Quick-Review Tables in Pediatric Gastroenterology & Hepatology

Aug 21, 2025

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Table 1: Cross-reactivity in Ig E-mediated food allergy

Table 2: Pathophysiology of Diarrhea in General

Table 3: Assessment of Dehydration

Table 4 : Hot: Recently Identified Genes Associated with IBD

Table 5 : Pediatric ulcerative colitis activity index

Table 6 : HD Vs Functional Constipation

Table 7 : Tests which Check for Synthetic Function of the Liver

Table 8 : Summary – Comparison Between CN 1, CN 2, and Gilbert Syndrome

Table 9 :Stages of Hepatic Encephalopathy

Table 10 :PFIC ( Progressive Familial Intrahepatic Cholestasis)

Table 1: Cross-reactivity in Ig E-mediated food allergy

Food Family	Risk of Allergy to 1 member (%; approximate)
Legumes	5
Tree nuts (e.g. almond, cashew, hazelnut, walnut, Brazil)	35
Fish	50
Shellﬁsh	75
Grains	20
Mammalian milks	90
Rosaceae (pitted fruits)	55
Latex-food	35
Food-latex	11

Table 2: Pathophysiology of Diarrhea in General

OSMOTIC DIARRHEA	SECRETORY DIARRHEA
Due to the presence of undigested/ unabsorbed osmotic substances in the gut lumen.	Due to the active secretion of water, electrolyte or both,due to bacterial/viral toxins
Moderate volume of stools	Large volume of stools
Reduces with fasting	No effect of fasting
The stool of the osmolar gap is ≥ 100 mOsm/L.	The stool of the osmolar gap is < 50 mOsm/L.

Table 3: Assessment of Dehydration

Parameter	No dehydration	Some dehydration	Severe dehydration
The clinical or mental status of the child	The child is active and alert.	The child is irritable and restless.	The child is lethargic or comatose (unconscious).
Eyes of the child	Normal	Sunken	Very sunken and dry
Tears of the child	Present	Absent	Absent
Oral mucosa of the child (tongue, mouth, and lips)	Wet	Dry	Very dry (parched)
Thirst	The child is not thirsty and drinks normally.	The child is thirsty and drinks eagerly.	The child is unable to drink.
Skin pinch test	Wrinkles go back quickly or immediately.	Wrinkles go back slowly.	Wrinkles go back very slowly, or there is tenting of the skin (it does not go back at all).

Table 4 : Hot: Recently Identified Genes Associated with IBD

Gene	Name and function	Associated
NOD2	Nucleotide binding oligomerization domain containing protein 2- Involved in innate immune responses	Crohn's disease
IL10	Codes for IL-10; Involved in immune tolerance	Crohn's disease
IL10RAIL10RB	IL-10 Receptors, Involved in immune tolerance	Crohn's disease
IL23R	Receptor for 10-23; Part of Th-17 Pathway	Crohn's disease
TKY2	Tyrosine Kinase-2, Part of Th17 Pathway	Crohn's disease Ulcerative colitis
IRMG	Immunity-related GTPase M; Role in Autophagy	Crohn's disease
ATG16L1	Autophagy related 16 like 1; Role in Autophagy	Crohn's disease
SLC22A4	Solute carrier family 22 members 4; A Solute Transporter	Crohn's disease
CCL2	C-C motif chemokine ligand 2; Monocyte Chemotaxis	Crohn's disease
CARD9	Caspase recruitment domain family member 9; Involved in oxidative stress and apoptosis regulation	Crohn's disease Ulcerative colitis
IL2	IL-2; T-Cell Regulation	Crohn's disease
MUC19	Mucin-19; Role in epithelial barrier formation	Crohn's disease Ulcerative colitis

Table 5 : Pediatric ulcerative colitis activity index

Items	Points
1. Abdominal pain		4. Number of stool per 24 hr
No pain	0	0-2	0
Pain can be ignored	5	3-5	5
Pain cannot be ignored	10	6-8	10
2. Rectal bleeding		>8	15
None	0	5. Nocturnal stool (any episode causing awakening)
Small amount only, in less than 50% of stools	10	No	0
Small amount in more than 50% of stools	20	Yes	10
Large amount, (> 50% of stool content)	30
3. Stool consistency of most stools
Formed	0	6. Activity level No limitation of activity	0
Partially formed	5	Occasional limitations of activity	5
Completely unformed	10	Severe restricted activity	10
		Sum of PUCAI: 0-85

Table 6 : HD Vs Functional Constipation

	HD (< 1)	Functional Constipation (> 1)
Passage and meconium	Delayed	Normal
Onset	< 1 year age	> 1 year age (Nelson - > 2 year)
Encoprasis and stool withholding	No	Yes
FTT	Yes	No
Enterocolitis	Yes	No
Abd. Distension	Yes	No
DRE	Empty rectum Gush of liquid stools on withdrawal of fingers	Stool + in rectum
Barium enema	Recto sigmoid Ratio < 1 Transition Zone +	Recto sigmoid Ratio > 1 Transition Zone -
RAIR	No	Yes
Rectal Biopsy	No Ganglion cells	Ganglion cells

