Gastroenterology Chapter 15 Childhood Disease

OBJECTIVES

Recurrent Abdominal Pain

1. Recognize the characteristic clinical presentations (history, physical exam,
    psychosocial factors) of benign recurrent functional abdominal pain in the child. 2. Be aware of the common organic causes of abdominal pain in children. 3. Be able to identify features of the history or physical exam that are not consistent
    with functional pain and suggest an organic basis. 4. Understand the approach to the investigation and management of recurrent
    abdominal pain in children.

Vomiting and Regurgitation

1. Understand the definitions of, and distinction between, vomiting and regurgitation. 2. Be aware of the range of gastrointestinal and nongastrointestinal causes of
    vomiting characteristic of neonates, infants, children and adolescents. 3. Be aware of an age- and presentation-appropriate approach to the investigation
    and management of vomiting in neonates, infants, children and adolescents. 4. Be aware of the pathophysiology and natural history of gastroesophageal reflux in
    infancy, the potential complications of gastroesophageal reflux, the features of
    history and physical exam that suggest GER-induced disease, available
    investigations and appropriate treatment of GERD.

Colic

1. Understand that colic describes a pattern of crying or fussiness the etiology of
which is not yet clear. 2. Know the possible etiologies for colic that have been proposed. 3. Develop an approach to history taking, physical exam and management of the
infant presenting with colic.

Chronic Constipation, Encopresis and Soiling

1. Understand the definitions of constipation, encopresis and soiling. 2. Understand the role of age, colonic motility, dietary fiber and transit time in
determining defecation frequency, fecal water and electrolyte content. 3. Recognize normal variations in patterns of elimination in infants (e.g., breastfed vs
formula-fed babies). 4. Be aware of the functional and organic causes of constipation.

5. Be able to differentiate chronic fecal retention from Hirschsprung's disease.

6. Understand the mechanism(s) and management of functional constipation and
soiling.

Growth Failure and Malnutrition

1. Define the terms failure to thrive and malnutrition. 2. Learn to categorize failure to thrive in order to facilitate diagnoses. 3. Review appropriate methods for the assessment and management of failure to
thrive.

Acute Diarrhea in Children

1. Understand the pathophysiology of acute diarrheal disease in the pediatric patient. 2. Be able to assess severity of dehydration in infants and children. 3. Understand the use of oral rehydration therapy for the management of acute
diarrheal disease.

Malabsorption

1. Understand the physiology of digestion and absorption in order to develop an
    approach to the clinical evaluation of a pediatric patient with the malabsorption
    syndrome. 2. Be aware of the role of history and physical examination in the assessment of
    children with the malabsorption syndrome, and in particular, the importance
    of the dietary record, growth parameters and the need to plot growth curves. 3. Be aware of the various laboratory tests used for the evaluation of children with
    malabsorption. 4. Understand basic concepts regarding the management of the infant with failure to
    thrive.

Approach to the Jaundiced Neonate

1. Be aware of the factors contributing to physiological jaundice in the newborn. 2. Be aware of the various causes of unconjugated hyperbilirubinemia in infancy.
    Know the symptoms and sequelae of unconjugated hyperbilirubinemia. Be aware
    of options for management. 3. Be aware of the various causes of neonatal conjugated hyperbilirubinemia. 4. Be aware of an approach (algorithm) for the investigation and management of
    neonatal hyperbilirubinemia.