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Gastroenterology Flashcards

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1
Q

What is vomiting?

A

Physical act that results in gastric contents forcefully brought up to and out of the mouth aided by sustained contraction of the abdominal muscles and the diaphragm at a time when the cardia of the stomach is raised and the pylorus is contracted

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2
Q

What is regurgitation?

A

Effortless expulsion of gastric contents

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3
Q

What is rumination?

A

Frequent regurgitation of ingested food

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4
Q

What is possetting?

A

Small volume vomits during or between feeds in otherwise well child

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5
Q

What controls vomiting?

A

Vomiting centre

Chemoreceptor trigger zone

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6
Q

What neurotransmitters are involved in vomiting?

A

Histamine (H1), dopamine (D2), serotonin (5-HT3), acetylcholine (muscarinic), neurokinin (substance P)

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7
Q

What are the key precipitants of vomiting?

A 
Toxic material in lumen of GI tract
Visceral pathology
Vestibular disturbance
CNS stimulation
Toxins in blood/CSF
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8
Q

What are the different types of antiemetics?

A

Antihistamines - H2 receptor antagonists, CI acute porphyrias, for motion sickness and PONV treatment
Dopamine D2 antagonist for medication related N&V
Serotonin 5-HT3 antagonists - CI in long QT syndrome, for treatment of PONV
Steroids
Neurokinin receptor antagonist

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9
Q

Name 2 antihistamines for anti sickness treatment and their dose

A

Cyclizine 50mg

Promethazine 20-25mg

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10
Q

Name 2 dopamine D2 antagonists for anti sickness treatment and their dose

A

Prochlorperazine 12.5mg
Metoclopramine 20mg over 3 mins, CI 3-4 days post intra-abdominal surgery, obstruction, haemorrhage, perforation, or obstruction and phaeochromocyomas
Droperidol 0.625-1.25mg, CI bradycardia, CNS depression, coma, hypokalaemia, hypomagnesaemia, phaeochromocytoma, long QT syndrome

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11
Q

Name 2 serotonin 5-HT3 antagonists used for anti-sickness treatment and their dose

A

Ondansetron 4mg

Granisetron 1mg diluted to 5ml given over 30s

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12
Q

Name a steroid used for anti-sickness treatment and their dose

A

Dexamethasone 3.3-6.6mg

For chemotherapy related N&V

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13
Q

Name a neurokinin receptor antagonist for anti-sickness treatment and its dose

A

Aprepitant 80mg

For chemotherapy related N&V

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14
Q

What questions are important to ask in a vomiting history?

A

Bilious/non-bilious (helps localise)
Bloody/non-bloody (inflammation/damage)
Projectile/non-projectile (specific diagnosis)
Age
Febrile/afebrile
Nausea, abdominal pain, distention, diarrhoea, constipation
Headache, changes in vision, polyuria, polydipsia, weight loss - rule out increased ICP or DKA
Hydration status

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15
Q

What are the red flags in a vomiting history?

A

Meningism
Costovertebral tenderness
Abdominal pain
Any evidence of raised ICP

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16
Q

What is the examinations you should do in a vomiting child?

A

General - hydration, temp, obs, weight loss, jaundice/pallor
Abdo - distension, scars, tenderness, rigidity, bowel sounds
Neuro - GCS, meningism, neurological deficit
Plot growth
Assessment of hydration status
Evidence of infection
Presence of dysmorphic features, ambiguous genitalia or unusual odours

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17
Q

What are the GI obstruction differentials for vomiting?

A 
Pyloric stenosis
Malrotation with intermittent volvulus
Intestinal duplication
Hirschsprung's disease
Antral/duodenal web
Foreign body
Incarcerated hernia
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18
Q

What other GI problems are differentials for vomiting?

A 
Achalasia		Gastroparesis
Gastroenteritis
Peptic ulcer
Eosinophilic oesophagitis/gastroenteritis
Food allergy
IBD
Pancreatitis
Appendicitis
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19
Q

What are some neurological differentials for vomiting?

A 
Hydrocephalus
SDH
Intracranial haemorrhage
Intracranial mass
Infant migraine
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20
Q

What are some infectious differentials for vomiting?

