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Pediatric Abdominal Mass

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1. CRACKCast E095 – Large Intestine

? What are the risk factors for developing each type? In general you can get a volvulus anywhere. Patients can present with a bowel obstruction pattern. Can get: Electrolyte disturbances secondary to third spacing / respiratory compromise from massive abdominal distention If left untreated bowel can get ischemic, gangrenous and perforate. Pearl: Sigmoid volvulus account for 60% of all intestinal volvulus. So if you’re a betting person that’s the most common. Gastric – Not large intestine…we know 2 (...) ….translocation of bacteria..from a compromised bowel can lead to sepsis. Perforation of the bowel wall follows if the process is not interrupted.” – From Rosen’s. In these patients, the rectal exam is crucial – because you may find a hard mass or stool, which may explain the cause for the obstruction! Management: Rehydration Electrolyte replacement Pain and nausea control Antibiotics (if perforated, sick, etc.) Gastric decompression and NPO Surgical consultation 6) What are the four types of GI volvulus

2017 CandiEM

2. Altered intestinal microbiota composition, antibiotic therapy and intestinal inflammation in children and adolescents with cystic fibrosis. Full Text available with Trip Pro

for age and sex. The CFG was subdivided based on the use of antibiotic therapy (CFAB group) and non-use of antibiotic therapy (CFnAB group). The following data were evaluated: colonization, antibiotic therapy, mutation, breastfeeding, use of infant formula, type of delivery, introduction of solid foods, body mass index, fecal calprotectin and intestinal microbiota composition (fluorescence in situ hybridization). Intestinal inflammation evaluated by fecal calprotectin was significantly higher (...) Altered intestinal microbiota composition, antibiotic therapy and intestinal inflammation in children and adolescents with cystic fibrosis. The aim of the present study was to evaluate the effect of cystic fibrosis and antibiotic therapy on intestinal microbiota composition and intestinal inflammation in children and adolescents. A cross-sectional controlled study was conducted with 36 children and adolescents: 19 in the cystic fibrosis group (CFG) and 17 in the control group (CG) matched

2018 PLoS ONE

3. Aneurysmal dilation of bowel mimicking an abscess in pediatric primary gastrointestinal lymphoma Full Text available with Trip Pro

Aneurysmal dilation of bowel mimicking an abscess in pediatric primary gastrointestinal lymphoma Primary gastrointestinal lymphoma, though rare, is the most common gastrointestinal malignancy in children. Signs and symptoms are nonspecific, and include abdominal pain, nausea, emesis, and a palpable abdominal mass. Imaging is therefore typically required to differentiate gastrointestinal lymphoma from other abdominal conditions. We present a pediatric case of primary gastrointestinal lymphoma (...) involving the distal bowel that was initially misdiagnosed as an intra-abdominal abscess. This case highlights the imaging findings of primary gastrointestinal lymphoma, potential pitfalls in imaging diagnosis, and the role of accurate imaging diagnosis in expediting patient management to reduce associated morbidity and mortality.

2018 Radiology Case Reports

4. Multiplex Real-Time PCR Detection of Intestinal Protozoa in HIV-Infected Children in Malawi, Enterocytozoon Bieneusi is Common and Associated with Gastrointestinal Complaints and May Delay BMI (Nutritional Status) Recovery. Full Text available with Trip Pro

-positive children (+0.29 +standard deviation 0.83) than E. bieneusi-negative children (+1.03 +standard deviation 1.25; P = 0.05). E. bieneusi was not detected after 12 months of ART.E. bieneusi was the most prevalent opportunistic intestinal protozoa, present in over a third of study participants before initiation of ART. Although all children cleared E. bieneusi after 12 months of ART, E. bieneusi was associated with gastrointestinal complaints and may delay body mass index recovery. Trials to assess (...) Multiplex Real-Time PCR Detection of Intestinal Protozoa in HIV-Infected Children in Malawi, Enterocytozoon Bieneusi is Common and Associated with Gastrointestinal Complaints and May Delay BMI (Nutritional Status) Recovery. Intestinal protozoa are common opportunistic infections in HIV patients. Longitudinal studies on either the clinical relevance or the effect of immune reconstitution by antiretroviral therapy on intestinal protozoan infections in children are lacking however. This study

