Paediatric Gastroenterology

An Atlas of Investigation and Management PAEDIATRIC GASTROENTEROLOGY An Atlas of Investigation and Management PAEDIATRIC GASTROENTEROLOGY José Manuel Moreno Villares, MD Nutrition Unit Department of Paediatrics Hospital Universitario 12 de Octubre Madrid, Spain Isabel Polanco, MD, PhD Professor of Paediatrics Head of Department of Paediatric Gastroenterology and Nutrition Hospital Infantil Univeritario La Paz Facultad de Medicina, Universidad Autónoma Madrid, Spain CLINICAL PUBLISHING OXFORD Clinical Publishing an imprint of Atlas Medical Publishing Ltd Oxford Centre for Innovation Mill Street, Oxford OX2 0JX, UK Tel: +44 1865 811116 Fax: +44 1865 251550 Email: [email protected] Web: www.clinicalpublishing.co.uk Distributed in USA and Canada by: Clinical Publishing 30 Amberwood Parkway Ashland OH 44805 USA Tel: 800-247-6553 (toll free within U.S. and Canada) Fax: 419-281-6883 Email: [email protected] Distributed in UK and Rest of World by: Marston Book Services Ltd PO Box 269 Abingdon Oxon OX14 4YN UK Tel: +44 1235 465500 Fax: +44 1235 465555 Email: [email protected] © Atlas Medical Publishing Ltd 2009 First published 2009 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Clinical Publishing or Atlas Medical Publishing Ltd. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. A catalogue record of this book is available from the British Library ISBN-13 978 1 84692 009 7 The publisher makes no representation, express or implied, that the dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publisher do not accept any liability for any errors in the text or for the misuse or misapplication of material in this work. Contents Preface vi 8 Abdominal masses 72 JUAN A. TOVAR, MD, PhD Contributors vi 9 Liver disease 84 Abbreviations viii Cholestasis 84 PIOTR SOCHA, MD, 1 Failure to thrive in infants and children 1 JOANNA PAWŁOWSKA, MD, AND JOSÉ MANUEL MORENO VILLARES, MD, AND ANIL DHAWAN, MD, FRCPCH ANTONIO MONICA GUERRA, MD Hypertransaminasaemia in childhood 92 LUÍS PEÑA-QUINTANA, MD, AND 2 Vomiting 11 DANIEL GONZÁLEZ-SANTANA, MD JOSÉ MANUEL MORENO VILLARES, MD, AND MARÍA JOSÉ GALIANO SEGOVIA, MD 10 Coeliac disease 99 ISABEL POLANCO, MD, PHD 3 Diarrhoea 19 Acute diarrhoea 19 11 Ulcerative colitis 104 ENRIQUETA ROMÁN RIECHMANN, MD CARLOS SIERRA SALINAS, MD, AND Chronic diarrhoea 25 JAVIER BLASCO ALONSO, MD ANGELES CALZADO AGRASOT, MD, BEGOÑA POLO MIQUEL, MD, AND 12 Crohn’s disease 110 CARMEN RIBES-KONINCKX, MD, PHD DAVID ZIRING, MD, AND JORGE VARGAS, MD 4 Constipation 34 CAROLINA GUTIÉRREZ, MD, AND 13 Short bowel syndrome 117 JERÓNIMO GONZÁLVEZ, MD JAVIER BUENO, MD 5 Abdominal pain in childhood 46 14 Congenital gastrointestinal IÑAKI X. IRASTORZA TERRADILLOS, MD, AND malformations 124 JUAN C. VITORIA CORMENZANA, MD, PHD IÑAKI EIZAGUIRRE, MD, AND AGUSTÍN NOGUÉS, MD 6 Gastrointestinal bleeding 56 GEORGE GERSHMAN, MD, PHD 15 Paediatric appendicitis 134 ADOLFO BAUTISTA CASASNOVAS, MD 7 Cow’s milk allergy 65 ANTONIO NIETO, MD, PHD, AND 16 Paediatric clinical dietetics 144 ANGEL MAZÓN, MD AMAYA PEÑALVA ARIGITA, RD Index 155 vi Preface Paediatric gastroenterology emerged as a speciality in the Management, provides concise and practical information for 1960s. Since then it has become an essential component of readers. Topics on the three main areas of the speciality – major academic paediatric programmes throughout the gastroenterology, hepatology, and nutrition – constitute the world. The introduction of new diagnostic techniques that body of this book. The authors were carefully selected to required special skills, as well as the development of provide a comprehensive and clear account of their assigned complex new therapies for children with gastrointestinal topics. All of them have been willing to dedicate their time, disorders, were cornerstones in the development of the knowledge, and effort in preparing their chapters. Our most speciality. The recognition that appropriate nurition during sincere thanks to them. It has been a pleasure to work with infancy and childhood is vital for health and the profound Clinical Publishing’s production team who have helped to impact that many gastrointestinal diseases may have upon produce a book of outstanding quality. growth also contributed to the discipline’s development. We hope and expect that this Atlas will be of benefit to all Many excellent paediatric gastroenterology texts have physicians dealing with gastrointestinal problems in been published since the first textbook on the subject was