On this page you will find the
Explanations of the specialist services of the departments
Hepatology (Liver conditions)
Complex Nutrition conditions
Specialised investigations (tests) and treatments/procedures:
The Department of Gastroenterology and Clinical Nutrition
Our department provides specialist care for children and teenagers with diseases of the digestive system. We provide diagnosis and treatment of diseases of the gut, which can affect one or many parts of the gastrointestinal tract.
- Bile ducts and gallbladder
- Small intestine
- Large intestine
How can we help?
The Department provides a number of specialised services that are described below. You may be referred to be seen in the clinic, or be admitted to hospital for a specialised test or treatment.
- Acute liver failure: Is a medical emergency that causes rapid deterioration of liver function and damage of liver cells. There are multiple causes such as infection or medication overdose.
- Alagilles syndrome: Is a genetic syndrome that causes the bile ducts inside the liver to be small and abnormal, it is also associated with problems in other parts of the body such as eyes, heart and blood vessels.
- Alpha-1-antitrypsin deficiency: This is a genetic disorder that causes abnormal production of the protein alpha-1 antitrypsin. Because the protein is developed abnormally, it can get ‘stuck’ in the liver cells, causing damage to the liver cells. There
are different types of alpha-1 antitrypsin deficiency, some of these cause little or no damage to the liver, and others cause much more damage to the liver.
- Autoimmune hepatitis: This is a chronic disease of the liver caused by the body’s own immune system to attack the liver cells, causing the liver to be inflamed and damaged.
- Biliary atresia: Is a rare disease in newborn infants where the bile ducts inside and outside the liver become damaged and sometimes completely blocked. The cause of the damage is unknown.
- Cirrhosis: Scarring of the liver that can be caused by many diseases.
- Fatty liver disease: Is a build-up of excess fat in the liver cells, which can damage the liver.
- Hepatitis: Hepatitis literally means ‘liver inflammation’. It can be caused by infections from viruses (such as hepatitis A, B or C), alcohol, drugs, and occasionally immune cells in the body attacking the liver and causing autoimmune hepatitis.
- Hirschprung’s disease: Is abnormal development of nerve cells of the colon, and sometimes in some of or all of the small and large intestine. Having no nerve cells results in the bowel being unable to use nerves to move digested food through
- Metabolic liver diseases:
Metabolic liver diseases are genetic disorders in which abnormal chemical reactions in the body controlled by the liver, disrupt the body’s normal metabolism.
- Oesophageal varices: Dilated veins in the oesophagus. The walls of the vein are thin, and therefore they have a high risk of bleeding.
- Primary sclerosing cholangitis: Is a disease that causes inflammation of the bile ducts both inside and outside the liver, the inflammation of the bile ducts continues until the bile ducts are scarred and damaged, leading to liver damage.
- Viral hepatitis: Inflammation of the liver caused by a virus.
- Wilson's disease: Is a rare genetic metabolic disorder where copper is not excreted properly from the body, causing copper to build up in the liver and other areas of the body such as the brain. Excess copper in the liver can cause liver damage and failure.
Complex nutrition conditions
- Chronic intestinal
pseudo-obstruction: It is a rare disorder of abnormalities in the normal involuntary coordinated muscular contractions (peristalsis) of the gastrointestinal tract
- Intestinal failure: Occurs when a person’s intestines can’t digest food and absorb the fluids, electrolytes and nutrients required for normal growth. It can be caused by many different diseases.
- Gastroschisis: Is a birth defect of the abdominal wall, where the newborn’s intestines are outside of the body through this hole in the abdominal wall.
- Short-gut syndrome: It is a condition of food malabsorption related to disease or the surgical removal of a large portion of the small intestine.
Investigations and procedures
Gastroscopy – Under anaesthesia, an endoscope (narrow flexible tube with a small camera and light on the end) is inserted into the mouth to
examine the oesophagus (swallowing tube), stomach and duodenum (first part of the small intestine). Biopsies are taken to be examined under the microscope by a pathologist.
Colonoscopy – Prior to this procedure, instructions will be given for bowel prep to clean the colon. Under anaesthesia, an endoscope is inserted into the anus to examine the whole colon and if possible the ileum
(last part of the small intestine) and biopsies are taken.
