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The IX t h Makassed Medical Congress - American University of Beirut

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EXPLORATION OF AN HEPATOMEGALY<br />

Florence Lacaille MD<br />

<strong>The</strong> liver is palpable beneath the costal rib only in infants.<br />

<strong>The</strong> span is measured clinically by palpation and percussion, and can be controlled by<br />

ultrasonography.<br />

<strong>The</strong> characteristics are defined: normal, firm, hard, s<strong>of</strong>t; painful or not.<br />

Other symptoms <strong>of</strong> liver disease are looked for.<br />

<strong>The</strong> complete interview and examination is completed by the first line <strong>of</strong> tests:<br />

- Ultrasonography<br />

- AST and ALT<br />

- Alphafoetoprotein<br />

<strong>The</strong> cause can be a:<br />

- tumour<br />

o cancer : especially hepatoblastoma in young children<br />

o benign : focal nodular hyperplasia in teenage girls<br />

- acute or chronic liver disease<br />

o acute viral hepatitis<br />

o cirrhosis<br />

o congenital hepatic fibrosis<br />

- metabolic liver disease<br />

o glycogen storage disease<br />

- infection<br />

o hydatid cyst<br />

- heart failure : in infants<br />

- vascular disease : Budd-Chiari syndrome<br />

<strong>The</strong> first tests allow for a specific orientation, and the diagnosis <strong>of</strong> emergencies (cancer, heart<br />

failure) and further specialized explorations.<br />

PEDIATRIC GASTROENTEROLOGY HEPATOLOGY AND NUTRITION<br />

Firas Semaan MD<br />

How should Helicobacter pylori infected children be managed?<br />

It is now recognized that Helicobacter pylori, like most enteric infections, is mainly acquired in<br />

Childhood. <strong>The</strong> findings in a number studies suggest that infection is acquired before the age <strong>of</strong><br />

five. <strong>The</strong> prevalence <strong>of</strong> infection is highest in children in the developing world where up to 75% <strong>of</strong><br />

children may be infected by the age <strong>of</strong> 10. In the developed world the prevalence <strong>of</strong> infection<br />

is noticeably increased among socially deprived children.<br />

<strong>The</strong> diagnosis <strong>of</strong> H pylori infection in childhood is most <strong>of</strong>ten made at endoscopy, for which there<br />

are many indications. Symptoms such as abdominal pain, vomiting, and haematemesis may be<br />

associated with duodenal ulcer and H pylori infection.<br />

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