By Deirdre Kelly, Ronald Bremner, Jane Hartley, Diana Flynn
Practical, convenient and succinct, this complete color pocketbook offers simple medical counsel to the most signs that babies and kids often current with in either basic and secondary care.
sincerely divided into particular sections overlaying the GI tract, liver and food, Professor Kelly and her staff speak about how top to enquire and deal with particular medical difficulties such as vomiting, belly ache, acute diarrhoea, constipation and jaundice utilizing a hugely scientific problem-orientated approach.
They disguise the administration of significant medical difficulties reminiscent of persistent liver ailment, ascites, malnutrition, weight problems, coeliac disorder and inflammatory bowel illness, and supply suggestion on dietary difficulties in untimely babies and youngsters together with weaning and nutrients aversion.
Key issues, strength pitfalls, and administration algorithms enable for rapid-reference, and hyperlink with the latest proof, guidance and protocols from ESPGHAN and NASPGHAN offering insurance of the most important expert society suggestions for scientific practice.
Brought to you via the specialists, Practical method of Gastroenterology, Hepatology and Nutrition is the suitable accompaniment for trainees in gastroenterology, hepatology and pediatrics, in addition to nutritionists, GI nurses and GPs.
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Additional info for Practical Approach to Pediatric Gastroenterology, Hepatology and Nutrition
Vomiting: bilious? • Bowel habit: frequency and character • Blood in stool? • Steatorrhoea • Growth • Past medical history: prematurity, jaundice or liver disease, infection, Crohn’s disease • Family history: Hirschsprung’s disease, malrotation, coeliac disease, irritable bowel syndrome Red f lags: Abdominal distension • Distension may be an early sign of necrotising enterocolitis in premature infants • Early referral to a specialist surgical centre is often required • Repeated episodes without surgical cause suggest chronic intestinal pseudo-obstruction Practical Approach to Paediatric Gastroenterology, Hepatology and Nutrition, First Edition.
Remission? Yes IV CS IV antibiotics EN or TPN ± thiopurine ± surgery Wean CS or EN No Thiopurine Response? No Yes Stricture or abscess? Relapse or CS dependent? Yes Yes No Wean EN or CS Remission? Yes No Surgery? EN or CS and/or other therapies: Unresponsive? infliximab, methotrexate, etc. Thiopurine maintenance 5-ASA, aminosalicylates; CS corticosteroids; EN, enteral nutrition. g. g. omeprazole 20 mg od, with oesophageal, gastric or duodenal involvement • Budesonide controlled ileal release 9 mg/day is less effective than prednisolone as first-line therapy for isolated ileo-caecal disease, but has fewer side-effects.
Deirdre Kelly, Ronald Bremner, Jane Hartley, and Diana Flynn. © 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd. 35 36 | Gastroenterology Clinical course • Infectious diarrhoea usually lasts 5–7 days and resolves within 2 weeks • Vomiting is commonly associated and lasts 2–3 days Causes • Viruses: rotavirus, norovirus, adenovirus type 40/41, calicvirus, astrovirus • Bacteria: Camplylobacter, Escherichia coli, Salmonella, Clostridium difficile (especially after antibiotics), Shigella, cholera • Parasites: Cryptosporidium, Giardia, Entamoeba • Drugs: antacids, oral calcium or phosphate salts, methylxanthines • Food additives: sorbitol, caffeine, monosodium glutamate • Food allergy or intolerances Assessment • Clinical assessment of dehydration is difficult and often inaccurate • If a recent accurate pre-illness weight is available, the fluid deficit can be estimated from the weight loss • Red flag symptoms indicate a child at risk of progression to shock (see Information: Signs of dehydration) • If shock is present, consider both severe dehydration and septicaemia • Most children do not require serum or urine tests, as they are unlikely to be helpful in determining the degree of dehydration • Some children with peritonism or meningitis present with diarrhoea (and/or vomiting), but often there are other clinical features to alert the clinician to this diagnosis The child with acute diarrhoea | 37 Information: Comparison of clinical features in mild/moderate dehydration and hypovolaemic shock in severe dehydration Assessing dehydration accurately at the bedside is difficult, but clinical signs of shock warn of severe illness.