Bøger af Rania Ben Rabeh

Autoimmune hepatitis (HAI) is a rare chronic inflammatory disease of the liver in children. A simplified diagnostic score was proposed by the International Auto-immune Hepatitis Group (IAIHG) in 2008. The diagnosis of HAI is based on clinical, immunological and histological criteria. Liver biopsy (LP) is an essential examination for the diagnosis of HAI. Histological criteria help confirm the diagnosis and guide treatment. The presence of interface hepatitis and plasma cells within this infiltrate are important diagnostic features, but are not specific. PBF can also be used to assess the presence of fibrosis, which is quantified using the METAVIR score. The IAIHG score helps clinicians make the diagnosis. Use of the HAI 2008 simplified diagnostic score could contribute to early diagnosis, particularly in forms of chronic hepatitis. Despite moderate specificity, it is preferable to over-diagnose while awaiting review, and prescribe corticosteroid therapy, rather than let the child progress to liver cirrhosis.

Cow's milk protein allergy (CMPA) is a frequent pathology that ranks among the three most common food allergies in children and involves IgE-mediated, non-IgE-mediated or mixed immunological mechanisms. These mechanisms are at the origin of various clinical manifestations. Its treatment is based on the avoidance of cow's milk proteins. The disease is cured in 60 to 70% of cases by the age of two years. The acquisition of tolerance to VMP is sought by the oral reintroduction of cow's milk test (OPT). The clinical signs of CMPA are not specific. In delayed forms, the clinical signs are dominated by digestive signs. The VLP avoidance regimen is essentially based on breastfeeding and cow's milk protein hydrolysates, the cost of which remains high. Primary prevention of VLP is based on exclusive breastfeeding for the first 4-6 months, without the mother following a specific diet.

Variceal bleeding is the most feared complication of portal hypertension (PH) in children. Digestive hemorrhage (DH) from ruptured esophageal (VO) or gastric (VG) varices is a pediatric emergency because it can threaten the child's vital prognosis. In this work we present the results of a retrospective study conducted in a Tunisian pediatric hepatology unit. The objective of this study was to describe the management of children presenting with ruptured OV or LV and to recall the principles of this management and the contribution of upper GI endoscopy in the treatment. PH was secondary to liver cirrhosis (54%) or portal cavernoma (46%). Hemorrhagic shock was noted in 21% of cases. Upper GI endoscopy (UGI) showed VO grade 1, 2 and 3 in 8%, 61% and 31% of cases respectively. LVs were objectified in 12% of cases. Elastic ligation of the VOs was performed in 27% of cases. Only one patient had LV obturation by biological glue. HRE is of diagnostic and therapeutic interest in HD due to VO or LV rupture in children.