomes chronic if it lasts more than 2 Becomes chronic if it lasts more than 2 weeksweeks..
Needs simple approach before rushing Needs simple approach before rushing to sophosticated investigationsto sophosticated investigations..
Needs a 5 steps approach based on Needs a 5 steps approach based on history,cl. exam.,investig.,individual history,cl. exam.,investig.,individual imagings and interventionsimagings and interventions..
DIFF. DIAG. OF PAEDIATRIC AGE DIFF. DIAG. OF PAEDIATRIC AGE ABDOMINAL PAINABDOMINAL PAIN
Location, intensity, character and duration of pain, time of day or night.
Appetite, diet, satiety, nausea, reflux, emesis Stool pattern, consistency, completeness of evacuationReview of systems: weight loss, growth or pubertal delay, fever, rash Medications and nutritional interventions Family history, travel Interference with school, play, peer relations and family dynamics
Imaging studies individualized Imaging studies individualized according to indicationaccording to indication
Abdominal and pelvic sonographyAbdominal and pelvic sonography Upper gastrointestinal contrast study Upper gastrointestinal contrast study with small bowel testing,with small bowel testing,
Patient and parent educationPatient and parent education Symptom diary of pain, bowel pattern, diet Symptom diary of pain, bowel pattern, diet and associated features, response to and associated features, response to interventionintervention
Constipation investigated as a factorConstipation investigated as a factor Dietary interventions, including adjusted Dietary interventions, including adjusted fiber intake, reduced lactose intake, fiber intake, reduced lactose intake, reduced juice intakereduced juice intake Trial of peptic management Trial of peptic management