GI Disorders Flashcards
(17 cards)
What are the different types of vomiting in children?
- vomiting with retching
- projectile vomiting
- bilious vomiting
- effortless vomiting
Describe vomiting with retching
Pre-ejection phase
- pallor
- nausea
- tachycardia
Ejection phase
- retch
- vomit
Post-ejection phase
- weakness
- shivering
- lethargy
What can cause stimulation of vomiting centre?
- enteric pathogens
- intestinal inflammation
- metabolic derangement
- infection
- head injury
- visual stimuli
- middle ear stimuli
Describe pyloric stenosis
Babies 4-12weeks Boys>girls Projectile non-bilious vomiting Weight loss Dehydration ± shock Electrolyte disturbance; increased pH, reduced chlorine, reduced potassium
What is management of pyloric stenosis?
Management; fluid resuscitation, refer to surgeons - Ramstedts pyloromyotomy
Describe bilious vomiting
ALWAYS ring alarm bells
Intestinal obstruction until proven otherwise
Causes; intestinal atresia, malrotation, ileus, intussusception, Crohn’s with strictures
Abdo xray
Consider contrast meal
Describe effortless vomiting
Almost always due to gastro-oesophageal reflux
Very common problem in infants
Self-limiting, resolves spontaneously in vast majority of cases
Few exceptions; cerebral palsy, progressive neurological problems
What is Sandifer’s syndrome?
Association of gastro-oesophageal reflux disease with spastic torticollis and dystonic body movements
What are the aims of barium swallow?
- dysmotility
- hiatus hernia
- reflux
- gastric emptying
- strictures
Problems; aspiration and inadequate contrast taken
Describe feeding advice treatment
Thickeners for liquids
Appropriateness of foods;
- texture
- amount
Behavioural programme;
- oral stimulation
- removal of aversive stimuli
Feeding position
Describe nutritional support treatment
Calorie supplements
Exclusion diet (milk free)
NG tube
Gastrostomy
Describe medical management of GI disorder
Feed thickener
- gaviscon
- thick and easy
Prokinetic drugs
Acid suppressing drugs
- H2 receptor blockers
- proton pump inhibitors
What are indications for surgery in GI disorders in children?
Failure of medical treatment
Persistent
- FTT
- aspiration
- oesophagitis
Vomiting without complications may not be an indication
Describe osmotic diarrhoea
Movement water into bowel to equilibrate osmotic gradient
Usually a feature of malabsorption
- enzymatic defect
- transport defect
Mechanism of action of lactulose
Describe secretory diarrhoea
Classically associated with toxin production from Vibrio cholerae and enterotoxigenic E coli
Intestinal fluid secretion predominantly driven by active Cl secretion
Describe features of coeliac disease
abdominal bloating diarrhoea FTT short stature constipation tiredness dermatitis herpatiformis
Screening tests for coeliac disease
Serological
- anti-tissue transglutaminase
- anti-endomysial
- anti-gliadin
Gold standard; duodenal biopsy
GEnetic testing HLA DQ2, DQ8
