Liver is a vital organ with its multitude of functions, especially in children in whom it plays a crucial role in digestion. The portal circulation rich with nutrients absorbed from the small intestines is also a portal to infection from the outside world through contaminated food. The pediatric population suffers the most due to the complications of infection primarily, hepatic abscess. The outcomes depend on timely intervention and appropriate management. This article aims at highlighting some of the aspects of established and evidence based treatment strategies. The similar clinical presentation of the two types of liver abscess was a major hurdle in managing this curable yet perilous disease. The identification of the infectious etiology and abscess morphology is the key in determining the appropriate therapy. Invasive intervention while having multiple risks become inevitable if the disease is not treated on time. Hence a targeted approach tangible by early clinical diminution of the severity of the disease is the mainstay of treating any kind of hepatic abscess. We validate the best approach while highlighting the diagnostic sequence and treatment algorithm from different settings. The efficacy of antibiotic therapy combined with invasive drainage had proved the most successful in larger liver abscess while monotherapy with antibiotics remained adequate for others. The outcome with respect to time was variable.
NAFLD; Non alcoholic fatty liver disease is accumulation of excessive fat in liver. It progress to inflammation and cirrhosis. Ethnic differences and clinical heterogeneity regarding NAFLD is well known. More children are getting diagnosed. Multiple factors are involved in pathology of NAFLD. This review focuses on diagnosis of NAFLD children based on available guidelines and literature. Clinical approach to NAFLD is suggested.
Clinicopathological Conference Report
DOI: 10.5005/jp-journals-11009-0026 |
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Udawat DP, Bhandari DA, Devpura DK, Mehta DA. A Rare Association of Celiac Disease with Gastric Antral Vascular Ectasia and Budd-Chiari Syndrome. Ann Pediatr Gastroenterol Hepatol 2019; 1 (3):36-40.
We are reporting a case of 11 year girl with Budd-Chiari syndrome (BCS) & gastric antral vascular ectasia (GAVE) occurring in a patient with celiac disease, who presented with symptoms of abdominal distension, easy fatigability, pallor for one year and shortness of breath for 2 days prior to admission. Initial assessment revealed the presence of severe pallor and splenomegaly. Blood investigation showed pancytopenia and USG abdomen with doppler was suggestive of portal hypertension. On routine endoscopy, she was found to have antral nodularity, GAVE, changes of portal hypertensive gastropathy and duodenal nodularity in first and second part of duodenum. Suspecting celiac disease, she was investigated further. Her serum IgA antitissue transglutaminase antibody titers were elevated (> 100 units/mL) and duodenal biopsy was suggestive of celiac disease. She showed functional deficiency of protein C and protein S. There was narrowing of inferior vena cava as the possible cause of portal hypertension. Patient was kept on gluten free diet (GFD) and GAVE completely resolved in 6 months. Literature on BCS with celiac disease is present but associated GAVE is interestingly rare finding. We are reporting first case of GAVE with celiac disease in India.