Gastro Flashcards
(45 cards)
How is abdominal pain present in babies?
Crying, drawing up of legs
With regard to abdominal pain in older children what are 3 important features in the history?
Pain lasting more than 4 hours
pain further away from umbilicus likely significant (except appendicitis)
Timing and character
What is the significance of the following symptoms/signs associated with abdominal pain? vomiting stools anorexia dysuria cough
Vomiting - bilious suggests obstruction stools - blood suggests inussusception in infact or IBD in older children anorexia - normal appetite reassuring dysuria - UTI cough - pneumonia
What 4 conditions does a fever suggest in a child with abdominal pain?
Appendicitis
mesenteric adenitis
UTI
pneumonia
What 2 conditions does Jaundice suggest in a child with abdominal pain?
infectious hepatitis
biliary colic
3 useful investigation in a child with abdominal pain
FBC - neutrophilia
Urinalysis - nitrites/leucocytes/glucose
CRP
5 features of functional recurrent abdominal pain
pain usually periumbilical
no associated anorexia or change in bowel habits
thriving and no physical signs
fam history of recurrent abdominal pain/IBS
sources of stress/anxiety
It’s quite common for babies to vomit up small quantities of milk but what does projectile vomiting suggest, particularly if the baby is hungry afterwards?
Pyloric stenosis
What does vomiting after a feed suggest? 3
Overfeeding
gastro-oesophageal reflux
pyloric stenosis
What does early morning effortless vomiting indicate?
raised inter-cranial pressure
6 red flag features associated with vomiting?
bilious vomiting localised abdominal pain persistent fever altered consciousness/bulging fontanelle petechial rash respiratory distress
What is the most common case of persistent loose stools in thriving pre-school child?
toddler diarrhoea
7 organic causes of constipation in children
Coeliac disease Food allergies (non-IgE) bowel obstruction Hirschsprung disease CF neuromuscular disorder Hypothyroidism
6 red flags associated with constipation?
Starts in first few weeks of life Meconium passed >24hours Abdominal distension of bilious vomiting Faltering growth delayed walking child protection concerns
Management of constipation
High fibre and adequate fluid.
Laxatives may be needed - MOVICOL first line
What factors would suggest that a child is just constitutionally small?
Small parents low birth weight for gestational age proportionally small normal height and weight velocities healthy normal physical examination
In a child with faltering growth what factors must be considered of inadequate food intake is the suspected cause?
psychosocial deprevation
neglect
fabricated of induced illness
What is characterised by recurrent inconsolable crying, often accompanied by drawing up of the legs and occurs from 2 weeks to 4 months.
infantile colic
Aside from colic 6 other causes of recurrent inconsolable crying in an infant?
Gastro-oesophageal reflux cow's milk protein allergy incarcerated hernia intussusception otitis media UTI
What are the symptoms/signs associated with gastro-oesophageal reflux?
Vomiting
some abdominal discomfort indicated by back arching and crying after feeds
worse when lying down
feed aversion
What is the typical management of gastro-oesophageal reflux in infants?
reassurance - 95% will resolve by 18 months
Thickening feeds might help
Management of more severe gastro oesphageal reflux?
H2 antagonists
PPI
Domperidone
When does pyloric stenosis usually present?
First 2-8 weeks of life
5 Clinical features of pyloric stenosis?
Persistent projectile non- bilios vomiting after feeds. Infant remains hungry after vomiting Weight loss Dehydration Jaundice