2018 Pediatric Infectious Dsease Journal

5. Inflammatory bowel disease and patterns of volatile organic compounds in the exhaled breath of children: A case-control study using Ion Molecule Reaction-Mass Spectrometry. Full Text available with Trip Pro

Inflammatory bowel disease and patterns of volatile organic compounds in the exhaled breath of children: A case-control study using Ion Molecule Reaction-Mass Spectrometry. Inflammatory bowel diseases (IBD) profoundly affect quality of life and have been gradually increasing in incidence, prevalence and severity in many areas of the world, and in children in particular. Patients with suspected IBD require careful history and clinical examination, while definitive diagnosis relies on endoscopic (...) and histological findings. The aim of the present study was to investigate whether the alveolar air of pediatric patients with IBD presents a specific volatile organic compounds' (VOCs) pattern when compared to controls. Patients 10-17 years of age, were divided into four groups: Crohn's disease (CD), ulcerative colitis (UC), controls with gastrointestinal symptomatology, and surgical controls with no evidence of gastrointestinal problems. Alveolar breath was analyzed by ion molecule reaction mass spectrometry

2017 PLoS ONE

6. Conceptual Model of Lean Body Mass in Pediatric Inflammatory Bowel Disease. Full Text available with Trip Pro

Conceptual Model of Lean Body Mass in Pediatric Inflammatory Bowel Disease. Youth with inflammatory bowel disease (IBD) demonstrate deficits in lean mass (LM) placing them at increased risk for future health problems, including reduction of bone mass and impaired bone architecture. Research suggests that deficits in LM are multifactorial, including influences from the disease and its treatment, and health behaviors such as diet and physical activity. Based on a systematic literature review

2018 Journal of Pediatric Gastroenterology and Nutrition

7. [Effect of healthy eating before intervention with a low FODMAP diet in pediatric patients with irritable bowel syndrome]. Full Text available with Trip Pro

with IBS, is able to improve gastrointestinal symptoms of children without following a diet low in FODMAP. Methods: prospective intervention study. Changes in gastrointestinal symptoms were analyzed by means of the Pediatric Quality of Life Inventory™ Gastrointestinal Symptoms (PedsQL™ GI Symptoms), after receiving nutritional education based on a healthy diet. Likewise, anthropometric changes and dietary habits were analyzed. Results: twenty-one patients were included (12 girls) with a mean age (...) [Effect of healthy eating before intervention with a low FODMAP diet in pediatric patients with irritable bowel syndrome]. Background: a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) may be effective in the treatment of pediatric patients with irritable bowel syndrome (IBS). Its complexity and side effects make it a secondary therapeutic alternative. Objective: to demonstrate that nutritional education, aimed at optimizing the diet of children

2019 Nutricion hospitalaria Controlled trial quality: uncertain

8. Michigan cohorts to determine associations of maternal pre-pregnancy body mass index with pregnancy and infant gastrointestinal microbial communities: Late pregnancy and early infancy. Full Text available with Trip Pro

Michigan cohorts to determine associations of maternal pre-pregnancy body mass index with pregnancy and infant gastrointestinal microbial communities: Late pregnancy and early infancy. About 25% of women in the United States are obese prior to becoming pregnant. Although there is some knowledge about the relationship between the gastrointestinal microbiota and obesity, little is known about the relationship between pre-pregnancy obesity and the gastrointestinal microbiota in pregnancy or its (...) impact on infant gut microbiota. However, the composition of the gut microbiota early in life may influence childhood health. Thus, the objective of this research was to identify associations between maternal pre-pregnancy obesity and the pregnancy (n = 39) or early infancy (n = 39) microbiotas.Fecal bacterial communities from overweight women had lower microbiota diversity (Chao1: p = 0.02; inverse Simpson: p = 0.05; Shannon: p = 0.02) than communities from normal weight or obese women. The within

2019 PLoS ONE

9. Childhood body mass index and risk of inflammatory bowel disease in adulthood: a population-based cohort study. (Abstract)

