Archive for category Medical Conditions

Prune Belly Syndrome

Posted by on Thursday, 10 March, 2011

Prune Belly Syndrome is also known as Triad Syndrome or Eagle-Barrett syndrome. It is characterized by a triad of abnormalities that include the following:

  • Absence of abdominal muscles
  • Undescended testicles – a condition seen in newborns whereby one (or both) of the male testes has not passed down into the scrotal sac.
  • An abnormal, expanded bladder and problems in the upper urinary tract, which may include the bladder, ureters, and kidneys.

Because of the substantial involvement of the urinary tract, children with prune belly syndrome are usually unable to completely empty their bladders and have serious bladder, ureter, and kidney impairment.

A child with prune belly syndrome may also have other birth defects. Most commonly, these defects involve the skeletal system, intestines, and heart. Girls may have defects in their external genitalia, as well.
Some infants who have prune belly syndrome may be stillborn or die within a few months of birth.

Prune belly syndrome is an uncommon birth defect occurring in about one in 30,000 to 40,000 births. In 95 percent of the cases, it occurs in males. It may occur if there is a urethral obstruction during fetal development preventing any urine from flowing through the urinary tract. The urethra is the tube that drains urine from the bladder to the outside of the body for elimination. If there is obstruction, urine can reverse flow and cause an expanded bladder.

The cause of prune belly syndrome is unknown, however, some cases have been reported in siblings, suggesting a genetic component.

The syndrome may occur in varying degrees from mild to severe. The following are the most common symptoms of prune belly syndrome. However, each child may experience symptoms differently.

Symptoms may include:

  • The abdomen may have a wrinkly appearance with multiple folds of skin.
  • An abdominal mass may sit above the pubic bones – this is a result of an expanded bladder.
  • The urinary tract organs may be easy to feel through the abdominal area.
  • An outline of the intestines may be visualized through the abdomen including visualization of peristalsis (the worm-like movements of the intestines shifting food forward.)
  • Absence of testes in the scrotum may be present in males.
  • There may be underdeveloped muscles of the abdomen preventing a child from sitting upright.
  • A child may experience frequent urinary tract infections (usually uncommon in children younger than 5 years and unlikely in boys at any age, unless an obstruction is present.)

The symptoms of prune belly syndrome may resemble other conditions and medical problems. Always consult your child’s physician for a diagnosis.

The severity of the defects often determines how a diagnosis is made. Often prune belly syndrome is diagnosed by fetal ultrasound while a woman is still pregnant. Because of the distinct abnormalities of prune belly syndrome, a physician is usually able to make a diagnosis after initial examination during the newborn period. A child who may not have the outward signs of prune belly syndrome may experience a urinary tract infection, which will prompt further testing by your child’s physician.

Additional diagnostic procedures may include the following:

  • Renal Ultrasound – a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
  • Voiding Cystourethrogram (VCUG) – a specific x-ray that examines the urinary tract. A catheter (hollow tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body) and the bladder is filled with a liquid dye. X-ray images will be taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys.
  • Intravenous Pyelogram (IVP) – a diagnostic imaging technique which uses an x-ray to view the structures of the urinary tract. An intravenous contrast of dye is given so that the structures can be seen on film. An IVP also reveals the rate and path of urine flow through the urinary tract.
  • Blood Tests (to determine how well the kidneys may be functioning.)
  • Specific treatment for prune belly syndrome will be determined by your child’s physician based upon:

    • Your child’s age, overall health, and medical history the extent of the disease.
    • Your child’s tolerance for specific medications, procedures, or therapies
    • Expectations for the course of the disease
    • Your opinion or preference

    Treatment for the syndrome depends on the severity of symptoms. If your child has mild prune belly syndrome, he/she may be maintained on precautionary antibiotic therapy to prevent upper and lower urinary tract infections.

    Your child may be referred to an urologist (physician who specializes in disorders and care of the urinary tract and the male genital tract). Some children may require a vesicostomy (a small opening made in the bladder through the abdomen) to facilitate emptying the bladder of urine. Other children may need to undergo extensive surgical remodeling of the abdominal wall and urinary tract. In boys, a surgical procedure to advance the testes into the scrotum may be performed, called an orchiopexy. Despite available surgical interventions, some children may develop extensive kidney failure.