Table 7 : Tests which Check for Synthetic Function of the Liver

	Blood						Stool	Urine
Type of jaundice	Hct	Unconjugated Bilirubin (Indirect)	Conjugated Bilirubin (Direct)	Alkaline phosphatase	Aminotransferases	Cholesterol	Color	Bilirubin	Urobilinogen
Hemolytic	↓	↑↑	N	N	N	N	N	0	↑
Gillbert’s syndrome	N	↑	N	N	N	N	N	0	N or ↓
Abnormal conjugation	N	↑	N	N	N	N	N	0	N or ↓
Hepatocellular damage	N	↑	↑	↑↑	↑↑	N	N	↑	↑
Obstructive Detective excretion	N	N	N	N	N	N	N	↑	N
Intrahepatic cholestasis	N	N	↑	N	N	N or ↑	Pale	↑	↓

Table 8 : Summary – Comparison Between CN 1, CN 2, and Gilbert Syndrome

	Crigler-Najjar Syndrome
Feature	Type I	Type II	Gilbert’s Syndrome
Total Serum bilirubin, µmol/L (mg/dL)	310-755 (usually > 345) (18-45) (usually > 20)	100-430 (usually ≤ 345) (6-25)(usually ≤ 20)	Typically ≤ 70 µmol/L (≤ 4 mg/dL in absence of fasting or hemolysis
Routine liver tests Response to phenobarbital Kernicterus Hepatic histology	Normal None Usual Normal	Normal Decrease bilirubin by > 25% Rare Normal	Normal Decreases bilirubin to normal No Usually normal: Increased lipofuscin pigment in some
Bile characteristic Color Bilirubin fractions	Pale or colorless> 90% unconjugated	PigmentedLargest fraction (mean: 57%) monoconjugates	Normal dark color Mainly deconjugates but monoconjugates increased (mean: 23%)
Bilirubin UDP-glucuronosyltransferase activity Inheritance (all autosomal)	Typically absent: Traces in some patient Recessive	Markedly reduced: 0-10% of normal predominantly recessive	Reduced: Typically 10-33% of normal Promoter mutation: Recessive Missense mutations: 7 of 8 dominant; 1 reportedly recessive

Table 9 :Stages of Hepatic Encephalopathy

Stage	Symptoms	Signs	EEG ﬁndings
Stage I	An altered sleep-wake cycle, alternating lethargy, euphoria, and apparent normalcy is found in some children.	Trouble drawing simple ﬁgures and cannot perform age-related mental tasks and calculations.	Normal EEG
Stage II	Drowsiness, disorientation, inappropriate behavior, agitation, and mood swings (Abnormally valid behavior).	Asterixis (ﬂapping tremors), Fetor hepaticus, and bladder and bowel incontinence.	Generalized slow rhythm
Stage III	Stupor but arousable and incoherent speech.	Asterixis, rigidity, hyperreﬂexia and extensor reﬂexes.	Triphasic waves
Stage IV	Onset of comaIVa: Responds to painful stimuliIVb: No response	Absence of asterixis, Arelfexia and ﬂaccidity.	Marked slowing of EEG, delta waves will appear, and in terminal areas, electrocortical silence.

Table 10 :PFIC ( Progressive Familial Intrahepatic Cholestasis)

PFIC 1	PGIC 2	PFIC 3
Inheritance	Autosomal recessive
Chromosome	18q21-22	2q24	7q21
Gene	ATP8B1	ABCB11/BSEP	ABCB4/MDR3
Protein	FIC1	BSEP	MDR3
Location	Hepatocyte, colon and intestine	Hepatocyte canalicular membrane
Function	ATP-dependent aminophospholipid flippase is involved in transporting phosphatidyl serine across the plasma membrane.	ATP-dependent bile acid transport	ATP-dependent phosphatidylcholine translocation
Phenotype	Progressive cholestasis, Diarrhea , Steatorrhea, Growth failure, Severe pruritis	Rapidly progressive cholestatic giant cell hepatitis , Growth failure, Pruritis.	late-onset cholestasis Portal hypertension, Minimal pruritis, Intraductul and gallbladder lithiasis
Histological features	Initial bland cholestatic; coarse, granular canalicular bile on electron microscopy	Neonatal giant cell hepatitis and amorphous canalicular bile on EM	The proliferation of bile ductules periportal fibrosis, eventual biliary cirrhosis
Biochemical features	Normal serum GGT; bile acid concentration is high in serum and low in bile secretion		Elevated serum GGT Low to absent biliary PC Absent serum LPX Normal bile concentration in bile secretion.
Treatment	Biliary diversion Ileal exclusion Liver transplantation with postoperative diarrhoea, steatorrhea, and fatty liver.	Biliary diversion Liver transplantation	Liver transplantation UDCA, if residual PC secretion

Also read: NEET SS Pediatric Neonatology Important Topics

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