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B - Paediatrics MANAGEMENT > Gastro-oesophageal Reflux > Flashcards

Gastro-oesophageal Reflux Flashcards

1
Q

What is gastro-oesophageal reflux?

A

The involuntary passage of gastric contents into the oesophagus

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2
Q

Is gastro-oesophageal reflux usually a problem?

A

No, it is usually a benign self-limiting problem

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3
Q

When does gastro-oesophageal reflux become more serious?

A

When it progresses to GORD and requires treatment

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4
Q

When is gastro-oesophageal reflux common?

A

In infancy

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5
Q

When should infantile gastro-oesophageal reflux usually resolve by?

A

12 months of age

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6
Q

What can cause the development of gastro-oesophageal reflux?

A
  • Inappropriate lower oesophageal sphincter relaxation
  • Predominantly fluid diet
  • Mainly horizontal posture
  • Short intra-abdominal lenght of oesophaus
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7
Q

What are the risk factors for gastro-oesophageal reflux?

A
  • Cerebral palsy
  • Other neurodevelopmental disorders
  • Pre-term
  • Following surgery for oesophageal atresia or diaphragmatic herniation
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8
Q

What are the symptoms of gastro-oesophageal reflux?

A

Recurrent regurgitation or vomiting

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9
Q

How would you expect gastro-oesophageal reflux to affect the infant systemically?

A

Putting on weight and otherwise well

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10
Q

How is gastro-oesophageal reflux typically diagnosed?

A

Clinically

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11
Q

When may further investigations be indicated?

A
  • Atypical history
  • Complications present
  • Treatment failure
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12
Q

What investigations can be used in assessment of gastro-oesophageal reflux?

A
  • 24 hours oesophageal pH monitoring
  • Endocsopy with biopsy
  • Contrast studies
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13
Q

What is a 24 hour oesophageal pH monitoring test used for?

A

To assess the degree of reflux

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14
Q

What is the purpose of endoscopy and biopsy?

A

To assess for oesophagitis and exclude other causes of vomiting

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15
Q

What is the purpose of contrast studies?

A

To exclude underlying anatomical abnormalities in the oesophagus, stomach and duodenum

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16
Q

What are the differentials for gastro-oesophageal reflux?

A
  • Upper GI tract disorders
  • Cows milk intolerance
  • Metabolic disorders
  • CNS disorders
  • Urinary tract disorders
17
Q

What upper GI tract disorders may present like gastro-oesophageal reflux?

A
  • Pyloric stenosis
  • Malrotation
  • PUD
18
Q

What metabolic disorders may cause recurrent vomiting?

A
  • Renal tubular acidosis

- Urea cycle defects

19
Q

What CNS disorders may present with recurrent vomiting?

A
  • Hydrocephalus

- Meningitis

20
Q

What urinary tract disorders may present with recurrent vomiting?

A
  • Infection

- Obstruction

21
Q

How is uncomplicated gastro-oesophageal reflux usually managed?

A

Conservatively

22
Q

What conservative management techniques can be used in gastro-oesophageal reflux?

A
  • Parental reassurance
  • Adding inert thickening agents to feeds
  • Giving smaller, more frequent feeds
23
Q

What type of treatment does significant GORD require?

A

Medical management and - possibly surgical management

24
Q

What types of medications can be used in the treatment of GORD?

A
  • H2 antagonists

- PPI’s

25
Q

Give an example of a H2 antagonist

A

Ranitidine

26
Q

Give an example of a PPI

A

Omeprazole

27
Q

What should failure to respond to medical management prompt?

A

Reconsideration of diagnosis

28
Q

When should surgical management be considered?

A

In children with complications unresponsive to medical treatment or oesophageal stricture

29
Q

What surgical procedure is used in the correction of gastro-oesophageal reflux?

A

Nissen fundoplication

30
Q

What are the potential complications of gastro-oesophageal reflux?

A
  • Faltering growth due to severe vomiting
  • Oesophagitis
  • Recurrent pulmonary aspiration
  • Dystonic neck posturing
31
Q

What are the symptoms of oesophagitis?

A
  • Haematemesis
  • Heartburn on feeding
  • Iron-deficiency anaemia
32
Q

What are the symptoms of recurrent pulmonary aspiration?

A
  • Recurrent pneumonia
  • Cough
  • Wheeze

B - Paediatrics MANAGEMENT (106 decks)

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