GORD

Question 1

What is Gastro-Oesophageal reflux?

What causes it?

Answer 1

Involuntary passage of gastric contents into the oesophagus

Caused by inappropriate relaxation of the lower oesophageal sphincter as a result of functional immaturity.
Predominantly fluid diet, mainly horizontal posture, short intra-abdominal oesophagus length contribute

Common in first year of life and most resolve by 12m

Question 2

What are complications of GORD?

Answer 2

Faltering growth from severe vomiting
Oesophagitis - haematemesis, discomfort on feeding, IDA
Recurrent pulmonary aspiration - pneumonia, cough, wheeze, apnoea
Dystonic neck posturing

Question 3

What are risk factors for GORD?

Answer 3

Cerebral palsy
Preterm infants
Bronchopulmonary dysplasia
Surgery for oesophageal atresia or congenital diaphragmatic hernia

Question 4

What investigations in GORD?

Answer 4

24h oesophageal pH monitoring
24h impedance monitoring
Endoscopy with oesophageal biopsy to identify oesophagitis

Question 5

What is management of uncomplicated GOR?

Answer 5

Parental reassurance
Avoid overfeeding
Add inert thickening agents to feeds - Carobel
Smaller more frequent feeds

Question 6

How is GORD managed?

Answer 6

Antacid - infant Gavison

Ranitidine (H2antagonist) or PPI (omeprazole)

If unresponsive or oesophageal stricture, consider Nissen fundoplication where fundus of stomach is wrapped around the intra-abdominal oesophagus

Question 7

What is pyloric stenosis?

Answer 7

=Hypertrophy of the pyloric muscle causing gastric outlet obstruction

Question 8

When/How does pyloric stenosis present?

Answer 8

2-8 weeks of age
More common in boys
May be FHx

Projectile vomiting
Hunger after vomiting until dehydration leads to loss of interest in feeding
Weight loss if presentation delayed

Question 9

What is seen in blood in pyloric stenosis?

Answer 9

Hypochloraemic, hypokalaemic, hyponatraemic metabolic alkalosis

Vomiting of stomach contests

Question 10

How is pyloric stenosis diagnosed?

Answer 10

Test feed - baby is given milk feed
Gastric peristalsis may be seen in abdomen
Pyloric mass - olive feeling - is usually palpable in RUQ
If stomach is over distended with air - NG to empty and all palpation

USS to confirm

Question 11

What is management of pyloric stenosis?

Answer 11

Correct fluid and electrolyte disturbance

Pyloromyotomy - division of hypertrophied muscles down to mucosa
Open procedure or laparoscopically

Post-op feed child within 6h and discharge in 2d

Question 12

Risk factors for Pyloric stenosis?

Answer 12

Male
First born
FHx