    Herpangina

    Posted by on Monday, 28 February, 2011

    Herpangina is an illness caused by a virus, characterized by small blister-like bumps or ulcers that appear in the mouth, usually in the back of throat or the roof of the mouth. The child often has a high fever with the illness.

    Herpangina is caused by a virus. The most common viruses that cause herpangina include the following:

    hyperpangina

    Herpangina is a very common disease in children and is usually seen in children between the ages of 1 and 4. It is seen most often in the summer and fall. Good hand washing is necessary to help prevent the spread of the disease.

    The following are the most common symptoms of herpangina. However, each child may experience symptoms differently.

      Symptoms may include:

    • Blister-like bumps in the mouth, usually in the back of the throat and on the roof of the mouth
    • Headache
    • Quick onset of fever
    • High fever, sometimes up to 106 º F
    • Pain in the mouth or throat
    • Drooling
    • Decrease in appetite

    Herpangina is usually diagnosed based on a complete history and physical examination of your child. The lesions of herpangina are unique and usually allow for a diagnosis simply on physical examination.

    Specific treatment for herpangina will be determined by your child’s physician based on:

    • Your child’s age, overall health, and medical history
    • Extent of the disease
    • Your child’s tolerance for specific medications, procedures, or therapies
    • Expectations for the course of the disease
    • Your opinion or preference

    The goal of treatment for herpangina is to help decrease the severity of the symptoms. Since it is a viral infection, antibiotics are ineffective.

    Treatment may include:

    • Increased fluid intake
    • Acetaminophen for any fever
    • Proper hand washing is essential in helping to prevent the disease from being spread to other children.

    If you suspect your child may have these underline symptoms, please consult your child’s pediatrician for more information.


    Asperger Syndrome

    Posted by on Wednesday, 19 January, 2011

    What is Asperger Syndrome?

    Asperger Syndrome or (AS) disorder is a neurological disorder characterized by poor social interactions, obsessions, odd speech and mannerisms. The syndrome is considered part of the spectrum of pervasive developmental delay and is sometimes referred to as “high-functioning autism.”

    Like children with autism and other pervasive development delay disorders, children with Asperger syndrome have difficulty with social interactions. They have the most difficulty with interpreting nonverbal cues from other people such as facial expressions and body language. Direct eye contact may be difficult. As a result, they have a hard time forming friendships with their peers. In addition, they do not seek to share interests or experiences with other people. For example, if they like toy trains, they do not bring the toy over to someone to show it off.

    Unlike most children with other forms of pervasive developmental delay, children with Asperger syndrome do not have obvious delay in language development. They often have very large vocabularies that seem advanced compared to other children their age; this sometimes earns them the moniker of the “little professor.” Despite their large vocabularies, these children are quite literal in their understanding of what others are saying. Also, with the exception of social skills, children with Asperger syndrome usually acquire self-help skills like toileting and dressing at the same ages as their peers.

    In addition to their problems with social interactions, children with Asperger syndrome often have an obsessive interest in a particular subject and very little interest in much else. They may obsessively seek information about maps or clocks or some other topic. They may also be very inflexible in their habits and rigidly adhere to certain routines or rituals. Children with Asperger syndrome may show odd mannerisms such as hand-flapping or peculiar postures that make them appear clumsy.

    At this time, there is no ‘cure’ for Asperger syndrome. Children with Asperger syndrome often grow up to be consider an “odd” or “eccentric” adult. However, they can be helped tremendously by treatment with social skills training, parental education and training, behavior modification and other psychosocial interventions. Because children with Asperger disorder can also have debilitating compulsions and anxiety related to social interactions, sometimes medications can be prescribed that will help with those aspects of the condition.

    Like so many behavioral disorders, there is a spectrum and it can be a difficult diagnosis to make. Because people with Asperger syndrome often have obsessive or compulsive behavior, they are frequently diagnosed with Obsessive-Compulsive Disorder (OCD); however, most people with OCD do not have difficulty in their social interactions or understanding body language. Another common misdiagnosis is anxiety disorder because of the distress noted with changes in routine or with social interactions. But again, people with anxiety disorders do not have difficulty with nonverbal language or obsessive interests or rituals.
    Aspergers syndrome is a type of Pervasive Developmental Disorder, and others include Autism and Retts syndrome.