Childhood body mass index and risk of inflammatory bowel disease in adulthood: a population-based cohort study. The increasing incidence of inflammatory bowel disease (IBD) in western countries has led to the hypothesis that obesity-related inflammation could play a role in the etiology of IBD. However, this hypothesis lacks confirmation in studies of individuals prior to the typical onset of IBD in young adulthood.In a cohort of 316,799 individuals from the Copenhagen School Health Records (...) was associated with a significantly decreased risk of UC (HRs = 0.9) and with a significantly increased risk of CD when diagnosed before age 30 (HRs = 1.2). We observed no associations between changes in BMI z-score between 7 and 13 years and later risk of CD or UC.We found a direct association between childhood BMI and CD diagnosed before 30 years of age, and an inverse association between childhood BMI and UC irrespective of age. Our results support the previous hypotheses of obesity being a risk factor

2018 American Journal of Gastroenterology

10. Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin, and school performance. Full Text available with Trip Pro

Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin, and school performance. The World Health Organization (WHO) recommends treating all school children at regular intervals with deworming drugs in areas where helminth infection is common. As the intervention is often claimed to have important health, nutrition, and societal effects beyond the removal of worms, we critically evaluated the evidence on benefits.To summarize the effects (...) are inconsistent, and at risk of bias (mean attendance 2% higher, 95% CI 4% lower to 8% higher; 20,243 participants, two trials, very low quality evidence).In a sensitivity analysis that only included trials with adequate allocation concealment, there was no evidence of any effect for the main outcomes.Treating children known to have worm infection may have some nutritional benefits for the individual. However, in mass treatment of all children in endemic areas, there is now substantial evidence that this does

2015 Cochrane

11. Postoperative outcomes in vedolizumab-treated pediatric patients undergoing abdominal operations for inflammatory bowel disease. (Abstract)

Postoperative outcomes in vedolizumab-treated pediatric patients undergoing abdominal operations for inflammatory bowel disease. Recent studies have found vedolizumab to be an independent predictor of increased rates of postoperative complications and surgical site infections (SSIs) in adults with inflammatory bowel disease (IBD), but studies in the pediatric surgical population are lacking. We sought to determine the 30-day postoperative infectious complication rate among pediatric IBD (...) pediatric patients (5 female) received vedolizumab within 12weeks of an abdominal operation and 36 patients received anti TNF therapy (20 female). There were no differences in the vedolizumab and anti-TNF therapy with regard to sex, median age of diagnosis or operation, IBD type, body mass index (BMI), smoking status, diabetes mellitus (DM), preoperative serum laboratory values, steroid or immunomodulatory use. The number of biologics previously exposed to was significantly higher in the vedolizumab

2017 Journal of Pediatric Surgery

12. Bone Mass Development from Childhood into Young Adulthood in Patients with Childhood-onset Inflammatory Bowel Disease. Full Text available with Trip Pro

Bone Mass Development from Childhood into Young Adulthood in Patients with Childhood-onset Inflammatory Bowel Disease. Children who have inflammatory bowel disease (IBD) have increased risk of low bone mineral density (BMD). There is a scarcity of information on BMD development through puberty and into young adulthood in patients with childhood-onset IBD.We conducted a prospective longitudinal study of BMD in patients with childhood-onset IBD. In total, 74 children with IBD were followed (...) to the standard references. There were no significant differences in the BMD Z-scores between patients with Crohn's disease and patients with ulcerative colitis. The female and male patients showed significantly improved mean lumbar spine BMD Z-scores during follow-up into young adulthood, indicating that bone accumulation in the lumbar spine continues beyond the expected age for achieving peak bone mass.Male patients with childhood-onset IBD seem to have an increased risk of compromised BMD in young

2017 Inflammatory Bowel Diseases

13. Rice Bran and Probiotics Alter the Porcine Large Intestine and Serum Metabolomes for Protection against Human Rotavirus Diarrhea Full Text available with Trip Pro