A 
Sepsis
Meningitis
UTI
Pneumonia
Otitis media
Hepatitis
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21
Q

What are some metabolic/endocrine differentials for vomiting?

A 
Galactosemia
Hereditary fructose intolerance
Urea cycle defects
Amino and organic acidaemias
Congenital adrenal hyperplasia
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22
Q

What are some renal differentials for vomiting?

A

Obstructive uropathy

Renal insufficiency

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23
Q

What are some toxic differentials for vomiting?

A

Lead
Iron
Vit A and D
Medications - digoxin, theophylline

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24
Q

What are some cardiac differentials for vomiting?

A

Congestive HF

Vascular ring

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25
What are some psychiatric differentials for vomiting?
Munchausen syndrome Child neglect or abuse Self induced
26
What are the most common causes of vomiting in children 0-2 days old?
Duodenal or other intestinal atresia | TEF (types A/C)
27
What are the most common causes of vomiting in children 3 days-1 month old?
``` Gastroenteritis Pyloric stenosis Malrotation +/- volvulus TEF (types B/D/H) Necrotising enterocolitis Milk protein intolerance CAH IEM ```
28
What are the most common causes of vomiting in children 1-36 months old?
``` Gastroenteritis UTI, pyelonephritis GOR/GORD Ingestion Intussusception Milk protein intolerance ```
29
What are the most common causes of vomiting in children 36 months-12 years old?
``` Gastroenteritis UTI DKA Increased ICP Eosinophilic oesophagitis Appendicitis Ingestion Post-tussive vomiting ```
30
What are the most common causes of vomiting in children 12 -18 years old?
``` Gastroenteritis Appendicitis DKA Increased ICP Eosinophilic oesophagitis Bulimia Pregnancy Post-tussive vomiting ```
31
How does malrotation/volvulus present and how is it managed?
Sudden bilious vomit, abdominal distension As progresses - abdomen can feel peritonitic Blood per rectum Metabolic acidosis Contrast study essential for diagnosis and USS Urgent surgical referral - division of Ladd bands (Ladds procedure) - return SB to right and LB to left, caecum in LUQ
32
How does Hirschsprung's disease/meconium ileus/intestinal atresia present and how is it managed?
Delayed passage of meconium, abdominal distension, bilious vomiting Surgical referral
33
How does necrotising enterocolitis present and how is it managed?
Usually pre-term infant, abdominal distension, bilious vomiting Antibiotics, enteral rest, surgical referral if severe
34
How does infection present and how is it managed?
May be non-specific or point to source of infection Investigations to establish cause May require fluid resuscitation and empirical antibiotic treatment
35
How does GORD present and how is it managed?
Vomiting associated with feeds Poor feeds Cough, wheeze Step-wise approach
36
How does food intolerance present and how is it managed?
Vomiting, loose stools, constipation, eczema | Elimination diet
37
How does pyloric stenosis present and how is it managed?
``` Progressive projectile vomiting, hypokalaemia, hypochloraemic metabolic acidosis FTT Palpable olive shaped mass Dehydration Fluid and electrolyte replacement prior to surgery NG tube NBM Ramdtedt's pyloromyotomy ```
38
How does intussusception present and how is it managed?
Usually 3-36 months of age, colicky abdominal pain, bilious vomiting, red-currant jelly stools Distended abdomen Peritonitic IVI IVabx Pneumatic air insufflation or barium enema for reduction Surgery
39
How does strangulation hernia/adhesion obstruction present and how is it managed?
Bilious vomiting, abdominal pain | Surgical referral
40
How does raised ICP present and how is it managed?
Early morning vomiting, bulging fontanelle | CT/MRI
41
How does acute appendicitis present and how is it managed?
Anorexia, central abdominal pain migrating to RIF, vomiting, pyrexia Appendectomy
42
How does pancreatitis present and how is it managed?
Vomiting, abdominal pain | Fluids, analgesia
43
How does cyclical vomiting syndrome present and how is it managed?
Recurrent episodes of vomiting, child well in between | Exclusion of other causes
44
How does DKA present and how is it managed?
