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Flashcards in Gastro Deck (31):

When does gastro-oesophageal reflux usually resolve by?

12 months of age, as the lower oesophageal sphincter matures, the child eats more solid food and stays more upright.


What are the features of GORD?

Frequent regurgitation (+/- vomiting) post-feed, faltering growth, oesophagitis (irritable post-feed), recurrent pulmonary aspiration (pneumonia, wheeze, cough).


What is the management of GORD?

1) Smaller, more frequent feeds. Keep more upright
2) Alginate (Gaviscon)
3) Thickeners
4) Ranitidine / omeprazole
5) Nissen fundoplication


What is the typical presentation of pyloric stenosis?

2-8 weeks of life, 4:1 male, increasing frequency and forceful vomiting, becoming projectile, hunger, dehydration, faltering growth.


How is pyloric stenosis investigated?

Trial feed showing wave of peristalsis moving from right to left abdomen. Palpable olive-like mass of pylorus. USS for confirmation prior to surgery.


What is management of pyloric stenosis?

Fluid resuscitation if required, followed by pyloromyotomy.


What is the typical presentation of appendicitis?

Most common aged 10-20y, but can occur at any age. Very uncommon <3y.

Pain, anorexia, vomiting, fever.


What investigations may be considered for appendicitis?

FBC, urinanlysis, USS.


What is management of appendicitis?

Simple: surgery, supportive care +/- ABx

Complicated: Immediate ABx, laparotomy, remain inpatient for 5-7 days.


What is the presentation of mesenteric adenitis?

Mild/moderate abdo pain following URTI, accompanied by cervical lymphadenopathy. Lasts 24-48 hours.


What is the presentation of intussusception?

3m-2y age, may have prodromal viral infection causing enlargement of Peyer's patches.

Paroxysmal severe colicky abdo pain, child draws knees to chest during episodes. Anorexia, vomiting, red currant jelly stool, abdo distension.


What investigations are used for intussusception?

Abdo X-ray (distended small bowel), USS (target / doughnut sign)


What is the management of intusussesception?

Fluid resus, rectal air insufflation +/- surgical reduction.


What are the ways in which Meckel's diverticulum can present?

Rectal bleeding, intusussecption, volvulus, diverticulitis (mimicking appendicitis).


What is the presentation of malrotation?

1-3 days of life. Bilious vomiting, abdo pain, +/- shock.


What investigation is required for bilious vomiting?

GI contrast study


What is management of malrotation?

Surgical correction


What are the most common pathogens responsible for gastroenteritis?

Rotavirus (60% <2y), adenovirus, norovirus etc.

Bloody? Consider bacterial (shigella, campylobacter, salmonella, E. coli, yersinia)


What is the typical presentation of gastroenteritis?

Diarrhoea, vomiting, abdo pain, fever, hyper-dynamic bowel sounds, weight loss, DEHYDRATION.


What is the most important assessment of a child with gastroenteritis?

Their hydration status - can become dehydrated very quickly.

Monitor weight, skin turgor, tears, mucous membranes, BP, urine output, pulse, eyes, fontanelle.


How are dehydrated children managed?

Clinical dehydration: oral rehydration solution 50ml/kg over 4 hours.

Prior to IV fluids, need U&Es.

Clinical shock: IV 0.9 saline bolus 20ml/kg.

If using IV therapy for rehydration, give deficit + maintenance over 24 hours. Clinical dehydration 50ml/kg deficit (5%), shock 100ml/kg deficit (10%).


What is the fluid challenge?

In children with gastroenteritis, the are offered 1-2ml/kg of ORS every 10 minutes.


What are maintenance fluids for children?

First 10kg: 100ml/kg
Second 10kg: 50ml/kg
Subsequent: 20ml/kg

Calculate total daily requirement then / 24 for hourly rate.

Usual fluids of choice is 500ml 0.9% saline + 5% dextrose + 10mmol K+


What are the presentations of coeliac?

Typical: 8-24 months after gluten introduction. Faltering growth, abdo distension and pain, diarrhoea, muscle wasting and general irritability.

Atypical: Anaemia, neuro deficits, fractures, bruising, growth faltering, T1DM association.


How is coeliac investigated?

Children can be diagnosed with +ve anti-TTG, EMA and HLA-DQ2/8 to avoid duodenal biopsy.


What is the presentation of IgE mediated food allergy?

Acute onset (<2 hours). Widespread urticaria, facial swelling, wheeze, stridor, abdo pain, vomiting, diarrhoea, shock.

Strongly +ve skin-prick test.


What is the presentation of non-IgE mediated food allergy? (E.g. non-IgE cow's milk allergy)

Gradual onset (hours to days). Loose stools, abdo pain faltering growth on formula feed (cow's milk).

-ve skin-prick test. Resolution of symptoms with elimination of cow's milk.


How is cow's milk allergy managed?

Avoidance of allergen: formula-fed infant should receive hydrolysed milk. Breast-fed infant's mother must avoid milk.

Challenge tests: children should gradually increase exposure according to the 'Milk Ladder' (i.e. biscuits, yogurt, glass of milk)

After 2y age, can try other milks (pea, oat, coconut). Do not use soya, as 10-15% will also react to this.


What is the presentation of lactose intolerance?

Generally older children / adulthood. Infants may have a transient lactose intolerance following gastroenteritis.

Abdo pain, bloating, flatus and loose stools (green, acidic).


What is the management of lactose intolerance?

Lactose free milk +/- small amounts of normal milk tolerated. May tolerate yogurts and cheese.


What are the causes of chronic constipation in children?

Idiopathic (majority)
Spinal cord disease (e.g. spina bifida)
Anorectal malformation