Rice Bran and Probiotics Alter the Porcine Large Intestine and Serum Metabolomes for Protection against Human Rotavirus Diarrhea Human rotavirus (HRV) is a leading cause of severe childhood diarrhea, and there is limited vaccine efficacy in the developing world. Neonatal gnotobiotic pigs consuming a prophylactic synbiotic combination of probiotics and rice bran (Pro+RB) did not exhibit HRV diarrhea after challenge. Multiple immune, gut barrier protective, and anti-diarrheal mechanisms (...) contributed to the prophylactic efficacy of Pro+RB when compared to probiotics (Pro) alone. In order to understand the molecular signature associated with diarrheal protection by Pro+RB, a global non-targeted metabolomics approach was applied to investigate the large intestinal contents and serum of neonatal gnotobiotic pigs. The ultra-high performance liquid chromatography-tandem mass spectrometry platform revealed significantly different metabolites (293 in LIC and 84 in serum) in the pigs fed Pro+RB

2017 Frontiers in microbiology

14. Small Intestinal Bacterial Overgrowth

. INTRODUCTION Small intestinal bacterial overgrowth (SIBO) has been recognized as a medical phenomenon for many decades. Although its definition has been debated, the principle concept is that the normal small bowel has lower levels of microbial colonization compared with the colon and this normal balance is significantly altered in SIBO. SIBO is defined as the presence of excessive numbers of bacteria in the small bowel causing gastrointestinal (GI) symptoms. These bacteria are usually coliforms, which (...) retrograde movement of colonic contents resulting in colonization of the small bowel with bacteria normally found in the large intestine ( ). Studies in patients with anatomical risk factors from intrinsic causes such as small bowel diverticulosis or fistula formation or iatrogenic consequences such as post–Roux-en-Y, ileocolonic anastomosis, or post–radiation stricture/adhesion formation have all shown a higher prevalence of SIBO ( ). Advanced age and female gender are also associated with a higher

2020 American College of Gastroenterology

15. Interventions for treating distal intestinal obstruction syndrome (DIOS) in cystic fibrosis. Full Text available with Trip Pro

Interventions for treating distal intestinal obstruction syndrome (DIOS) in cystic fibrosis. Cystic fibrosis is the most common life-limiting autosomal recessive genetic disorder in white populations. Distal intestinal obstruction syndrome (DIOS) is an important morbidity in cystic fibrosis. It is the result of the accumulation of viscid faecal material within the bowel which combines with thick, sticky mucus produced in the intestines of people with cystic fibrosis. The intestine may (...) . The mean age of participants was 13.1 years. The trial was a double-blinded, randomised cross-over trial which had a duration of 12 months in total and compared high-dose and low-dose pancreatic enzyme therapy. As only the abstract of the trial was available, the overall risk of bias was judged to be unclear. The trial did not address either of our primary outcomes (time until resolution of DIOS and treatment failure rate), but reported episodes of acute DIOS, presence of abdominal mass and abdominal

2018 Cochrane

16. Interventions for preventing distal intestinal obstruction syndrome (DIOS) in cystic fibrosis. Full Text available with Trip Pro

Interventions for preventing distal intestinal obstruction syndrome (DIOS) in cystic fibrosis. Cystic fibrosis (CF) is the most common, life-limiting, genetically inherited disease. It affects multiple organs, particularly the respiratory system. However, gastrointestinal problems such as constipation and distal intestinal obstruction syndrome (DIOS) are also important and well-recognised complications in CF. They share similar symptoms e.g. bloating, abdominal pain, but are distinct conditions (...) . Constipation occurs when there is gradual faecal impaction of the colon, but DIOS occurs when there is an accumulation of faeces and sticky mucus, forming a mass in the distal part of the small intestine. The mass may partially block the intestine (incomplete DIOS) or completely block the intestine (complete DIOS). Symptoms of DIOS can affect quality of life and other aspects of CF health, such as airway clearance, exercise, sleep and nutritional status. Treatment of constipation and prevention of complete

2018 Cochrane

17. Childhood Body Mass Index is associated with risk of adult colon cancer in men - an association modulated by pubertal change in Body Mass Index. (Abstract)