Polydipsia, polyuria, hyperglycaemia, ketonuria, metabolic acidosis on blood gas As per national and local guidance
45
How does medication/alcohol/illicit drug intoxication present and how is it managed?
History of ingestion, recently commenced on new medication | Remove offending substance, supportive care
46
How is post-operative/pain managed?
Analgesia | Anti-emetics
47
How do psychiatric causes of vomiting present and how is it managed?
As part of eating disorder | Psychiatry referral
48
How does pregnancy present and how is it managed?
Weight gain May not admit to being sexually active Pregnancy test
49
How does infection present in older children and how is it managed?
Pyrexia, tachycardia, identifiable source of infection | Antibiotics
50
What investigations should you do in a child that is vomiting?
Depends on underlying cause, history, presentation, and age of patient Acute - U&E, stool virology, abdo XR, surgical opinion, exclude systemic disease Chronic - FBC, ESR/CRP, U&E, LFT, H pylori serology, urinalysis, upper GI endoscopy, abdo USS, small bowel enema, brain imaging, test feed Cyclic - amylase, lipase, glucose, ammonia
51
What are the metabolic consequences of vomiting?
K+ deficiency Alkalosis Sodium depletion
52
What are the consequences of vomiting?
Metabolic Nutritional Mechanical injuries to oesophagus and stomach Dental Oesophageal stricture, Barrett's, broncho-pulmonary aspiration, FTT, anaemia
53
What types of mechanical injury can you get to oesophagus and stomach due to vomiting?
Mallory-Weiss Boerhaave's syndrome Tears of short gastric arteries resulting in shock and haemoperitoneum
54
What is the treatment for vomiting?
Supportive - IV fluids, analgesia, antiemetics Treat cause - medical/surgical Pharmacological
55
What signs may suggest disorders other than GORD?
``` Bilious vomiting GI bleeding Persistently forceful vomiting New onset of vomiting > 6 months Failure to thrive Diarrhoea Constipation Fever Lethargy Hepatosplenomegaly Bulging fontanelle Macro/microcephaly Seizures Abdominal tenderness or distension Suspected metabolic syndrome ```
56
When is reflux normal?
Reflux is normal physiological response in children, often resolves by a year in most children
57
What is GOR?
Passage of gastric contents into oesophagus, with or w/o regurgitation or vomiting
58
What is GORD?
Presence of troublesome symptoms and/or complications of persistent GOR
59
What complications can you get from GORD in children?
``` Faltering growth Oesophagitis +/- stricture Apnoea, ALTE, SIDS Aspiration, wheeze, hoarseness IDA Seizure-like events, torticolis ```
60
How does GORD present in children?
Heart burn | Epigastric pain
61
What investigations should you do for GORD?
``` pH Barium swallow and meal Endoscopy Nuclear scintigraphy, tests on ear, lung and oesophageal fluids, USG, combined multiple intraluminal impedance PPI test ```
62
What is the management of GORD?
``` Conservative - Optimise position - Parental education and support - Thicken eg carobel/change feeds - Avoid over feeding - Smaller, more frequent feeds - Weight monitoring - Gaviscon Drugs - antacid, H2 blocker, PPI Surgery - fundoplication ```
63
What is a food allergy?
Body's immune system reacts adversely to specific foods, characterised by multisystem reaction - skin, GI, resp, cardio, immediate reaction
64
What is a food intolerance?
Food intolerance - unpleasant physical reaction to food due to difficulty digesting them, characterised by mainly GI symptoms, bloating, abdominal pain, diarrhoea, delayed reaction few hours after eating food
65
What are the different types of food allergy?
IgE mediated - acute, urticaria, oral allergy Non-IgE mediated - food protein induced enteropathy Mixed IgE and non-IgE mediated - gastroenteritis Cell mediated - allergic contact dermatitis
66
What are the different types of food intolerance?
Metabolic (lactose intolerance) Pharmacologic (caffeine) Toxic (fish toxin) Other idiopathic/undefined
67
What is the most common food allergy?
Cow's milk protein alelrgy
68
What is CMPA associated with?
Atopy, IgA deficiency, and IgG subclass abnormalities
69
How common is CMPA?
Prevalence varies from 2% to 7.5%
70
How do you diagnose CMPA?
