Flashcards in Gastroenterology Deck (75)
Blood in vomit
Oesophagitis, peptic ulceration, oral/nasal bleeding
Projectile vomiting in first few weeks of life
Vomiting at the end of paroxysmal coughing
Intestinal obstruction, including strangulated inguinal hernia
Blood in stool
Intussusception or gastroenteritis
Failure to thrive
GORD, coeliac disease and other chronic GIT conditions
What is posseting?
Is the return of small amounts of milk with the return of swallowed air - occurs in nearly all babies from time to time
What sort of infections can be associated with vomiting in infants
Gastroenteritis but also with UTI and CNS infections
When does GORD usually resolve by?
Usually resolves spontaneously by 12 months of age - due to maturation of lower oesophageal sphincter, assumption of upright posture and more solids in diet (liquid diet, lying down and immature sphincter are reasons for GORD)
Complications of GORD
Failure to thrive
Recurrent pulmonary aspiration
Dystonic neck posturing (sandifer syndrome)
Management of uncomplicated GORD
Adding inert thickening agents to feeds and positioning in head up 30degree position after feeding
Management of more severe GORD
Acid suppression with h2 receptor antagonists (ranitidine) or proton pump inhibitors (omeprazole)
Surgery if don't respond to medication or have oesophageal stricture
What is pyloric stenosis
Hypertrophy of pyloric muscle causing gastric outlet obstruction
Presents between 2-7 weeks of age
Which infants is pyloric stenosis more common in
More common in boys 4:1
Particularly in first borns and may have a family history especially on maternal side
Type of vomiting in pyloric stenosis
Increases in frequency and forcefulness over time until it becomes projectile
Hunger after vomiting until dehydration causes loss of interest in eating
Diagnosis of pyloric stenosis
Feed test - gastric peralstasis wave moving across abdomen and pyloric mass (like olive) usually palpable in RUQ - ultrasound can be helpful
Management of pyloric stenosis
IV fluids to correct any fluid and electrolyte imbalance
Treatment by pyloromyotomy - Ramsteadt - division of muscle - quick recovery
Green vomit in child
What is colic?
Paroxysmal, inconsolable crying or screaming often accompanied by drawing up of the knees and passage of flatus several times a day - particularly in the evening
Incidence and period of colic
Occurs in first few weeks of life and resolved by 4 months of life and occurs in up to 40% of babies
Benign condition but can be worrying for parents
What can severe and persistent colic be due to?
Milk protein allergy or GORD
Causes of acute abdomen pain? x8
Appendicitis , hernia, hip joints and testes need to be checked
Lower lobe pneumonia
Primary peritonitis with nephrotic syndrome or liver disease
UTI and acute pyelonephritis
In what age is acute appendicitis uncommon in?
Uncommon in children under 3 years
Symptoms of acute appendicitis? x3
Vomiting (usually only a few times)
Abdominal pain, initially central and colicky and then localising to RIF
Signs in acute appendicitis?
Flushed face with oral fetor
Low grade fever
Abdominal pain aggravated by movement
Persistent tenderness with guarding in RIF
Why does diagnosis of acute appendicitis need to be made quickly in preschool children?
Perforation may be rapid - omentum is less developed
What might be identified in urine of acute appendicitis
White blood cells or organisms as inflamed appendix may be adjacent to ureter or bladder
What is intusseception?
Invagination of proximal bowel into a distal segment - most commonly the ileum passes into the caecum through the ileocaecal valve
At what age does intusseception commonly occur?
May occur at any age but peak age is between 3 months and 2 years