    Chicken Pox

    Posted by on Tuesday, 18 January, 2011

    CHICKEN POX

    Chicken pox is a viral infection caused by the Herpes varicella zoster virus. It’s spread in droplets inhaled into the respiratory tract. Complications are rare but serious, and can occur in previously healthy children.

    chicken pox

    Chicken pox tends to affect children under ten. Most children have had the infection by this age. In older children and adults, chickenpox can be more severe.
    It’s more common in late winter and spring. Children who are immunosuppressed (for example, on steroids) are particularly vulnerable to complications, as are newborn babies who may catch the infection from their mother in late pregnancy.

    The incubation period (from exposure to onset of symptoms) is 14 to 24 days. The initial symptoms are mild fever and headaches. Younger children may seem generally grouchy. These are followed within hours by the appearance of a typical rash. Crops of red spots appear, which quickly develop central fluid-filled blisters that are intensely itchy. After a couple of days these scab over and dry up.
    The rash mostly affects the trunk, but may appear anywhere on the body, including the scalp and the mouth. In about one in ten cases symptoms are so minimal the infection goes unnoticed. Complications of the infection are uncommon but include viral pneumonia, secondary bacterial infection and encephalitis.

    The doctor should be notified if the child seems particularly unwell, has a cough, headache, if the skin is particularly inflamed or infected, or there are other worrying symptoms. For young babies or children with immunity problems, always seek medical advice. Give pain-relieving syrup and plenty of fluids. Calamine lotion and antihistamine medicines may relieve the itching. Keep the child’s hands clean and their fingernails short. Try to discourage them from scratching the spots, as they can scar.

    The spots may be infectious until they’ve fully scabbed over, but no child should need to be kept from school for more than five days. In severe cases, antiviral treatment may be recommended.

    Most children recover without long-term problems. But children at high risk who are exposed to chicken pox must be treated with immunoglobulin injections to prevent the infection, or antiviral drugs to treat it. There is also a vaccine that can be given to prevent chickenpox. After infection the virus lies dormant in the body but can emerge later to cause shingles.


    Croup

    Posted by on Monday, 17 January, 2011

    What is Croup?

    Croup is a common childhood viral illness that is easily recognized because of the distinctive characteristics that children have when they become infected. Like most viral illnesses, there is no cure for croup, but there are many symptomatic treatments that can help the child to feel better faster.

    croup

    Croup, also called laryngotracheobronchitis, most commonly affects children between the ages of six months and three years, usually during the late fall, winter and early spring. Symptoms, which often include a runny nose and a brassy cough, develop about 2-6 days after being exposed to someone with croup.

    One of the distinctive characteristics of croup is the abrupt or sudden onset of symptoms. Children will usually be well when they went to bed, and will then wake up in the middle of the night with a croupy cough and trouble breathing. The cough that children with croup have is also distinctive. Unlike other viral respiratory illnesses, which can cause a dry, wet, or deep cough, croup causes a cough that sounds like a barking seal.

    Another common sign or symptom of croup is inspiratory stridor, which is a loud, high-pitched, harsh noise that children with croup often have when they are breathing in. Stridor is often confused with wheezing, but unlike wheezing, which is usually caused by inflammation in the lungs, stridor is caused by inflammation in the larger airways.

    The pattern of croup symptoms is also characteristic. In addition to beginning in the middle of the night, symptoms, which are often better during the day, worsen at night, although they are usually less intense each night. Symptoms also become worse if the child becomes anxious or agitated.

    The symptoms of croup are caused by inflammation, swelling and the buildup of mucus in the larynx, trachea (windpipe) and bronchial tubes. Since younger infants and children have smaller airways, it makes sense that they are the ones most affected by croup. In contrast, older children will often just develop cold symptoms when they are infected by the same virus.

    Children with croup will usually also have a hoarse voice, decreased appetite and a fever, which is usually low grade, but may rise up to 104 degrees F.

    Croup Assessment

    Because of the characteristic signs and symptoms of croup, this diagnosis is usually fairly easy to make. You can often tell a child has croup while they are still in the waiting room or before you enter the exam room, therefore, testing is usually not necessary.

    Specifically, an xray is usually not required, and is usually only done to rule out other disorders, such as ingestion of a foreign body. When an xray is done, it will usually show a characteristic ‘steeple sign,’ which shows a narrowing of the trachea.

    When assessing a child with croup, it is important to determine if he is having trouble breathing. Fortunately, most children have mild croup and have no trouble breathing, or they may only have stridor when they are crying or agitated. Children with moderate or severe croup will have rapid breathing and retractions, which is a sign of increased work of breathing. They may also have stridor when they are resting.

