Paediatric Gastroenterology and Hepatology

A polypectomy is a procedure to remove polyps—small, abnormal growths that can appear on mucous membranes such as those in the colon, stomach, or nasal passages. This procedure is often performed because polyps can be precursors to cancer, especially in the colon. Removing them helps prevent potential cancer development.

If someone ingests a corrosive substance, rinse the mouth with water if the person is conscious and alert, but do not induce vomiting as it can cause further damage. Symptoms include severe pain in the mouth, throat, and stomach, difficulty swallowing, nausea, vomiting, and in severe cases, difficulty breathing.

Preparation depends on the location of the polyp. For colon polyps, you might need to follow a special diet or undergo bowel cleansing. The procedure is generally performed under sedation or anesthesia, with minimal discomfort. Recovery is typically short, with mild discomfort or cramping. Full recovery can take a few days, depending on the procedure’s complexity.

Long-term effects of corrosive ingestion can include scarring of the gastrointestinal tract, chronic pain, and swallowing difficulties, often requiring ongoing medical treatment or surgeries. Prevention includes safely storing corrosive substances out of reach of children and ensuring that all containers are clearly labeled and handled with care.

Constipation can be caused by a low-fiber diet, inadequate fluid intake, sedentary lifestyle, certain medications, and medical conditions such as hypothyroidism. Symptoms include infrequent bowel movements, hard or lumpy stools, and abdominal discomfort. It’s advisable to see a doctor if constipation persists despite lifestyle changes, or if it is accompanied by severe pain, bleeding, or sudden changes in bowel habits.

Constipation can be managed by increasing fiber intake through fruits, vegetables, and whole grains, drinking plenty of water, and engaging in regular exercise. Over-the-counter treatments like fiber supplements, stool softeners, and mild laxatives can also be used, though they should not be relied upon long-term without medical advice.

Metabolic screening is a test used to detect metabolic disorders, often in newborns. Early detection through metabolic screening allows for prompt intervention, which can prevent severe health issues or developmental delays. Conditions commonly screened include phenylketonuria (PKU), cystic fibrosis, and galactosemia.

The screening typically involves a blood test, usually from a heel prick in newborns. If a screening test is positive, further diagnostic testing is necessary to confirm the presence of a disorder. A positive result doesn't necessarily mean that the child has the condition, but it does suggest that additional evaluation is required. Early diagnosis and treatment are crucial for better health outcomes.

While complications from a polypectomy are rare, they can include bleeding, infection, or perforation of the organ where the polyp was removed. Similarly, ingesting corrosive substances can lead to severe complications such as scarring of the esophagus or stomach, chronic pain, and, in severe cases, perforation or infection. Both situations require careful monitoring and follow-up care to manage and mitigate risks.

Follow-up care is essential to ensure that any removed polyps have been fully excised and to monitor for the development of new polyps. In cases of corrosive substance ingestion, follow-up care helps to assess the healing process, manage any complications, and ensure proper nutritional rehabilitation. Regular screenings, tests, and consultations with healthcare providers are critical components of effective follow-up care.

