When should you contact hepatologist Dr Kinisha Patel

Paediatric hepatologist is a super specialist doctor who diagnose and treat liver and biliary diseases
in children.
Liver diseases in children are different than adults as they have varied presentation, as most of them
are progressive from birth or from early infancy.

COMMON SIGNS & SYMPTOMS OF LIVER DISEASE:

  • Jaundice – yellow eyes, skin
  • Dark color urine
  • Change in stool color (Pale yellow or clay or white)
  • Abdominal distension (Fluid in abdomen –ascites)
  • Loss of appetite
  • Itching
  • Pain abdomen (right upper quadrant)
  • Vomiting
  • Blood in vomiting
  • Tarry black color stool

COMMON SIGNS & SYMPTOMS OF PROGRESSIVE CHRONIC LIVER DISEASE:

  • Jaundice
  • Liver &/or spleen enlargement
  • Abnormal behavior
  • Neurological disorientation or other abnormalities with jaundice
  • Nails clubbing
  • Abdominal distention (Ascites)
  • Swelling of limbs
  • Other organ involvement (kidney, lungs)

Role of liver transplant Physician:

  • An expert with experience to manage all children from birth to 18 years of age, who needs liver transplantation along pre & post transplant surgery care (Medical management).
  • To decide when child needs transplant-specific indication other than liver failure How much time we have till liver transplant procedure- to take a decision from advancement of liver disease –whether can be treated medically for longer duration/other option till transplant – supportive management.
  • When transplant is planned – certain contraindication for management like blood transfusion, certain medication use Pre transplant preparations- counselling, documentations, donor & recipient investigations, continuous supportive treatment. To send to correct centre for transplant based on finance, age, weight, emergency, Finance.
  • Post transplant – PICU Care, medical management, immunosuppressant decision, Complication identification & management.
  • Long term follow up care- Regular medications, doses changes, investigations to choose, any complication like rejection, PTLD, Infection, GVHD, surgical complication, drug related complication – to identify correctly & to manage – to contact transplant surgeon (As who has done the surgery must be in loop to know anatomical changes while surgery is been done)

Important Liver Disease

  • Biliary atresia
  • Choledochal cyst
  • Hemochromatosis
  • Viral infection causing liver failure
  • Budd chiari syndrome
  • Metabolic liver disease/In born error of metabolism
  • Neonatal hepatitis
  • PFIC
  • Alagille syndrome

In older children:

  • Autoimmune hepatitis
  • Sclerosing cholangitis
  • Wilson disease
  • Metabolic liver disease
  • Acute liver failure
  • PFIC
  • Viral Hepatitis (A to E)
  • Portal Hypertension
WHAT DOES A PAEDIATRIC GASTROENTEROLOGIST DO

WHAT DOES A PAEDIATRIC GASTROENTEROLOGIST DO?

Paediatric gastroenterologist is a specialist doctor who diagnose and treat gastrointestinal disorders
in children. Gastrointestinal system includes organs like esophagus (food pipe), stomach, intestine (small and large), pancreas, liver, biliary system (gall bladder and biliary tree), rectum and anus. Any disorder related to above organs present with various signs and symptoms.

Children are not small adults. Gastrointestinal disorders’ presentation are different in children than
adults so they need consultation from Paediatric gastroenterologist.

COMMON SIGNS AND SYMPTOMS OF GASTROINTESTINAL DISORDER

  • Pain abdomen
  • Vomiting
  • Diarrhea
  • Blood in stool
  • Constipation
  • Abdominal distension or mass
  • Anorexia (loss of appetite)

These are some common presentations for gastrointestinal disorders. There are other causes also for above symptoms so need specialist consultations for correct diagnosis and management. Few symptoms can be due to functional disorders. Functional disorders mimic pathological condition’s symptoms but requires certain investigations to rule out.

WHEN SHOULD YOU CONSULT PAEDIATRIC GASTROENTEROLOGIST?: 
If your child is having any of the symptoms as given below, you should consult Paediatric gastroenterologist:

  • Recurrent vomiting
  • Chronic diarrhea (Diarrhea lasting more than 2 weeks)
  • Chronic constipation
  • Recurrent abdominal pain
  • Unexplained not gaining height & weight
  • Feeding difficulties (Regurgitation of food, difficulty in swallowing, painful swallowing)
  • Suspected any food allergy (Symptoms like rash, vomiting, loose stool after ingestion of specific food or milk)
  • Palpable abdominal mass or unusual abdominal distension
  • Blood in stool
  • Blood in vomiting
  • Foreign body (coin, pin, button battery, sharp object etc.) ingestion