    The croup score is an easy and standardized way to figure out if a child has mild, moderate or severe croup, which can help to dictate what treatments are necessary. The croup score is based on a child’s color, level of alertness, degree of stridor, air movement, and degree of retractions, with 0 points given if these findings are normal or not present, and up to 3 points given for more severe symptoms.

    • Inspiratory Stridor
    • None (0 points)
    • When agitated (1 points)
    • On/off at rest (2 points)
    • Continuous at rest (3 points)
    • Retractions
    • None (0 points)
    • Mild (1 points)
    • Moderate (2 points)
    • Severe (3 points)
    • Air Movement/Entry
    • Normal (0 points)
    • Decreased (1 points)
    • Moderately decreased (2 points)
    • Severely decreased (3 points)
    • Cyanosis (Color)
    • None (0 points)
    • Dusky (1 point)
    • Cyanotic on room air (2 points)
    • Cyanotic with supplemental oxygen (3 points)
    • Level of Alertness (Mentation)
    • Alert (0 points)
    • Restless or anxious (1 points)
    • Lethargic/Obtunded (2 points)

    In general, children with a croup score of less than 4 have mild croup, 5-6 have mild/moderate croup, 7-8 have moderate croup, and greater than 9 have severe croup.

    Treatments

    Although, like most viral infections, there is no cure for croup, there are many treatments that can help improve the symptoms and make the child feel better. Mild croup symptoms can usually be safely treated at home. Common treatments include using humidified air, which can be delivered by a cool mist humidifier. Using a hot steam vaporizer is usually discouraged because of the risk of the child getting burned if he touches it. Instead, warm steam can be delivered by turning on all of the hot water in the bathroom, including from the shower and sink, close the bathroom door and holding the child as he breathes in the steamy, humidified air.

    On cool nights, exposure to the cool nighttime air may also help symptoms, and this phenomenon is responsible for another characteristic finding of croup, the fact that children often get better on the way to the emergency room. To take advantage of this, it may help to bundle the child up and walk around outside for several minutes. It is probably not a good idea to keep his window open though, as you don’t want him to get too cold.

    Other treatments can include using a fever reducer (acetaminophen or ibuprofen containing products) and/or a non-narcotic cough suppressant (although they probably won’t suppress the cough of croup).

    Since symptoms worsen if the child is crying and agitated, trying to keep the child calm may also improve his symptoms.

    Children with moderate or severe croup, or who aren’t quickly responding to home treatments, will need medical attention for further treatments, which usually includes administering a steroid to help decrease swelling and inflammation and improve breathing. An injection of dexamethasone has been the standard way of administering this steroid, but new studies have shown that an oral steroid (Prelone, Orapred, etc) or steroid delivered by a nebulizer (Pulmicort) may also be effective.

    For children with severe respiratory distress, treatment, in a hospital setting may include a breathing treatment with racemic epinephrine. Because there is a risk of a ‘rebound’ and worsening breathing, children are usually observed for 2-4 hours after receiving racemic epinephrine. Chlildren who continue to have difficulty breathing, or who require more than one treatment, are usually hospitalized.

    A mist or oxygen tent has long been used to treat children who are hospitalized, but there use has been decreased because it makes it harder for the hospital staff to observe the child and notice if he is getting worse. Instead, blow by oxygen or cool mist may be used.

    A newer treatment that is being researched is the use of a helium-oxygen mixture for children with severe croup.

    The main symptoms of croup typically last only 2-5 days, but more rarely, they can last several weeks. Once the barking cough and difficulty breathing improve, the child may continue to have cold symptoms for 7-10 days.


    Celiac Disease

    Posted by on Sunday, 16 January, 2011

    CELIAC DISEASE

    Celiac disease is an autoimmune disorder, with symptoms that range from gas and diarrhea to irritability and depression. It is caused by an intolerance to the protein gluten, which is found in foods that contain wheat, rye, and barley.

    intestine_inflamation

    Children can develop symptoms of celiac disease once gluten has been introduced into their diet, and is usually sometime between 6 months and 2 years of age, although the symptoms may not be formally diagnosed as being caused by celiac disease until they are much older.