1. Recurrent & Chronic Abdominal Pain
   • Diagnosis: GERD, Peptic ulcer disease, H. pylori related gastritis, Giardiasis, Functional abdominal pain.
   • Procedure: Upper GI Endoscopy (Duodenal biopsy, Antral biopsy, Esophageal dilatation).
2. Malabsorption Syndromes (Failure to Thrive)
   • Diagnosis: Celiac Disease, Tropical Sprue, Small intestinal bacterial overgrowth, Intestinal & peritoneal Tuberculosis.
   • Procedure: Upper GI Endoscopy (Duodenal biopsy), Colonoscopy, Sigmoidoscopy (Biopsy).
3. Diarrhoeal Diseases
   • Diagnosis: Persistent diarrhoea, Lactose Intolerance (Primary/Secondary), Inflammatory Bowel Disease (Ulcerative colitis/Crohn disease), Chronic diarrhoea, Congenital diarrhoeas.
   • Procedure: Colonoscopy, Sigmoidoscopy (Biopsy, Sclerotherapy), Polypectomy.
4. Constipation
   • Diagnosis: Functional constipation, Hirschsprung Disease, Slow motility constipation, Pelvic floor dys-synergia.
   • Procedure: Colonoscopy, Sigmoidoscopy, GI physiology and motility services (Anorectal manometry).
5. Recurrent Vomiting
   • Diagnosis: Cyclical vomiting, Malrotation of gut, Pyloric stenosis, Duodenal stenosis/atresia.
   • Procedure: Upper GI Endoscopy, PEG Tube Placement, Post Caustic Ingestion Esophageal/Pyloric Stricture Dilatation.
6. Accidental Ingestion of Corrosive Injury
   • Diagnosis: Management of post caustic injury, Nutritional rehabilitation & preparing for corrective surgery.
   • Procedure: Upper GI Endoscopy, Esophageal Stricture Dilatation, PEG Tube Placement, Post Caustic Ingestion Esophageal/Pyloric Stricture Dilatation, Nutritional rehabilitation.
7. Gastrointestinal Issues
   • Diagnosis: Pain abdomen, Vomiting, Constipation, Swelling of the tummy, Blood in stool or vomiting of blood, Not gaining weight and height, Poor appetite, Collection of water in the abdomen (Ascites), Gastroesophageal reflux (GERD), Acidity, Celiac disease (Gluten allergy), Food allergy, Inflammatory bowel disease.
   • Procedure: Upper GI Endoscopy, Colonoscopy, ERCP, Capsule endoscopy, Enteroscopy, Feeding Tube Placement, Polypectomy, Esophageal Stricture Dilatation, GI physiology and motility services (Esophageal manometry, Anorectal manometry, Esophageal Ph metry and Impedance study).

1. Liver Transplantation
   • Diagnosis: Chronic liver diseases, Jaundice and liver failure.
   • Procedure: Liver Biopsy (Percutaneous, Transjugular), TIPSS, Endoscopic variceal ligation, Metabolic screening.
2. Jaundice and Liver Failure
   • Diagnosis: Acute Viral hepatitis, Acute Liver Failure, Viral Hepatitis A, B, C, E.
   • Procedure: Liver Biopsy (Percutaneous, Transjugular), TIPSS, Endoscopic variceal ligation.
3. Chronic Liver Diseases
   • Diagnosis: Wilson disease, Autoimmune liver disease, Extra-hepatic portal vein obstruction, Metabolic Liver disease, Budd Chiari syndrome, Cryptogenic cirrhosis.
   • Procedure: Liver Biopsy (Percutaneous, Transjugular), Endoscopic variceal ligation, Metabolic screening.
4. Diseases of Pancreas
   • Diagnosis: Acute Pancreatitis, Chronic Pancreatitis, Recurrent Acute Pancreatitis, Annular Pancreas, Pancreatic duct calculi, Pancreatic divisum.
   • Procedure: ERCP, Capsule endoscopy, Liver Biopsy, Metabolic screening.
5. Neonatal Cholesatasis (Conjugated Hyperbilirubinemia)
   • Diagnosis: Biliary Atresia, Choledochal cyst, Idiopathic hepatitis, Galactosemia, Hereditary Fructose Intolerance, Tyrosinemia, Hereditary hemochromatosis, PFIC (Progressive familial Intra-hepatic Cholestasis), Metabolic liver diseases (Mitochondriopathy, Urea cycle defects).
   • Procedure: Liver Biopsy, TIPSS, ERCP, Capsule endoscopy, Metabolic screening.
6. Storage Diseases
   • Diagnosis: Glycogen Storage disease, Lysosomal storage disease, Tay-Sachs disease, Neimann-Pick disease, Gaucher disease.
   • Procedure: Liver Biopsy, Metabolic screening.
7. Diseases of Gall Bladder
   • Diagnosis: Choledochal cyst, Gall stones, Cholecystitis, Choledocholithiasis.
   • Procedure: ERCP, Liver Biopsy (Percutaneous), Capsule endoscopy, TIPSS.