Gastroenterology

Question 1

What are the common causes of vomiting in children?

Answer 1

Infants
- Bilious
>> Pancreatitis
>> Intestinal obstruction
:: (Sometimes) Pyloric stenosis
:: Duodenal atresia
:: Intussusception
:: Malrotation with or without volvulus
:: Strangulated inguinal hernia
:: Necrotizing enterocolitis
:: Meconium ileus
:: Hirschsprung disease
- Non-bilious
>> Upper tract obstruction
:: Tracheo-esophageal fistula/atresia
:: Pyloric stenosis
>> GERD
>> Infections
:: GI infections: gastroenteritis, appendicitis, pancreatitis
:: Urinary tract infection
:: Respiratory infections
:: Meningitis
:: Sepsis
>> Metabolic causes
:: Inborn errors of metabolism
:: Electrolyte abnormalities
:: Congenital adrenal hyperplasia
>> Renal failure

Preschool Children
- Bilious
>> Pancreatitis
>> Intestinal obstruction
:: Malrotation with or without volvulus
:: Intussusception
:: Strangulated inguinal hernia
:: Adhesions
:: Foreign body
- Non-bilious
>> Infections
:: GI: gastroenteritis
:: Urinary tract infection
:: Meningitis
:: Respiratory infections
:: Sepsis
>> Metabolic causes
:: Inborn errors of metabolism
:: Electrolyte disturbances
>> Renal failure
** >> Surgical causes
:: Increased intracranial pressure
:: Testicular torsion**

School-Aged Children and Adolescents
- Bilious: IO
- Non-bilious:
>> Infections
:: GI: gastroenteritis, appendicitis, pancreatitis
:: Urinary tract infections
:: Meningitis
:: Sepsis
>> Metabolic
:: Electrolyte disturbances
:: DKA
>> Renal failure
>> Anorexia/bulimia
>> Pregnancy
>> Drugs/toxins/alcohol
>> Surgical causes
:: Increased ICP
:: Testicular torsion

Question 2

What are the signs for dehydration assessment?

Answer 2

• *Vitals**
• Heart rate
• Blood pressure
• Alertness
• Urine output
• *Signs_ _from P/E**
• Skin turgor
• Capillary refill
• Anterior fontanelle
• Eyes sunken
• Oral mucosa

C BASE H2O – Capillary refill, BP, Anterior fontanelle, Skin turgor, Eyes sunken, Heart rate, Oliguria, Oral mucosa

Question 3

How does one manage GERD?

Answer 3

1. Conservative
2. Medical
   >> NG re-feeding
   >> Ranitidine, omeprazole (to decrease gastric aciditiy)
   >> Domperidone, metoclopramide (to increase gastric tone and motility)
3. Surgical
   >> Nissen fundoplication

Question 4

What are the complications of GERD?

Answer 4

• Esophagitis
• Barrett’s esophagus
• Esophageal stricture
• Failure to thrive
• Aspiration
• Oral feeding aversion

Question 5

In all cases involving vomiting or swallowing difficulty, RMB TO RULE OUT ASPIRATION by asking signs of respiratory distress.