liv clinics
Pediatric Gastroenterology and Hepatology
The diagnosis and treatment of digestive system (esophagus, stomach, duodenum, small intestine and large intestine) diseases, liver and biliary tract diseases are performed at Liv Hospital Pediatric Gastroenterology Clinic. Moreover, special nutritional support is provided to both healthy children and children with various chronic diseases that require nutritional support.
Complaints in the field of Pediatric Gastroenterology
- Chronic or recurrent abdominal pain
- Vomiting
- Diarrhea, bloody diarrhea
- Failure to gain weight
- Abdominal swelling
- Constipation
- Digestive system hemorrhages (black stool, vomiting in the form of coffee grounds)
- Unexplained growth retardation
- Anemia with no cause and resistant to treatment
- Liver fat
- Jaundice, elevation in liver tests
- Ingestion of foreign matter
Diseases in the field of Pediatric Gastroenterology
- Gastrouesophageal reflux (reflux)
- Corrosive esophagitis
- Gastritis (acute and chronic)
- Gastritis due to Helicobacter pylori
- Ulcer
- Dyspepsia (indigestion)
- Chronic diarrhea and inability to grow
- Celiac disease
- Food and cow's milk allergy
- Constipation
- Bloody stool
- Growth retardation and colitis (ulcerative colitis, Crohn's disease)
- Polyp
- Jaundice and hepatitis (hepatitis b, c, d, e) autoimmune hepatitis
- Wilson's disease
- Biliary tract and gallbladder diseases
- Diseases of the pancreas
- Food allergies (cow's milk allergy)
- Loss of appetite
- Obesity
- Nutritional support (disease-specific nutrition)
Diagnosis and Treatment Procedures in Pediatric Gastroenterology Clinic
- Diagnostic endoscopy
- Esophagogastroduodenoscopy
- Rectosigmoidoscopy
- Colonoscopy
- Endoscopic procedures for treatment
- Endoscopic band ligation of varicose veins
- Polypectomy
- Dilatation of esophageal stenosis
- Percutaneous endoscopic gastrostomy
- Liver biopsy
- 24-hour pH monitoring
- 13C urea breath test
What are some ways of treatment of obesity in children? Can endoscopic methods be included?
Obesity in children can be endogenous or exogenous. First, hormonal disorders and genetic causes should be ruled out. After deciding that the obesity is exogenous, the treatment is regime and exercise just like in adults. Obesity brings together with it the insulin resistance. Medical treatments for insulin resistance may be given in cases that do not improve with exercise and diet. In morbid obese people (BMI>35 severe comorbidity) that have comorbidity despite this or in situations where BMI is >40 and comorbidity is slight, additional treatment modalities can be tried. Bariatric surgeries (sleeve gastrectomy that has been performed lately). However surgical methods are not recommended during prepubertal period (generally 14 years old for girls and 15 years old for boys). Endoscopic methods (balloons that can be swallowed or endoscopic placed) can be performed in underage morbid obese children or those who are adolescents but do not want to take the surgical risk. Since it is more non-invasive, botilinium injections can be performed in the whole stomach, however; Botox is not a primary preferred method even in adults due to it being expensive, requiring repetitive injections, having a short-lasting effect and less efficiency compared to the balloon. In brief, endoscopic methods can be applied specific to the patient in underage morbid obese children with severe comorbidity. No contraindication has been declared in these cases to date. However, there is no study that shows its effects in comparison.How to approach a child with poor appetite? Which child with poor appetite could have deglutition disorder?
Parents frequently complain that their children eat less or they are picky over their food. In this case, mother-baby or child diet should be observed for a couple days and calories calculation should be performed by looking at daily menus to see if there really is a nutrition deficiency. When looked this way, it is seen that these children essentially take the necessary energy for their growth and they grow normally. If a child cannot take necessary nutrients for its growth at least 2 weeks, this child should be researched for nutrition problems.This can be caused by an organic, psychosocial or behavioral reason. While these can be the way the food is presented, the food being in a texture and look that does not appeal to the age, diet not compliant with culture, frequent eating, keeping the eating time long, eating food rich in fat and carbohydrate, attachment problems between mother/baby-sitter and baby, infantile anorexia and diet, they can also be anemia, cardiac diseases and other systemic diseases and especially deglutition disorders should be researched. There does not have to be a muscle or nerve disease for the deglutition disorder to exist. If the child or baby that we depict as with poor appetite is refusing to eat, keeping the food in its mouth too long and in the cheek instead of chewing to make it dissolve and then swallow it, if it is holding its head to the back while eating, if it is creating specific postures such as holding its body to the back, if it is making multiple swallow attempts for one bite such as putting out its head forward, if it is coughing or facing dangers such as aspiration (slipping the food in the liver), if it is coughing after eating, if it has frequent pneumonia, if milk or nutrient come from its nose while swallowing, if it chooses the same texture (for example if it chooses liquid solid or pudding) or same temperature food, the child or baby can have deglutition disorders. The baby or the child should be definitely first evaluated by a pediatric gastroenterologist and then a speech and language therapist.
What is Celiac disease? In what situations should we think about it?
Celiac disease is a disease that develops in the intestine due to an autoimmune mechanism, which is somewhat an allergic mechanism, resulting from gluten in the grains. It is only one of many diseases related with gluten. Gluten hypersensitivity, gluten allergy and gluten intolerance are other gluten related diseases and they are all different from each other. Normally, there are finger-like bulges in the intestine called villous structure that are responsible of absorption of nutrients. In Celiac disease, the finger-like bulges in the intestine that we call villous structure shorten, become blunt and smooth due to a reaction developing against this substance called Gluten. As a result the intestines lose their absorbing power and nutrient absorption deteriorates. Since it is an autoimmune disease, it does not stick with just intestine, it is a systemic disease and it can effect other organs like liver, bones and brain. Celiac disease is found in 4.7 of a thousand children in our country, which means one out of every 212 children has celiac. It is essentially a frequently seen disease however it is not as frequently diagnosed. The reason for this is that our doctors think only about the classic celiac scenario. Diarrhea, abdominal distention and growth retardation are most significant complaints in classic celiac. However, this scenario only equals to 10% of the cases. Today we can see celiac patients who are obese or have constipation. Celiac disease should be thought about in situations such as chronic abdominal pain, short stature, growth retardation, frequently relapsing and resistant anemia, osteoporosis, arthritis, high liver enzyme, tooth enamel hypoplasia or epilepsy. There are diseases that celiac disease loves to be together with. Thyroid gland diseases, diabetes, down syndrome ... and some other diseases. When these diseases exist, celiac disease should be looked for, or vice versa, when celiac disease exists, these diseases should be looked for.Specialities
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