Child or infant with vomiting or diarrhea Flashcards Preview

Pediatrics > Child or infant with vomiting or diarrhea > Flashcards

Flashcards in Child or infant with vomiting or diarrhea Deck (24):
1

Causes of vomiting in newborns and infants

Overfeeding
GOR
Pyloric stenosis
Whooping cough
SBO
Constipation
Systemic infection
Foreign body

2

Causes of vomiting in children and adolescents

Gastroenteritis
Migraine
Raised ICP
Bulimia
Toxic ingestion/medications
DKA
Pregnancy
Foreign body

3

Important history

Posseting vs vomiting
Growth
Feeding history
Projectile vomiting
Fever
HA, photophobia
Dysuria, frequency, foul smelling urine
Diarrhea, sick contacts
Paroxysms of cough followed by vomiting

4

Important examination

Hydration
Palpable pyloric mass
Abdominal distension
Papilloedema, hypertension
Evidence of meningism

5

Investigations

FBE
UEC
pH
Barium swallowing
Upper GI contrast study->mandatory in bile stained vomiting to exclude malrotation

6

What investigation is mandatory in bile stained vomiting ND what does it exclude

Upper GI contrast study->to exclude malrotation, duodenal or ileal atresia

7

In what group is GOR particularly common

Preterm

8

Investigations for severe reflux

Barium swallow
Esophageal pH monitoring for 24 hours

9

Management of reflux

Sit infant upright
Thicken feeds
Gaviscon before feed
Wind baby after feeds

Usually improves over time as child sits upright more and progresses to more solid feeds

10

Commonest indication for surgery in infancy

Pyloric stenosis

11

GE without diarrhea, cause

Norovirus

12

When is duodenal atresia more common

Down's

13

Immediate management of bile stained vomiting

ABC
NGT->aspirate stomach
Stop feeds pending upper GI study
Fluids
NBM

14

What 2 diagnoses should always be considered in an unwell infant with vomiting

Urinary tract infection
Meningitis

15

Oral rehydration regime

Replace deficit over 4 hours
Add 10ml/kg for each loose stool

16

Amount of fluid required % loss

10%= 100ml/kg

17

Causes of dehydration

1) Excess fluid loss
->Excessive sweating: fever, climate, CF
->Vomiting
->Acute diarrhea
->Fluid loss: burns, surpgery
->Polyuria: DKA

2) Inadequate intake
->Unable to drink
-> X access to water

18

Causes of chronic diarrhea

1) Non pathological
->Toddler diarrhea: well and thriving, loose w/ undigested food, +gut transit time
->Non specific diarrhea: loose watery, thriving, may follow acute GE
2)Malabsoroption
->CF
->Celiac: FTT, irritable, wasted, after wheat diet, fatty stool, duodenal biopsy
->secondary lactose intolerance: following GE
3)Infectious
->Giardia: wt loss, abdominal pain, nurseries
4) Inflammatory
->Crohn's
->Ulcerative colitis
->Cows milk protein intolerance: may have urticaria, stridor, bronchospasm, eczema
5) Overflow constipation

19

Important history in chronic diarrhea

Bowel pattern: frequency, consistency, odoour, blood, mucus
Precipitating: recent GE, change in diet, foods, family members
Associated symptoms: cough, wt loss, abdominal pain
Review of symptoms

20

Investigations blood and outcomes in chronic diarrhea (3)

FBC->anemia due to malabsortion, chronic disease, blood loss
Celiac screen->will need confirmation with jejunal biopsy
ESR->elevated in IBD

21

Investigations other in chronic diarrhea and outcomes (6)

Urine culture
Sweat test
Breath hydrogen test->high H2 in carbohydrate malabsorption
Jejunal biopsy
Barium follow through->characteristic findings of crohns in small bowel
Endoscopy

22

Investigations stool in chronic diarrhea and outcomes (6)

Blood->colitis
OCP->parasites
Reducing substances and low pH->lactose intolerance
Fecal elastase->low in pancreatic insufficiency
Microscopy for fat globules->fat malabsorption
Fecal calprotectin->IBD

23

Examination in chronic diarrhea

General:
Pallor, jaundice, wasted
Growth percentiles
Hydration
Abdominal distension, tenderness
Finger clubbing
Does the child look ill

24

Jejunal biopsy findings in celiac

Subtotal villous atrophy with crypt hyperplasia

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