Elimination diet Skin prick testing RAST Oral food challenge
71
How is CMPA managed?
Hydrolysed or AA feeds - broken down into smaller peptides
72
What are the symptoms of IgE mediated allergy? GI
``` Angioedema of lips, tongue, palate Oral pruritis Nausea Colicky abdominal pain Vomiting Diarrhoea ```
73
What are the symptoms of non-IgE mediated immunity? GI
``` GORD Loose or frequent stools Blood and/or mucus in stools Abdominal pain Infantile colic Food refusal or aversion Constipation Perianal redness Pallor and tiredness Faltering growth in conjunction with at least one or more GI symptom (with or without significant atopic eczema) ```
74
What skin symptoms do you get with IgE mediated allergy?
Pruritus Erythema Acute urticaria - localised/generalised Acute angioedema - most commonly around lips, face, and eyes
75
What skin symptoms do you get with non-IgE mediated allergy?
Pruritus Erythema Atopic eczema
76
What respiratory symptoms do you get with IgE mediated allergy?
Upper - nasal itching, sneezing, rhinorrhoea, congestion | Lower - wheezing/SOB
77
What respiratory symptoms do you get with non-IgE mediated allergy?
Cough, chest tightness
78
What are the different types of lactose intolerance?
Primary - rare | Late onset - common
79
What are the symptoms of lactose intolerance?
Explosive watery stools, abdominal distension, flatulence, audible bowel sounds
80
How do you diagnose lactose intolerance?
Stool chromatography, lactose hydrogen breath test, small bowel biopsy and elimination diet
81
How do you treat lactose intolerance?
Lactose free formula/milk-free diet with calcium and vitamin D supplements
82
What is constipation?
Infrequent passage of stool associated with pain and difficulty, or delay in defecation
83
What is encopresis?
Involuntary faecal soiling or incontinence secondary to chronic constipation
84
What is the ROME IV criteria for constipation?
2/fewer defecations per week for at least one month At least 1 episode of faecal incontinence per week Retentive posturing or stool retention Painful or hard bowel movements Presence of large faecal mass in rectum Large diameter stools that may obstruct the toilet After appropriate evaluation, the patient symptoms must not be fully explained by another medical condition
85
What is the pathogenesis of constipation?
Cycle of painful defecation, voluntary withholding, prolonged fecal stasis, re-absorption of fluids and increase in size and consistency, more pain
86
What should you ask about in the history of a child with constipation?
Frequency and consistency of stools (Bristol Stool chart) Pain with passing stool or straining, rectal bleeding, ever clog the toilet, changes in appetite, abdominal pain, medications (opioids)
87
What examination should you do in a child with constipation?
General physical examination, palpable faecal mass on abdominal examination Visual inspection of anorectal area completed for all patients to identify possible organic aetiologies Rectal examination - often not required
88
What are the red flags in a constipation history?
``` Delayed passage of meconium Fever, vomiting, bloody diarrhoea Failure to thrive Tight, empty rectum with presence of palpable abdominal faecal mass Abnormal neurological exam ```
89
What are possible differentials for constipation?
``` Hirschsprung's disease Anorectal malformations Neuronal intestinal dysplasia Spina bifida Neuromuscular disease Hypothyroidism Hypercalcaemia Coeliac disease Food allergy/intolerance CF Perianal group A streptococcal infection Anal fissure Pelvis/spinal tumours Child sexual abuse Drugs ```
90
What are the short term complications of constipation?
No sequelae
91
What are the long term complications of constipation?
Acquired megacolon, anal fissures, overflow incontinence, behavioural problems
92
What investigations can you do for constipation?
Usually not necessary Only if organic cause suspected, remain constipated despite medical treatment T4/TSH, serum Ca, coeliac panel, sweat test, AXR, anal manometry, rectal biopsy, spinal imaging
93
What is the management of constipation?