Bowel washout brochure for families
Dilatation of Strictures – A narrowing of the gut is visualised with an endoscope and a very narrow balloon is place at the narrowing via the endoscope. The balloon is carefully inflated under vision to stretch the narrowing
of Foreign bodies – foreign objects that have passed beyond the reach of the surgical team can be retrieved by endoscopy
of Oesophageal Varices – Children with chronic liver disease may develop abnormally swollen blood vessels around the oesophagus. These can be treated endoscopically by applying a special band to occlude the vessel or in certain circumstances to inject a chemical into the vessel to occlude it
- Polypectomy – In rare cases, children may develop polyps that can be removed at endoscopy and sent to a pathologist for examination
injection – Botulinim toxin can be injected into muscles to relax them and prevent them from contracting. If a part of the muscle of the GI tract is too tight and cannot relax properly to allow food to pass through, botox may be injected by endoscopy
- ERCP – Endoscopic retrograde cholangio pancreatography, is a technique to access the bile and pancreatics ducts, the tubes that connect the liver and pancreas to the intestine. When the ducts are accessed, dye can be injected to look for any abnormalities, narrowings or obstructions
and balloons or stents can be used to treat any obstruction
Transhepatic Cholangiogram – PTC is another technique for accessing the bile ducts using a needle passed into the liver. Again, dye can be used to look at the ducts, and balloons and stents can treat obstructions
– A specialised ultrasound machine that sends sound waves into the liver to estimate how stiff or scarred it may be.
Biopsy – Under anaesthesia, and using ultrasound guidance, a specialist Radiologist uses a needle to take a tiny sample of the liver to send for examination by a pathologist.
Procedures relating to Liver disease
transplantation - The liver transplant team is made up of Clinical Nurse Specialists, Gastroenterologists, Liver Transplant Surgeons from the Austin Hospital as well as a team of allied health professionals and junior doctors. Children with severe liver
disease may be undergo the process of being work-up for and listed for transplantation, which takes place at the Royal Children’s Hospital.
Information for families:
Food saftey after transplantation
Dilatation / Stents – Abnormalities, narrowing or obstruction of the bile ducts can be treated with balloons or stents as described above
or Angiography of Liver Vessels
Intrahepatic Portosystemic Shunt (TIPS)
Gastrostomy tubes (PEGS)
Percutaneous Endoscopic Gastrostomy Insertion (initial PEG insertion) – Using endoscopy to guide, and opening is made from the skin directly into the stomach, into which a tube is placed that provides semi-permanent access for nutrition or medication
– a small disposable camera, housed in a capsule the size of a large jelly bean is swallowed. This camera takes images of the inside of the small intestine and transmits them to a special belt that is worn for the day and stores the images to be then reviewed.
oesophageal pH-monitoring – While awake, a very fine tube is passed into the nose down the back of the throat and into the oesophagus (swallowing tube). This is taped in place and connected to a small monitor that records information from the acid sensors on the tube.
oesophageal pH and multiple intraluminal impedance monitoring (pH-MII, or known
as Impedance monitoring) – The procedure is identical the one above. The tube has additional sensors that can detect movement of fluid and air as well as acid.
Manometry – a procedure lasting approximately one hour and performed awake that looks at the movement and pressures of the swallowing tube and stomach, to understand the function of the muscles and nerves.
Manometry - a procedure lasting under one hour and usually performed awake that looks at the movement and pressures of the anus and rectum, to understand the function of the muscles and nerves involved in defecation.
RCH Anorectal Manometry Fact Sheet V2.1 20.10.20
Manometry – a day procedure with the initial component under anaesthetic and the rest performed awake that looks at the movement and pressures of the colon, to understand the function of the muscles and nerves
Manometry – a procedure lasting a day or overnight with the initial component under anaesthetic and the rest performed awake that looks at the movement and pressures of the small intestine, to understand the function of the muscles and nerves
Procedures for complex nutritional conditions
- Enteral Nutrition(see also: Gastrostomy; Jejunal tube insertion)
- Parenteral Nutrition
- Intestinal Transplantation
By: Prof Winita Hardikar, Dr Mark Safe, Di Simpson June2019
Updated October 2020.