Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
What does a pediatric gastroenterologist do?
Gastroenterologists in adults deal with ulcers and outpouches
of the colon called diverticuli, but kids don't get these
diseases too often. They get reflux early in life, where food
is regurgitated up the feeding tube (esophagus) and into the
airways. It can cause inconsolability, and pain.
Meckel's diverticulum is a small growth on the bowel which is
present from birth and is usually discovered at around age
two. It has the characteristics of stomach, so it secretes
acid into the bowel, causing intense pain. It may need to be
removed surgically.
Pyloric stenosis is where the valve from the stomach to the
small bowel is too thick and won't open, leading to projectile
vomiting; that is vomiting that is so forceful it can go
across the room. It is seen soon after birth and is diagnosed
by ultrasound.
Volvulus is where the bowel twists on itself. Intasusseption
is where the bowel telescopes on itself. Both of these have
pain that can come and go. The former has vomiting without
diarrhea, whereas the latter can look innocent enough until it
is too late. A child who cries out in pain between the ages of
two and six and then continues playing as if nothing happened
is at risk for this disease.
Malrotation of the bowel is a cause of vomiting in infancy.
This is where the bowel never assumed its correct position.
Esophageal atresia is when the feeding tube never connected
with the stomach. Imperforate anus is where the anus never
opened. Hirschprung's disease is a piece of colon that doesn't
move stool forward and creates megacolon which could explode.
All of these are life threatening and require surgery.
Necrotizing entercolitis is a disease of early infancy where
part of the colon dies and is characterized by high fever and
pain. It is a very dangerous condition.
All of the above do not occur in adults, with the exception of
volvulus and reflux, but they are due to different mechanisms.
Fortunately, they are all fairly rare but a good parent will
be wary of unusual behavior or feeding problems. A rule of
thumb is that green vomitus in a child is a dangerous sign.
A common problem these doctors do see is Crohn's disease and
ulcerative colitis, where the body attacks itself. You will
see unexplained abdominal pain, and perhaps bloody diarrhea.
Kids do also get appendicitis of course as well as suffering
from diarrhea, especially from pathogens that are not as
common in adults, such as rotavirus. Fluid losses in these
diseases are poorly tolerated by the child and intravenous
fluids are often required. Write me in care of the
Yated.
A message from Glaxo, sponsor of this column. A few
people have severe vomiting which is uncontrollable by the
usual medications. Here is where Zofran can help. It is the
number one drug used to help vomiting in chemotherapy.