    Symptoms of celiac disease can include:

    • delayed growth and failure to thrive
    • chronic diarrhea
    • behavioral changes, including irritability

      recurrent gas, abdominal bloating, and pain

      pale, foul-smelling, or fatty stools

      constipation

    • fatigue
    • unexplained iron deficiency anemia (a low red blood cell count)
    • delayed puberty

    These symptoms do vary though, and some people with celiac disease have no symptoms at all, infants with classic celiac disease are often described as ‘clingy, irritable, unhappy children who are difficult to comfort.’

    Diagnosis of Celiac Disease

    Although some people simply try and see if their child will improve on a gluten-free diet to see if their child has celiac disease, since this is a lifelong condition, formal diagnosis and testing is usually a good idea.

    Testing for celiac disease can include screening blood tests, such as:

    • Immunoglobulin A (IgA)
    • anti-tissue transglutaminase (tTGA)
    • IgA anti-endomysium antibodies (AEA)

    If these screening tests are suspicious for celiac disease, a small bowel biopsy will usually be done by a pediatric gastroenterologist to confirm the diagnosis.

    Treatments for Celiac Disease

    There is no cure or medication to treat celiac disease. Instead, parents must put their children on a gluten-free diet that doesn’t contain any foods that are made with wheat, rye, or barley.

    To help avoid gluten, including many grains, pasta, cereals, and other processed foods with gluten, it can help to learn to read food labels and look for and avoid products with the following ingredients on the label:

    • wheat, including durum, graham, kamut, semolina, spelt, triticale

      barley, including malt, malt vinegar, or malt flavoring which can be made from barley

      rye

    Gluten can also be found in some candy, cold cuts, soy sauce, vitamins, herbal supplements, over the counter medications, and prescription medications. And although often overlooked, gluten is also found in communion wafers, lip balms, and Play Doh.

    Fortunately, there are many gluten-free breads and pastas and even gluten-free medications for children on a gluten-free diet. Still, it can be hard to follow a gluten-free diet, so you may seek help from a registered dietician to make sure that your child still eats well balanced meals, while keeping gluten out of his diet.

    What You Need To Know About Celiac Disease

    Infants are often first introduced to gluten when they ‘graduate’ from rice cereal and start a single grain cereal with barley or Cheerios, etc. Many experts also recommend that a child on a gluten-free diet also avoid oats, although this is controversial and is still being researched. The Celiac Sprue Association, a nonprofit support group, states that ‘pure oats may be included as part of a gluten-free diet,’ but then goes on to suggest that people on a gluten-free diet avoid oats anyway because ‘uncontaminated oat sources are not readily available.’

    Celiac disease is genetic and so can run in certain families, especially if they are descendants of people from northern Europe.

    Many experts think that celiac disease is underdiagnosed in the United States.

    Celiac disease is also known as celiac sprue, gluten-sensitive enteropathy, and non-tropical sprue. Children don’t outgrow celiac disease and so must continue the gluten-free diet their whole life.


    Short Bowel Syndrome

    Posted by on Monday, 4 October, 2010

    What is Short Bowel Syndrome?

    Short bowel syndrome (SBS) occurs after congenital (before birth) or postnatal loss of at least half of the small intestine, with or without loss of a large part of the intense carmine. The loss of the bowel may be due to disease or surgical removal. Short Bowel Syndrome (SBS) produces malabsorption, a condition where the body can not break and / or absorb sugars, proteins or fats.

    short bowel syndrome

    The extent of the problems associated with SBS depends mostly articles from the small intestine are affected. The small intestine normal height ranges between 10 and 28 meters and is divided into three sections.

    Few conditions in pediatric gastroenterology pose as great a challenge as short bowel syndrome (SBS).

    Short bowel syndrome is the result of the alteration of intestinal digestion and absorption that occurs following extensive bowel resection. It represents a complex disorder that affects normal intestinal physiology with nutritional, metabolic, and infectious consequences.

    Few conditions in pediatric gastroenterology pose as great a challenge as short bowel syndrome (SBS).
    The small intestine of the newborn is about 250 cm in length. In adulthood, small intestine, grows to about 750 cm. Consequently, infants and toddlers have a favorable long-term prognosis compared with an adult in terms of growth potential of the intestine after intestinal resection. Intestinal adaptation can take weeks or months to achieve, in the meantime, children who underwent intestinal resection require nutritional support through a variety of therapies, including parenteral nutrition. The duodenum and jejunum are responsible for the absorption of most dietary components with the exception of vitamin B-12 and bile acids.