Childhood Body Mass Index is associated with risk of adult colon cancer in men - an association modulated by pubertal change in Body Mass Index. The relative contribution of childhood and pubertal BMI for the risk of adult colorectal cancer is not known. The aim of this study was to evaluate the independent associations for childhood BMI and pubertal BMI change with risk of colorectal cancer in men.We included 37 663 men born 1946-1961 who had weight and height measured at age 8 (childhood (...) ) and 20 (young adult age) years of age available from the BMI Epidemiology Study (BEST). Information on colorectal cancer was retrieved from the Swedish National Patient Register (257 cases of colon cancer, 159 cases of rectal cancer).Childhood BMI at 8 years of age (Hazard Ratio 1.19 per SD increase [95% Confidence Interval 1.06;1.33]), but not pubertal BMI change (HR 1.02 [0.90;1.15]), was associated with increased risk of colon cancer. Due to a significant interaction between childhood BMI

2019 Cancer Epidemiology & Biomarkers and Prevention

18. Comparison Between Small and Large Bowel Intussusception in Children: The Experience of a Large Tertiary Care Pediatric Hospital. (Abstract)

Comparison Between Small and Large Bowel Intussusception in Children: The Experience of a Large Tertiary Care Pediatric Hospital. Intussusception is the most common cause of intestinal obstruction in young children, and delayed diagnosis may lead to serious sequelae. The objective of this study was to determine the prevalence of ileoileal intussusception and to document and compare clinical outcomes with ileocolic intussusception.A retrospective cohort study of children with an abdominal (...) ultrasound that diagnosed intussusception. Clinical data and diagnostic studies were retrieved, to compare ileoileal with ileocolic intussusception.A total of 488 patients were evaluated with an abdominal ultrasound on suspicion of intussusception; 54 (11%) had ileoileal intussusception and 30 (6%) ileocolic intussusception. The significant features distinguishing the 2 conditions were fever, more common in patients with ileoileal intussusception, and an abdominal mass, which was papable more commonly

2018 Pediatric Emergency Care

19. Mass deworming for improving health and cognition of children in endemic helminth areas: A systematic review and individual participant data network meta?analysis Full Text available with Trip Pro

burden in endemic areas in the updated World Health Organization guidelines, depending on prevalence of worm infection (WHO, ). These updated WHO guidelines cite the Campbell and Cochrane systematic reviews on deworming which both concluded there was little to no effect of deworming on child health outcomes which included growth, anaemia and cognitive outcomes (Taylor‐Robinson et al., ; Welch et al., ). Mass deworming can be applied to school‐aged children or whole communities. Selective treatment (...) might work Even with heavy infections, the nutritional requirements of intestinal worms relative to their human hosts are small. The harm to child welfare is expected to be caused by three factors: (a) malabsorption, (b) tissue damage and bleeding and (c) loss of appetite (Crawley, ). STH infections may cause malabsorption of nutrients in their hosts because of damage to the gastrointestinal surfaces. Hookworm infections are associated with anaemia, thought to be due to hookworm feeding on host

2019 Campbell Collaboration

20. Proteomic Discovery of Stool Protein Biomarkers for Distinguishing Pediatric Inflammatory Bowel Disease Flares. (Abstract)

Proteomic Discovery of Stool Protein Biomarkers for Distinguishing Pediatric Inflammatory Bowel Disease Flares. Fecal calprotectin, the heterodimer of S100A8/S100A9, makes up ∼60% of neutrophil cytoplasmic protein content and is a canonical clinical biomarker of gut inflammation.1,2 Fecal calprotectin is commonly used to diagnose inflammatory bowel disease (IBD) and has an average sensitivity of 93% and specificity of 96%.1 For diagnosing pediatric IBD, calprotectin fecal tests have similar (...) IBD flare and remission but have distinct abundance ranges between each condition. From a pilot cohort of 10 pediatric patients in states of either active disease or remission, we discovered and relatively quantified hundreds of stool proteins. Of these, our mass spectrometry-based study prioritized at least 5 that have potential to augment negative predictive power of mucosal-level inflammation alongside fecal biomarkers such as calprotectin.Copyright © 2019 AGA Institute. Published by Elsevier

2019 Clinical Gastroenterology and Hepatology

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