Pediatric Gastroenterology

·         2 yr is the critical time for enamel defects on permanent incisors.

Yellow-brown discoloration or even color changes that are visible with a fluorescent lamp have been reported with long periods of tetracycline use before the age of 8 yr.

·         Prolonged thumb-sucking after the eruption of permanent teeth may produce maxillary tooth protrusion.

·         Significant reduction in the number of teeth is seen in Ectodermal dysplasia.

·         The best place to put a dislodged tooth is back in its socket. Reimplantation of the tooth (rinse it first, but don't scrub it) is the best approach in a cooperative patient.

·         Excessive quantities of oral pancreatic enzyme replacements can produce fibrosing colonopathy. If insufficient enzymes were used, a meconium ileus-like picture could develop.

·         Medium-chain triglycerides are absorbed through the venous plexus and not the lymphatics.

·         Imperforate anus without a fistula is a common pattern of anal anomalies in children with trisomy 21.

·         Determination of fecal fat content is useful in the diagnosis of fat malabsorption from hepatobiliary or pancreatic disease. Acute pancreatitis is not associated with significant steatorrhea. Chronic pancreatitis may cause fat malabsorption.

·         Vitamin E deficiency has a long latency (years) before it eventually produces ataxia, posterior (spinal cord) column signs, and peripheral neuropathy. Early treatment with water-soluble vitamin E may prevent and reverse these neurologic processes.

·         The pneumococcus is a common pathogen producing peritonitis (primary)in any condition causing ascites (nephrosis, cirrhosis). Next in frequency is Escherichia coli.

·         Palatopharyngeal incompetence may first become evident or be exacerbated by adenoid removal.

·         Congenital cystic adenomatoid malformation (CCAM) is in the differential diagnosis of congenital diaphragmatic hernia.

In children with congenital diaphragmatic hernia (CDH) and no other anomalies, fetal survival is quite good. Fetuses with other anomalies have a high intrauterine fetal demise rate, the hidden mortality of CDH. Group B streptococcal sepsis is, for some unknown reason, associated with right-sided CDH.

·         Testing for chronic active hepatitis with LKM antibodies in patients may result in a false-positive test result, incorrectly suggesting a diagnosis of an autoimmune process. RT/PCR is the best method to confirm the diagnosis of hepatitis C.

·         Daily therapy with corticosteroids is essential for initial management of autoimmune hepatitis. Patients with chronic active autoimmune hepatitis respond quite well to daily prednisone. This is also called lupoid hepatitis.

·         The whey-to-casein ratio of cow's milk protein is 18:82 and that of human milk protein is 60:40.

The predominant whey protein in cow's milk is ß-lactoglobulin, and the predominant whey protein in human milk is a-lactalbumin.

·         Omega-6 LCPUFA: Reduced growth

·         Omega-3 LCPUFA: Alterations in electroretinogram responses, reduced visual acuity, and possible cognitive abnormalities

·         Manganese and copper supplements should be withheld from TPN solutions when hepatic cholestasis is present. Monitoring of serum levels of copper and manganese is indicated in patients with cholestasis who require a prolonged course of TPN.

·         Fat is the most variable content of all nutrients in human milk. The fat content rises slightly during lactation, increases from the beginning (foremilk) to the end (hindmilk) of the feeding, varies among women (probably a direct effect of body fat stores), and varies over the course of the day.

·         Osteopenia of prematurity results primarily from inadequate intake of mineral substrate (calcium and phosphorus) and not vitamin D. High doses of vitamin D do not appear to aid in the prevention or treatment of osteopenia of prematurity.

·         Riboflavin is a photosensitive vitamin, and requirements may be increased in infants being treated with phototherapy.

·         Features of gastroesophageal reflux and allergic esophagitis may be clinically similar; the latter should be considered when standard antireflux therapy is ineffective.

·         Allergic colitis is a relatively common cause of rectal bleeding and bloody stools in the otherwise healthy-appearing infant.

·         The presence of Clostridium difficile toxin in stools is a common finding in healthy infants.

·         Hirschsprung's disease can be associated with an inflammatory enterocolitis that can be quite severe.

·         The following features suggest a diagnosis of congenital chloride diarrhea (AR):

1.       High concentrations of fecal chloride (exceeding the sum of sodium and potassium)

2.       Polyhydramnios

3.       Distended loops of bowel on a prenatal ultrasound

4.       Prematurity

·         In 1957, Bishop and Koop described the technique of resection of the dilated ileal segment and proximal end-to-distal side ileal anastomosis with distal ostomy, also known as the Bishop-Koop ileostomy done for Complicated Meconium Ileus.

·         BILE SALT TRANSPORTER DEFECTS comprise group of conditions is collectively known as progressive familial intrahepatic cholestasis. PFIC type I (Byler's disease)

·         Alberto Peña devised the posterior sagittal anorectoplasty in which the anal and rectal sphincter muscles are divided posteriorly in the midline; this operative approach has become the standard procedure for the pull-through due to the excellent visualization obtained. Recently, a laparoscopic pull-through operation has become feasible.