    Jejunum is characterized by long and wild large absorbent surface. Tight junctions are relatively large, so that the epithelium of larger molecules to pass more, and the free circulation and quick water and electrolytes. Comparison of the ileum is less wild, and the absorption capacity of surfaces unless the jejunum. In addition, tight connections are more stringent, reducing the flow of water and electrolytes in the vascular space into the intestinal lumen and, consequently, the ileum is a more efficient absorption into the water. Although nutrients are not as well absorbed in the small intestine, which has specific receptors on the site, the absorption of bile acid and vitamin B12. In addition, many hormones that affect the gastrointestinal tract, intestine, including enteroglucagon and peptide YY, produced in the ileum. 

    Sites of nutrient absorption:

    • Duodenum – Iron
    • Jejunum – Carbohydrates, proteins, fat, vitamins
    • Ileum – Bile acids, vitamin B-12

    In general, virtually all digestion and absorption is completed within the first 100-150 cm of jejunum in a healthy individual. In the absence of an intact colon, the minimum length of healthy bowel necessary to avoid parenteral nutrition is approximately 100 cm. Patients who have less than 100 cm of jejunum exhibit significant malabsorption. Although the ileum is limited in its capacity to form chylomicrons compared to the jejunum, studies have shown that the ileum has greater adaptive function as far as improving its absorptive function in the presence of short bowel syndrome. Similarly, studies in animals have shown that intestinal transit time is more likely to improve (ie, increase) in patients with proximal small-bowel resection as opposed to patients with distal small-bowel resection.

    Since the jejunum can not develop site-specific carriers for the transport of vitamin B12 and bile salts, and therefore poorly absorbs permanently in patients after ileal resection. In addition, the loss of enteroglucagon and peptide YY can not be stressed in the regulation of bowel motility.

    The leading causes of death among infants with short bowel syndrome who are treated with parenteral nutrition include central line sepsis and liver failure with prolonged use of parenteral nutrition.

    The history of patients with short bowel syndrome (SBS) is usually a child born with a congenital anomaly, such as omphalocele, gastroschisis, intestinal atresia or, requiring small bowel resection. In addition, premature infants with necrotizing enterocolitis and require extensive bowel resection, with or without loss of the ileocecal junction also contribute to this patient population.

    Other patients have a history of malrotation and volvulus, ischemic bowel, which had to undergo a bowel resection. Congenital short bowel syndrome is a rare cause of short bowel syndrome.

    Children with short bowel syndrome may have various medical problems, according to the degree of intestinal resection and the level of medical complexity. The history should consider all potential ramifications of clinical case management of short bowel syndrome, including:

    Parenteral nutrition

    • The degree of home nutrition support necessary in the management of a child on total parenteral nutrition (TPN) is noteworthy.
    • Guidelines for the safe use of parenteral nutrition have been established by the American Society for Parenteral and Enteral Nutrition.
    • Patients may present with issues entirely separate from the medical problems related to short bowel syndrome, including problems associated with intravenous access, infection, and signs and clinical symptoms associated with TPN-related liver disease.

    Enteral Feeding

    • Quickly initiate enteral feeding for all children with short bowel syndrome.
    • Once again, patients can present a full history of medical problems associated with short bowel syndrome, including questions gastrostomy tube or nasogastric tube. For example, gastrostomy tubes may fall accidentally. In these patients, the immediate replacement of these tubes is important to maintain patency of the tube entry site.
    • Although complications are rare, be aware of the potential of gastric ulcer migration, and tube gastrostomy, intestinal obstruction, which may be associated with bilious vomiting and the risk of pancreatitis.

    Nutrition

    • Supervise all children in enteral and parenteral long-term specific nutritional problems.
    • Patients may present with various symptoms related to specific nutritional deficiencies, including vitamins specific (or mineral) deficiencies and associated signs, symptoms and electrolyte disturbances and possible complications.

    Medical and surgical histories: get a detailed account of past medical and surgical patient.

    • Pathology that leads to surgical resection
    • The extent and location of intestinal resection, the presence or absence of ileocecal valve.
    • Medical complications
    • RPT dependence
    • Enteral nutrition
    • enteral access
    • Type nutritional formula used
    • Dietary Supplements
    • Drugs
    • Allergies

    History of complications associated with short bowel syndrome

    • Malabsorptive diarrhea
    • Dehydration
    • Vomiting
    • Bloating
    • Gastroesophageal reflux
    • Failure to thrive
    • Drug toxicities