Day 10 Pediatric Gastroenterology Endoscopic Theater

Patient 1: Recurrent helicobactor pylori- gastritis
Second treatment levofloxin strong new agent resistant to hp
30% pop here have it, but not all have problems.
General Anesthesia: propofol.
Duodenal valve enters CE, stomach,esophagus
Urea CLOtest...put biopsy in it.(clostridium like that's why they call it CLO).
Europe says to do endoscopy first, Israel treats first. 
Possible ibd inflammatory bowl 14yr old girl disease terminal ileus?
Crohns or uc
Inflammatory markers, iron deficient, seen in crohns disease
And pain over months in waves 
Intermittent diarrhea, Decreased energy, celiac negative, weight loss, ect.

Difference between Crohn's disease and UC is location and depth
Crohns is whole depth of intestine
Uc only mucosa, sub musosa, 
Crohns causes cancer of small bowl, 
Large bowl both cause cancer, 
Crohns has skip lesion

Uc micro ulcers
Iliocecal most common in crohns, terminal ileitis. 
Cramping if small intestine, large bowl diarrhea.
Check raised crp esr, 
Stool sample of wbc
Calprtotectin s100 inflammatory white cells can check
Endo and colonoscopy
patient had anal Skin tags 
No fiber no solid food three days prior colonoscopy

Give antibiotics: flagyl for study. And azithromycin
Normal colon, inflammed IC valve, and terminal ileum, 

Patient 2: Celiac disease, young boy
Duodenal bulb flattens so take sample
Celiac serology negative sensitivity 95-97% except for 2 yr olds.
Could be gastritis 

Treated twice for hp, still has pain although hp gone.
Esophageal polyp.
Mild gastritis
Could still be hp although urease negative or could just be psychosomatic complainer.
Belly pain
Lancon ppi has not helped.
Focal epigastric pain for a month, missing school...could be stones or many possibilities.
Normal esophagus, stomach, duodenum, biopsies taken.
Boy, mouth sores, fever, belly pain, 
Mild crp elevated.
Could be mild crohns disease? 
Gastro and colonoscopy.
In kids usually upper GI crohns
Upper not inflammed
Checking colon
Lymphatic nodules are normal in terminal ileum around villi

Lost weight
Aphoid small ulcers half mm or lass with red halo not seen.
Looks normal
Was tested for fmf- familial episodic fevers- negative. This genetic disorder is only in Israel in the Jewish population.
Reflux despite prylosect ppi
Gastroscopy
Lost 12 kilos in a month
Non acid reflux.
Eosinophillic esophagutis-has reflux symptoms,,,would see furrows and longitudinal fissurs, but had none.
Has hp-tested positive.
Treat hp
Dyspesia correlation? Hp does/ does not cause dyspepsia?

Patient 3: gastroscopy
Ketolamine, propofol
Belly pain, 
No inflammation found on procedure.

Patient 4: 9 month old with bile duct atresia.

Had no bile duct, surgery to attach liver to intestine ,now there is a two Way flow of bacteria because usually the ampulla of vater stops the flow of bacteria to liver.
Use prophylaxis antibiotics.
Ascending cholengitis

Patient 5: Hirschsprung's Disease 
Distended belly
Air fluid levels, standing shows levels better.
No air lower bowl-means no Hirschsprung's disease. 

http://www.aafp.org/afp/2006/1015/p1327.html