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O THER CAUSES OF DIARRHEA. T RANSIENT L ACTASE D EFIENCENCY Occurs following AGE Resolves in weeks to months Use lactose free milk/formula But NOT on.

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Presentation on theme: "O THER CAUSES OF DIARRHEA. T RANSIENT L ACTASE D EFIENCENCY Occurs following AGE Resolves in weeks to months Use lactose free milk/formula But NOT on."— Presentation transcript:


2 T RANSIENT L ACTASE D EFIENCENCY Occurs following AGE Resolves in weeks to months Use lactose free milk/formula But NOT on routine basis!

3 DIARRHEA Toddlers diarrhea Common and self-limited Most common cause of chronic diarrhea in kids <3 Loose stools with undigested fibers No carbohydrates or fats Treatment Dietary Unrestricted fat Elimination of nonmilk fluids (juice and soda)

4 Q UESTION 6 A 5 yo patient presents with chronic diarrhea, abdominal distention, anemia and failure to thrive. Endoscopy with biopsy showed villous atrophy and crypt hyperplasia of the small bowel. What would be the most effective treatment for this patient? A. Triple drug therapy with 2 Abx and a PPI B. Systemic steroids C. Pancreatic enzyme replacement D. Removal of lactose from the diet E. Removal of gluten from the diet

5 M ALABSORPTION Celiac Disease AKA gluten senstitive enteropathy 1/133 Intolerance to dietary gluten that results in malabsorption Symptoms Chronic diarrhea Abdominal distention Weight loss/failure to thrive Classic appearance Potbelly Wasted extremities and buttocks

6 M ALABSORPTION Celiac Disease Other findings Short stature Abdominal pain Constipation Arthritis Delayed puberty Anemia Osteoporosis Diagnosis Gold standard Small bowel biopsy Villous atrophy, crypt hyperplasia and abnormal surface epthelium

7 M ALABSORPTION Celiac Disease Testing Endoscopy Flattening of duodenal villi scalloping Serologic tests Antigliadin or antiendomysial antibodies Can be used to monitor adherence Treatment Complete removal of gluten Wheat Rye Barley Oats


9 Achalasia Incomplete relaxation of the LES during swallowing Uncoordinated peristalsis of esophageal smooth muscle Diagnosis Esophagram Esophageal motility studies Treatment Esophageal dilation Botox to LES Heller myotomy

10 D YSPHAGIA Ingestion Caustic Alkali Low threshold for endoscopy Injury heals with fibrosis Strictures Long-term dysphagia Treatment Repeat dilations

11 Q UESTION 7 A patient who has been treated for reflux with a PPI for the last 3 months returns to the clinic with worsening dysphagia, vomiting and abdominal pain. The endoscopy findings are pictured. The most appropriate treatment for this patient includes diet modification and _____? A. Corticosteriods B. Antibiotics C. H2 blocker D. Antihistamines E. An immune modulator

12 DYSPHAGIA Eosinophilic Esophagitis Isolated intense eosinophilic infiltration of the esophagus Symptoms Similar to reflux Dysphagia Vomiting Feeding refusal Heartburn CP Abdominal pain Does not completely respond to PPIs

13 DYSPHAGIA Eosinophilic Esophagitis Diagnosis Endoscopy with biopsy Linear furrowing of esophagus Esophageal ring formation Granularity Eosinophils Treatment Diet modification Corticosteroids

14 T RAUMA Duodenal hematoma Bicycle handlebar or blunt trauma Partial or complete obstruction Present with vomiting Usual slow resolution May be suspicious of NAT


16 Q UESTION 8 A 14-year-old boy is brought to your clinic for evaluation of short stature. He complains of decreased appetite, but always feels full. He has had some bilateral hip and knee pain as well as low-grade fevers intermittently over the past year. Physical exam reveals apthoid lesions in the mouth and fleshy skin tags and fissures around the anus. Of the following, the MOST appropriate diagnostic test to obtain is a(n): A. Barium enema B. CT scan of the abdomen to look for abscess formation C. Stool smear for WBCs D. US of the abdomen E. Endoscopy with biopsies

17 GI B LEEDING Upper Melanotic stools Coffee ground emesis Frank hematemesis Lower Bright red blood per rectum

18 IBD Crohns and UC Symptoms Abdominal pain Weight loss Chronic diarrhea Rectal bleeding Fever Growth failure Delayed puberty

19 IBD Crohns Severe perianal disease Fistulas Fissures Perianal skin tags Abscesses UC Rectal disease

20 IBD Crohns Transmural inflammation Granuloma Skip areas Mouth to anus

21 IBD Crohns UGI

22 IBD UC Crypt abscesses Mucosal inflammation Confined to large bowel Continuous