children. published in the early 1970s, but there are not so many based on excellent figures and comprehensive tables. Paediatric José Manuel Moreno Villares, MD Gastroenterology, An Atlas of Investigation and Isabel Polanco MD, PhD Contributors Adolfo Bautista Casasnovas, MD, PhD Mª Ángeles Calzado Agrasot, MD María José Galiano Sego via, MD Head of Paediatric Surgery Section Paediatric Gastroenterology and Centro de Salud Maria Montessori University Hospital of Santiago de Hepatology Unit Leganés Compostela Hospital La Fe Madrid, Spain Santiago de Compostela, Spain Valencia, Spain George Gershman, MD, PhD Javier Blasco Alo nso , MD Anil Dhawan, MD, FRCPCH Associate Professor of Pediatrics Gastroenterology, Hepatology and Paediatric Liver Centre David Geffen School of Medicine Nutrition Division Institute of Liver Studies Chief, Division of Pediatric Hospital Materno-Infantil Variety Club Children’s Hospital Gastroenterology and Nutrition Málaga, Spain. King’s College Hospital Harbor-UCLA Medical Center London, UK Torrance Javier Bueno, MD California, USA Paediatric Liver Transplantation Unit Iñaki Eizaguirre, MD, PhD Paediatric Surgery Department Paediatric Surgery Department Jerónimo Gonzálvez Piñera, MD, PhD Hospital Valle de Hebrón Donostia Hospital Associated Professor of Paediatric Barcelona, Spain San Sebastian, Spain Surgery Department of Paediatric Surgery University General Hospital Albacete, Spain Contributors vii Daniel González-Santana, MD Joanna Pawłowska, MD Carlos Sierra Salinas, MD Paediatric Gastroenterology Division Department of Gastroenterology, Gastroenterology, Hepatology and Las Palmas de Gran Canaria Hepatology and Immunology Nutrition Division University The Children’s Memorial Health Hospital Materno-Infantil Hospital Universitario Materno-Infantil Institute Málaga, Spain de Canarias Warsaw, Poland Spain Piotr Socha, MD Luis Peña-Quintana, MD Department of Gastroenterology, Antonio Monica Guerra, MD, PhD Paediatric Gastroenterology, Hepatology and Immunology Nutrition Unit Hepatology and Nutrition Division The Children’s Memorial Health University of Porto University Hospital Institute Porto, Portugal Universidad de Las Palmas de Gran Warsaw, Poland Canaria Carolina Gutiérrez Junquera, MD, PhD Spain Juan A. To var, MD, PhD Associated Professor of Paediatrics Professor and Chief, Department of Department of Pediatric Am aya Peñalva Arigita, MD Paediatric Surgery Gastroenterology University Hospital Valle de Hebrón University Hospital University General Hospital Barcelona, Spain La Paz Albacete, Spain Madrid, Spain Isabel Polanco, MD, PhD Iñaki X. Irastorza Terradillos, MD Professor of Paediatrics Jorge Vargas, MD Paediatric Gastroenterology Division Head of Department of Paediatric Division of Gastroenterology and Hospital de Cruces Gastroenterology and Nutrition Nutrition Bilbao, Spain University Hospital La Paz Department of Paediatrics Universidad Autónoma Mattel Children’s Hospital at UCLA Angel Mazón, MD Madrid, Spain Los Angeles, USA Paediatricc Allergy Division Hospital Infantil La Fe Begoña Polo Miquel, MD Juan C. Vito ria Co rm enzana, MD, PhD Valencia, Spain Paediatric Gastroenterology and Professor of Paediatrics Hepatology Division Basque Country University José Manuel Moreno Villares, MD Hospital La Fe Chief, Paediatric Gastroenterology Nutrition Unit Valencia, Spain Division Department of Paediatrics Hospital de Cruces University Hospital 12 de Octubre Carmen Ribes-Koninckx, MD, PhD Bilbao, Spain Madrid, Spain Paediatric Gastroenterology and Hepatology Division David Ziring, MD Antonio Nieto, MD, PhD Hospital La Fe Division of Gastroenterology and Paediatric Allergy Division Valencia, Spain Nutrition Hospital Infantil La Fe Department of Paediatrics Valencia, Spain Enriqueta Román Riechmann, MD Mattel Children’s Hospital at UCLA Department of Paediatrics Los Angeles, USA Agustín Nogués, MD Hospital de Fuenlabrada Paediatric Radiology Department Madrid, Spain Donostia Hospital San Sebastian, Spain viii Abbreviations α1-ATD alpha-1-antitrypsin deficiency FGID functional gastrointestinal NKT natural killer T cells AAP American Academy of Pediatrics disorders NPD negative predictive value AFP alpha-fetoprotein FTT failure to thrive NSAID nonsteroidal anti-inflammatory AIH autoimmune hepatitis GER gastro-oesophageal reflux drug ALT alanine aminotransferase GERD gastro-oesophageal reflux disease OA open appendectomy AMA antimitocondrial antibodies GFD gluten-free diet OCTN organic cation

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