``` Explanation of normal bowel function Diet/fluids and exercise Behavioural advice Toilet training advice Simple reward schemes Medications - Softener - lactulose, liquid parafin - Bulking agent - fybogel - Movicol - Senna, dulcolax - stimulants - Enema - Anal fissure - anaesthetic cream +/- vasodilator If treatment for constipation is unsuccessful or organic cause of constipation suspected refer to paediatric gastro ```
94
What is diarrhoea?
Change in consistency of stools and/or increase in frequency of evacuations with or without fever or vomiting which lasts less than 7 days and not longer than 14 days
95
What questions should you ask in a diarrhoea history?
When did it start? What's its progression been? How many times per day? Watery? Blood? Mucus? ssociated symptoms - fever, vomiting, urine output, abdominal pain, lethargic, weight loss Context - immune status, recent hospitalisation, antibiotic use, any recent medications, recent travel, vaccination
96
What are the causes of infection causing acute diarrhoea?
Viruses Bacteria Parasites
97
What viruses can cause acute diarrhoea?
Rotavirus Calicivirus Astrovirus Enteric-type adenovirus
98
What bacteria can cause acute diarrhoea?
``` Campylobacter jejuni Salmonella E coli Shigella Yerninia enterocolitica Aeromonas hydrophilia C difficile ```
99
What parasites can cause acute diarrhoea?
Giardia lamblia | Cryptosporidium
100
What other things can cause acute diarrhoea?
Other infections - otitis media, tonsilitis, pneumonia, septicaemia, UTI, meningitis Allergy/food hypersensitivity reactions Drugs Haemolytic uraemic syndrome Surgical causes - pyloric stenosis, intestinal obstruction, appendicitis, intussusception
101
How common is diarrhoea?
24 of 1000 consultations with GPs in children under 5 for gastroenteritis Annual hospital admission rate about 7 per 1000
102
How does diarrhoea present?
Diarrhoea +/- blood stools (dysentry) Fever +/- vomiting Dehydration and reduced consciousness
103
What investigations should you consider for a child with diarrhoea?
Perform stool microscopy if - Suspect septicaemia - Blood or mucus in stool - Child immunocompromised Consider performing stool microscopy if - Recently travelled abroad - Diarrhoea has not improved by day 7 - Uncertain about diagnosis of gastroenteritis Bloods not necessary in simple gastroenteritis but measure serum electrolytes including glucose if - Severe dehydration - IV fluid therapy required - Symptoms and/or signs suggesting hypernatraemia - Altered conscious state - Co-morbidity of renal disease or on diuretics Ileostomy
104
What examination should you do in children with diarrhoea?
Assess for dehydration | Best clinical indicators > 5% dehydration are prolonged CRT, abnormal skin turgor and absent tears
105
How do you treat diarrhoea?
Most cases self resolving Antibiotics - bacterial GE complicated by septicaemia or systemic infections or immunocompromised and malnourished patients Probiotics No antiemetics/anti-motility drugs
106
What is hypernatraemic dehydration?
Unusual and serious Irritable with doughy skin Water shifts from intracellular to extracellular Rehydration should be slow
107
What is chronic diarrhoea?
> 2 weeks
108
What can cause chronic diarrhoea?
``` Continued infection with first pathogen Infection with second pathogen Post enteritis syndrome Spurious - constipation Chronic non-specific diarrhoea Food intolerance Malabsorption ```
109
How common is IBD in children?
Prepubertal males > females Ileo-colonic or colonic UC Inflammatory phenotype, non-structuring, non-penetrative More have surgery than adults 40% in 10 years from diagnosis vs 20% Similar presentation depending on location Extrintestinal manifestations Same treatment
110
What is the most significant difference between adult and paediatric IBD?
``` Growth - Poor growth - Delayed puberty - Reduced final adult height - Catch up growth Persistent poor growth - only sign of disease activity ```
111
How is IBD diagnosed?
- Nuclear medicine - Clinical evaluation - Biochemical - faecal calprotectin in stool - Endoscopic - Radiological - Histological - biopsy
112
What treatment might you give for Crohn's?
``` Exclusive enteral nutrition Corticosteroids (prednisolone/budesonide) - problems with bone health Aminosalicylates (topical and oral) Antibiotics Immunomodulators (6-mercaptopurine, azathioprine, methotrexate) Biologics (infliximab, adalimumab) Surgery Parenteral nutrition ```
113
