Science and Profession (Magill’s Medical Guide, Sixth Edition)
The pediatric gastroenterologist is a pediatrician who has received extra training in the diagnosis and treatment of gastrointestinal diseases and disorders. The full course of training requires a medical degree followed by three years of pediatric residency, plus an additional three years of solely studying children’s gastrointestinal diseases. The six years of postdoctoral training are almost always conducted at a large teaching hospital.
The gastrointestinal tract extends from the mouth to the anus. It is responsible for the ingestion, digestion, and absorption of food and for the elimination of unusable waste from the diet. Its principal parts are the esophagus, the stomach, the small intestine and colon, and the liver, gallbladder, and pancreas.
Children suffer the same wide range of gastrointestinal problems that afflict adults. Each age group, however, has its own special problems. For example, children very rarely have stomach or colon cancer, both relatively common in adults. On the other hand, diarrhea is a very common cause of infant death worldwide but is seldom life-threatening for adults.
Childhood gastrointestinal disease varies widely in its severity, from simple constipation needing only a change in diet to liver disease so severe that the child must undergo a liver transplant in order to survive. Common problems that a pediatric gastroenterologist might treat include gastroenteritis,...
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Diagnostic and Treatment Techniques (Magill’s Medical Guide, Sixth Edition)
Much of the pediatric gastroenterologist’s work involves obtaining a thorough, detailed history of the ailment from the child and parent. Often, skillful questioning will lead to the proper diagnosis and suggest the best treatment. A careful physical examination of the entire child, not simply the abdomen, is also important.
The pediatric gastroenterologist conducts a wide variety of laboratory tests in evaluating the nature and severity of the illness, such as complete blood counts and liver enzyme measurements. Bowel movement specimens often provide important data, such as the presence of blood or infectious bacteria in the intestines.
The pediatric gastroenterologist performs several diagnostic and therapeutic procedures. Flexible endoscopy is the use of a thin, bendable tube of optic fibers to view the interior of the esophagus, stomach, or colon. The physician can obtain biopsies, small samples of gastric or intestinal tissue, through the endoscope and can remove benign intestinal growths called polyps. The gastroenterologist may place a pH probe, a small electrode on a wire, in the esophagus to test acidity levels for periods as long as twenty-four hours. This probe is used to monitor acid reflux from the stomach into the esophagus. This disease, called gastroesophageal reflux, can lead to weight loss, recurrent pneumonia, or a scarred esophagus if left untreated.
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
Subspecialties of pediatrics began to be recognized in the middle of the twentieth century. The first organization for pediatricians interested in gastroenterology was formed in the early 1970’s.
In adult gastroenterology, diagnostic tools such as endoscopy and therapies such as antirejection medications for transplantation procedures improved rapidly in the last quarter of the twentieth century. Taking advantage of this new knowledge, pediatric gastroenterologists were also able to diagnose accurately more disorders in their own patients and to treat them effectively.
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Cunningham, Carin L., and Gerard A. Banez. Pediatric Gastrointestinal Disorders: Biopsychosocial Assessment and Treatment. New York: Springer, 2006. Discusses the prevalence and etiology of pediatric gastrointestinal disorders. Covers psychological and behavioral symptoms, treatment strategies, and case studies.
Kirschner, Barbara S., and Dennis D. Black. “The Gastrointestinal Tract.” In Nelson Essentials of Pediatrics, edited by Richard E. Behrman and Robert M. Kliegman. 5th ed. Philadelphia: Saunders/Elsevier, 2006. A chapter in a great text for medical students rotating through pediatrics. It has thorough explanations of diseases and treatments.
Walker, W. Allan, et al., eds. Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. 4th ed. Lewiston, N.Y.: B. C. Decker, 2004. This reference textbook deals extensively with the pathophysiologic basis of gastrointestinal disease in children of all ages. An approach to dealing with the families of children with gastrointestinal diseases augments the in-depth approach to disease manifestations and management. A careful approach to diagnosis follows.
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