Intestinal disorders
This disease is rare in children.
It most commonly affects the duodenum.
•
Helicobactor pylori infection (strong familial link,
associated with increased risk of
adult gastric cancer).
•
Stress
ulcers, e.g. post-trauma, HIE.
•
Drug-related,
e.g. NSAIDs.
•
Increased
acid secretion (Zollinger–Ellison syndrome, multiple endocrine neoplasia type
I, hyperparathyroidism).
•
Crohn’s
disease.
•
Eosinophilic
gastroenteritis.
•
Hypertrophic
gastritis.
•
Autoimmune
gastritis.
•
Often
asymptomatic.
•
Chronic
abdominal and epigastric pain.
•
Nausea
+/– vomiting.
•
GI
haemorrhage.
•
FTT
+/– anorexia.
•
Iron
deficiency anaemia.
•
Perforation
(very rare).
•
C14
urea breath test (H. pylori).
•
Upper
GI endoscopy and biopsy (H. pylori histology and culture).
•
Treat
underlying cause, e.g. eradicate H. pylori with 7–10 days oral amoxycillin
(clarithromycin), bismuth, metronidazole +/– omeprazole (quadruple therapy).
•
‘fall’
gastric acid production, e.g. proton pump inhibitors (PPI), H2
antagonists; sucralfate (cytoprotective).
•
Antacids,
e.g. aluminium hydroxide.
This disorder is characterized by
chronic intestinal protein loss.
•
GI
infection, e.g. giardiasis.
•
Severe
food hypersensitivity.
•
Coeliac
disease or IBD.
•
Severe
cardiac failure.
•
SLE;
graft vs. host disease.
•
Polyposis
or lymphatic obstruction.
There is hypoalbuminaemia +/–
diarrhoea or abdominal pain.
Increased faecal A1-antitrypsin confirms the
condition.
Treat the underlying disease; give
nutritonal support and albu-min infusions as required.
Is due to severe intestinal
disease or the surgical removal of a large por-tion of the small intestine. The
condition manifests as malabsorption, fluid and electrolyte loss, and
malnutrition.
•
Diarrhoea,
steatorrhoea.
•
FTT.
•
Dehydration,
electrolyte loss (Na, K, Mg, Ca).
•
Cholestasis
(bile salt loss).
•
Peptic
ulcer disease (due to increased gastrin).
•
Specific
(e.g. vitamin B12) +/– generalized malnutritional disorders.
•
Renal
stones (oxalate).
•
Correct
fluid and electrolyte disturbance.
•
Specific
nutritional supplements; hydrolysed protein/elemental diets.
•
PN.
•
Gastric
acid reducing drugs, e.g. PPI or H2 antagonists.
•
Anti-diarrhoeal
drugs, e.g. loperamide.
•
Cholestyramine
(chelates bile salts).
•
Parenteral
somatostatin.
•
Oral
antibiotics to reduce bacterial overgrowth.
•
Surgery
to reduce GI motility or small bowel transplant.
Prognosis is improving, with 90% 5yr
survival. Retention of ileo-caecal valve significantly
improves prognosis.
Most juvenile polyps are
hamartomas, single, and located in the distal colon. Polyposis (multiple
polyps) syndromes include:
•
Peutz–Jegher’s
syndrome (mucocutaneous pigmentation).
•
Familial
polyposis coli.
•
Gardner’s
syndrome (GI polyps, osteomas and soft tissue tumours).
•
Often
asymptomatic.
•
Haematochezia.
•
Rectal
polyp prolapse.
•
Protein-losing
enteropathy.
•
Intussusception.
•
Mucoid
diarrhoea.
Gastroscopy and ileo-colonoscopy,
barium radiology.
•
Endoscopic
or surgical removal.
•
Periodic
colonoscopy surveillance is required in polyposis syndromes because of
significant risk of neoplasia.
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