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Acute Pancreatitis Steven L. Werlin Michael Wilschanski Keywords Acute pancreatitis acute pancreatitis etiology acute pancreatitis diagnosis drug-induced pancreatitis (serum) amylase (serum) lipase Acute pancreatitis (AP), the most common pancreatic disorder in children, is increasing in incidence, and 50 or more cases are usually seen in major pediatric centers per year. In children, blunt abdominal injuries, multisystem disease such as the hemolytic uremic syndrome and inflammatory bowel disease, biliary…
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Disorders Associated With Pancreatic Insufficiency Other than cystic fibrosis (CF), conditions that cause pancreatic insufficiency are very rare in children. They include Shwachman-Diamond syndrome (SDS), Johanson-Blizzard syndrome, Ivemark syndrome, Pearson syndrome, isolated enzyme deficiencies, enterokinase deficiency (see Chapter 364 ), chronic pancreatitis, protein-calorie malnutrition (see Chapters 57 and 364 ), and IMNEPD (infantile onset multisystem neurologic, endocrine, and pancreatic disease). Cystic Fibrosis (see Chapter 432 )…
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The human pancreas develops from the ventral and dorsal domains of the primitive duodenal endoderm beginning at about the 5th wk of gestation ( Fig. 374.1 ). The larger dorsal anlage, which develops into the tail, body, and part of the head of the pancreas, grows directly from the duodenum. The smaller ventral anlage develops as 1 or 2 buds from the primitive liver and eventually…
Inguinal hernias are one of the most common conditions seen in pediatric practice, with an overall incidence of 0.8–4.5% in term infants and children and increasing to nearly 30% in premature and low birthweight (<1 kg) infants. The repair of congenital inguinal hernia is the most common surgical procedure performed in pediatric surgical practice. The frequency of this condition, along with its potential morbidity of ischemic injury…
Tumors of the digestive tract in children are mostly polypoid. They are also commonly syndromic tumors and tumors with known genetic identification ( Table 372.1 ). They usually manifest as painless rectal bleeding, but when large they can cause obstruction or serve as lead points for intussusception. Most intestinal tumors can be generally classified into 2 groups: hamartomatous or adenomatous. Table 372.1 General Features of the…
Anorectal Malformations Christina M. Shanti Keywords Imperforate anus Perineal fistula Fourchette fistula Rectovaginal fistula Cloaca Rectourethral fistula Caudal regression Anal stenosis Anterior ectopic anus Rectal atresia Currarino triad Tethered Cord PSARP: Posterior sagittal anorectoplasty Fecal continence ACE Antegrade continence enema MACE Malone antegrade continence enema To fully understand the spectrum of anorectal anomalies, it is necessary to consider the importance of the sphincter complex, a mass of…
Acute appendicitis remains the most common acute surgical condition in children and a major cause of childhood morbidity and health care costs, mostly associated with complicated/perforated appendicitis (PA). The peak incidence of acute appendicitis occurs in children in the second decade, and approximately 100,000 children are treated in children's hospitals for appendicitis each year. The broad spectrum of clinical presentation in acute appendicitis has been associated…
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Functional gastrointestinal disorders (FGIDs) comprise a group of conditions that relate to the gastrointestinal (GI) tract. These disorders cannot be completely explained by anatomical or biochemical abnormalities (infectious, inflammatory). FGIDs commonly afflict children across a broad range of manifestations and are defined primarily by symptoms. The symptom-based criteria employed to classify FGIDs have been developed by expert consensus and opinion under the auspices of the Rome…
Definition of Epidemiology Chronic diarrhea is defined as stool volume of more than 10 g/kg/day in toddlers/infants and greater than 200 g/day in older children that lasts for 4 wk or more. Persistent diarrhea began acutely but lasts longer than 14 days. In practice, this usually means having loose or watery stools more than 3 times a day . Awakening at night to pass stool is often a sign…
The term gastroenteritis denotes inflammation of the gastrointestinal tract, most commonly the result of infections with bacterial, viral, or parasitic pathogens ( Tables 366.1 to 366.3 ). Many of these infections are foodborne illnesses ( Table 366.4 ). Several clinical syndromes are often described because they have different (albeit overlapping) etiologies, outcomes, and treatments. Acute gastroenteritis (AGE) captures the bulk of infectious cases of diarrhea. The…
The introduction of tacrolimus and the development of the abdominal multiorgan procurement techniques allowed the tailoring of various types of intestine grafts that can contain other intraabdominal organs, such as the liver, pancreas, and stomach. The understanding that the liver protects the intestine against rejection demonstrates the interaction between recipient and donor immunocytes (host-versus-graft and graft-versus-host) which under the cover of immunosuppression allows varying degrees of…
All disorders of malabsorption are associated with diminished intestinal absorption of one or more dietary nutrients. Malabsorption can result from a defect in the nutrient digestion in the intestinal lumen or from defective mucosal absorption. Malabsorption disorders can be categorized into generalized mucosal abnormalities usually resulting in malabsorption of multiple nutrients ( Table 364.1 ) or malabsorption of specific nutrients (carbohydrate, fat, protein, vitamins, minerals, and…
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The term inflammatory bowel disease (IBD) is used to represent 2 distinctive disorders of idiopathic chronic intestinal inflammation: Crohn disease and ulcerative colitis. Their respective etiologies are poorly understood, and both disorders are characterized by unpredictable exacerbations and remissions. The most common time of onset of IBD is during the preadolescent/adolescent era and young adulthood. A bimodal distribution has been shown with an early onset at…
Peptic ulcer disease, resulting from inflammation caused by an imbalance between cytoprotective and cytotoxic factors in the stomach and duodenum, manifests with varying degrees of gastritis or frank ulceration. The pathogenesis of peptic ulcer disease is multifactorial, but the final common pathway for the development of ulcers is the action of acid and pepsin-laden contents of the stomach on the gastric and duodenal mucosa and the…
Foreign Bodies in the Stomach and Intestine Asim Maqbool Chris A. Liacouras Once in the stomach, 95% of all ingested objects pass without difficulty through the remainder of the gastrointestinal tract. Perforation after ingestion of a foreign body is estimated to be <1% of all objects ingested. Perforation tends to occur in areas of physiologic sphincters (pylorus, ileocecal valve), acute angulation (duodenal sweep), congenital gut malformations (webs, diaphragms,…