1
Fifth stage
Pediatric
Lec-4
.د
أوس
14/12/2015
Malabsorption
Disorders affecting the digestion or absorption of nutrients
Manifest as:
• abnormal stools(The true malabsorption stool is difficult to flush down the toilet and
has an odor which pervades the whole house,pale,bulky)
• failure to thrive or poor growth in most but not all cases
• specific nutrient deficiencies, either singly or in combination.
Inflammatory bowel disease
Approximately a quarter of patients present in childhood or adolescence. Crohn disease can
affect any part of the gastrointestinal tract from mouth to anus, whereas in ulcerative
colitis the inflammation is confined to the colon
2
Ulcerative colitis
Diagnosis:
made on endoscopy (upper and ileocolonoscopy) and on the histological features, after
exclusion of infective causes of colitis
In contrast to adults, in whom the colitis is usually confined to the distal colon, 90% of
children have a pancolitis
TREATMENT
In mild disease, aminosalicylates (balsalazide and mesalazine) are used for induction and
maintenance therapy. Disease confined to the rectum and sigmoid colon may be managed
with topical steroids
More aggressive or extensive disease requires systemic steroids for acute exacerbations
and immunomodulatory therapy, e.g. azathioprine to maintain remission alone or in
combination with low-dose corticosteroid therapy.
3
CRONH DIASEASE
Diagnosis is based on endoscopic and histological findings on biopsy. Upper gastrointestinal
endoscopy, ileocolonoscopy and small bowel imaging are required.
TREATMENT : Remission is induced with nutritional therapy, when the normal diet is
replaced by whole protein modular feeds (polymeric diet) for 6–8 weeks. This is effective in
75% of cases. Systemic steroids are required if ineffective.