What treatment might you give for UC?
Mild to moderate induction - aminosalicylate Moderate to severe induction - corticosteroids Mild to moderate remission - aminosalicylate Moderate to severe remission - 6 MP/azathioprine Surgical resection
114
What is chronic abdominal pain?
Long lasting, intermittent or constant that is functional or organic disease, 3 attacks over at least 3 months duration
115
What is functional abdominal pain?
Abdominal pain w/o evidence of disease/pathologic process - functional dyspepsia, IBS, abdominal migraine, functional abdominal pain syndrome
116
What is recurrent abdominal pain?
One of most common recurrent pain syndromes in children Classic definition based on 4 criteria - Hx of at least 3 episodes of pain - Pain that is severe enough to affect activities - Episodes that occur over 3 months - No known organic cause
117
What are the organic causes of abdominal pain?
``` GORD PUD H pylori infection Food intolerance Coeliac disease IBD Constipation UTI Dysmenorrhoea Pancreatitis Hepato-biliary disease ```
118
What functional disorders can cause abdominal pain?
``` Functional dyspepsia IBS Functional abdominal pain Abdominal migraine Aerophagia ```
119
What is the pathogenesis of functional disorders?
Abnormal bowel reactivity to - Physiological stimuli (meal, gut distension, hormonal) - Noxious stressful stimuli (inflammatory process) - Psychological stressful stimuli (parental separation, anxiety) Leading to development of visceral hyperalgesia
120
What questions should you ask in an abdominal pain history?
``` Onset, duration Location and radiation How long does it last? Character Aggravating/relieving factors Intermittent/constant Associated symptoms ```
121
What in the history suggests functional disorder?
``` Concurrent stressful event in life Peri-umbilical or epigastric Prolonged duration with no clear signs Vague, gradual onset, variable severity Reinforcement from parents No relationship to interventions Constant Signs of anxiety FHx of IBS Migraines ```
122
What in the history suggests organic cause?
Trauma/travel Well localised away from umbilicus Variable duration Isolated sudden onset pain Sometimes medications or position change help Intermittent Associated with fever, rash, weight loss, growth faltering, FHx of ulcers or IBD
123
What are red flags in an abdominal pain history?
Weight loss or poor growth Pain that is not periumbilical Change in bowel habits, nocturnal or diarrhoea/constipation Disturbed sleep due to pain Repeated vomiting, especially bilious Any constitutional symptoms such as fever, lethargy, reduced appetite
124
What are red flags in an abdominal examination?
Weight loss or decreased growth velocity suggest serious underlying cause Any organomegaly Abdominal tenderness that is localised, especially if not periumbilical Perianal abnormalities like fissures, skin tags, ulcerations Swollen, warm or hot joints Ventral hernias of the abdominal wall
125
What alarm S&S warrant diagnostic testing in children with abdominal pain?
``` Involuntary weight loss Deceleration of linear growth GI blood loss (visible or occult) Significant vomiting (including bilious, protracted, cyclical) Chronic severe diarrhoea Persistent R upper/lower quadrant pain Unexplained fever Family Hx IBD Abnormal or unexplained physical findings ```
126
What are the primary aims of treatment for abdominal pain?
Return to normal function Avoidance of reinforcement of pain behaviours Distraction, providing attention, rest, identifying triggers for pain Reassurance Education for family Emphasize that no serious life-threatening process/condition
127
What are the secondary goals of treatment for abdominal pain?
``` Relief of symptoms Pharmacologic Cognitive therapy Relaxation Massage/PT/OT/exercise ```
128
What is acute abdominal pain?
Less than 7 days duration, sudden onset and severe
129
What are the 2 most common cause of acute abdominal pain in children?
Non-specific abdominal pain and appendicitis in children presenting to hospital
130
What is guarding?
Contraction of abdominal wall musculature, classically in response to underlying peritoneal inflammation
131
How can you tell the difference between voluntary and involuntary guarding and why is this important?
