Chapter 22. Approach to Abdominal Masses 217
FIGURE 22.7. Sixteen-year-old female with (a) a large abdominal mass, (b) with a heterogenous appearance on CT scan, (c) resected via a laparotomy with a mixed solid and cystic appearance which was determined to be an ovarian teratoma on pathology.
Suggested Readings
1.Golden CB, Feusner JH. Malignant abdominal masses in children: quick guide to evaluation and diagnosis. Pediatr Clin North Am. 2002;49(6):1369-1392.
2.Seidel FG. Imaging of a pediatric abdominal mass. Semin Surg Oncol. 1986;2(3):125-138.
3.Kaste SC, McCarville MB. Imaging pediatric abdominal tumors. Semin Roentgenol. 2008;43(1):50-59.
4.Caty MG, Shamberger RC. Abdominal tumors in infancy and childhood. Pediatr Clin North Am. 1993;40(6):1253-1271.
5.Pearl RH, Irish MS, Caty MG, Glick PL. The approach to common abdominal diagnoses in infants and children. Part II. Pediatr Clin North Am. 1998;45(6):1287-1326.
Chapter 23
Gastro-Esophageal Reflux
Disease
David I. Campbell
Key Points
››Gastro-esophageal reflux disease (GORD) may present in a variety of ways and the presentation may vary according to age.
››Simple GORD may be treated empirically depending on age of the child.
››Troublesome GORD will require investigations such as endoscopy and pH run or a contrast study.
››Severe GORD is oftern associated with cow’s milk protein intolerance in children.
23.1 Introduction
Consider infants and young pre-school children as different from older children. The vomiting child is very obvious, but the consequences of reflux esophagitis can be marked with a lesser grade of reflux (GORD without vomiting) (Tables 23.1 and 23.2).
P.P. Godbole et al. (eds.), Guide to Pediatric Urology and |
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Surgery in Clinical Practice, DOI: 10.1007/978-1-84996-366-4_23,
© Springer-Verlag London Limited 2011
220 D.I. Campbell
TABLE 23.1. Consider differential diagnoses in suspected GORD with the following components of GORD. Presentation and differential diagnosis of GORD in young children.
Profuse vomiting |
3 months pyloric stenosis |
|
(dry FTT, inexorable history). |
|
UTI |
|
Raised intracranial pressure |
|
Metabolic diseases |
Failure to Thrive |
Due to calorie loss (i.e., vomiting, |
|
see above) |
|
Due to insufficient calorie intake |
|
(i.e., feed aversion (see below)). |
|
General medical clerking to identify |
|
other body systems involved. |
|
Always consider Cystic Fibrosis, |
|
coeliac in the weaned child and |
|
neglect. |
Feed aversion |
GORD may be co-existent with |
|
milk allergy |
|
Any cause of feed induced pain |
|
(peptic ulcer, small bowel stricture |
|
or ulcer, esophagitis) |
Feeding problems |
Neurological problems such as |
(Gagging or choking) |
CP/bulbar or pseudobulbar palsies |
Hematemesis |
Esophageal varices |
|
Peptic ulcer |
|
Swallowed blood (pharyngitis |
|
or cracked nipples in breast fed |
|
babies) |
Poor sleep |
Raised intracranial pressure |
Sandifer Syndrome |
Dystonia syndromes, epilepsy |
|
(rare situations) |
Drooling |
Causes of hypotonia |
Colic and abdominal pain |
UTI, constipation, milk allergy |
|
(often co-exists with GORD) |
Chest infections |
Cystic fibrosis |
|
Primary immunodeficiency |
|
|