Voluntary - contraction of the abdominal wall muscles in anticipation of painful stimulus Involuntary - true guarding, conducted at reflex arc level, when patient distracted or relaxed, voluntary guarding disappears Causes of involuntary guarding often need surgery
132
How does your examination of the abdomen differ in a child compared to an adult?
Hop/jump test - get child out of bed to jump up and down, positive if provokes pain In/out tummy test - blow abdominal wall in/out Stethoscope test - pretend listening to abdomen while gently pressing with stethoscope, useful if considering non-organic pain Percussion test - looks for peritonism and rebound tenderness
133
What are the 6 most useful clinical indicators of acute appendicitis?
``` Migration of pain to RIF Anorexia Guarding Nausea Elevated temperature Tenderness in RIF ```
134
What colour vomit is associated with malrotation?
Green
135
What colour vomit is associated with intussusception?
Milky the green
136
What colour vomit is associated with pyloric stenosis?
Milky
137
What are the 4 most common causes of vomiting in young babies?
Overfeeding GORD Sepsis Pyloric stenosis
138
Why does an intussusception happen?
A lead point in bowel wall causes peristalsis to drag the bowel forward into itself
139
Name 3 causes of acute vomiting
``` GI infection Non-GI infection eg UTI GI obstruction - congenital/acquired Adverse food reaction Poisoning Raised ICP Endocrine/metabolic disease eg DKA ```
140
Name 3 causes of chronic vomiting
``` PUD GI obstruction eg pyloric stenosis GORD Chronic infection Gastritis Gastroparesis Food allergy Psychogenic Bulimia Pregnancy ```
141
Name 3 causes of cyclic vomiting
``` Idiopathic CNS disease Abdominal migraine Endocrine eg Addison's Metabolic eg acute intermittent porphyria Intermittent GI obstruction Fabricated illness ```
142
How is pyloric stenosis diagnosed?
USS but don't need if can feel olive shaped mass
143
What is malrotation?
Midgut volvulus Failure of gut to rotate 90 of the 270 anticlockwise before returning to the abdominal cavity Normally DJ flexure is to left of midline and terminal ileum is in RIF - broad mesentery In malrotation - DJ to right - SMV to left of SMA - Narrow base of mesentery - Caecum displaced to epigastrium or right hypochondrium - Ladd bands
144
What happens in volvulus?
Ladd bands can cause duodenal obstruction | SM vessels can twist and cause ischaemia
145
Name 2 differentials for duodenal obstruction
Duodenal web | Annular pancreas
146
What can cause intussuception?
Most cases idiopathic | 10% - Meckel's diverticulum, Peutz Jaghers polyps, SB lymphoma
147
What are the different types of intussuception?
SB into SB SB into LB LB into LB LB into rectum
148
Name 5 causes of acute diarrhoea in children
``` Infective gastroenteritis - tends to be viral Non-enteric infections eg resp tract Food poisoning Colitis Food intolerance/hypersensitivity reactions NEC Drugs eg antibiotics HSP Intussusception Haemolytic-uraemic syndrome Pseudomembranous enterocolitis ```
149
Name 5 causes of chronic diarrhoea in children aged 0-24 months
``` Malabsorption eg post-enteritis syndrome due to lactose intolerance, CF, coeliac disease Food hypersensitivity Toddler's diarrhoea Excessive fluid intake Protracted infectious gastroenteritis Immunodeficiencies eg HIV Hirschsprung's disease Congenital mucosal transport defects Autoimmune encephalopathy Tumours (secretory diarrhoea) Fabricated illness ```
150
Name 5 causes of chronic diarrhoea in older children
``` IBD Constipation Malabsorption IBS Laxative abuse Infections including bacterial overgrowth and pseudomembranous colitis Excessive fluid intake Fabricated illness ```
151
Name 2 other causes of diarrhoea in children
Loss of sphincter control | Spina bifida
152
What is the treatment for chronic diarrhoea?
Oral disimpaction
153
What is the treatment for oral regimen for disimpaction?
Movicol | Stimulant laxative +/- osmotic laxative
154
What is the treatment for maintenance therapy for constipation?
Movicol
155
Name an osmotic laxative
Movicol | Lactulose
156
Name a stimulant laxative
Sodium picosulfate Bisacodyl Senna
157
Name a stool softener
Docusate

Paediatrics (21 decks)

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