Paeds gastrointestinal Flashcards
(31 cards)
How does Viral gastroenteritis occur?
It starts with sudden diarrhoea, with or without vomiting and sometimes assoc with fever.
It mainly affects the stomach not much of SI
Viral gastroenteritis is caused by?
Enteric virus e.g. rotavirus
How long is the course of viral gastroenteritis ?
Usually resolves without treatment, vomiting could take 1-2 days and diarrhoea could take a bit longer
What ques do you include in the history ?
Duration
Abdo pain, urinary symptoms
Fever ?
Number of episodes per day such as
How many times are you vomiting in a day?
How many times have you had diarrhoea ?
Content of diarrhoea must be loose stools/ ordinary
How is your eating and drinking?
Check their behaviour, alertness and look at their face, eyes , is it sunken?
mucous membrane ? is it moist
Look at their skin ? prick a skin on their hands or the tummy and if it stays for a more secs there is no fluid in the body
What investigation would you carry out for Viral gastroenteritis ?
Usually not necessary but I would investigate if there have been abroad or if it doesn’t settle for a while.
Faces test to microbiology
Blood cultures ( if worried about sepsis)
Who are mostly at risk of Viral gastroenteritis ?
Children younger than 1 year esp less tha 6 months
Low birth weigh t
> 5 time of diarrhoea within 24hrs
2 vomited in 24 hrs
For who has stopped breast feeding during illness
If there’s any signs of malnutrition
What are the red flags of viral gastroenteritis ?
Fever above 38
SOB
Tachypnoea
Neck Stiffness
Altered conscious
Foreign travel
Bulging fontanelle in infants
Blood or mucus in stool
Non blanching rash
What is the Management for Viral gastroenteritis ?
encourage fluid intake
continue the usual diet
continue breastfeed/ other milk feeds
oral rehydration solution
What are the causes of constipation in Paeds ?
idiopathic and factors include pain, fever, dehydration,dietry and fluid intake, psycological issues
toilet training, anal fissure, medicines and FH
What are the signs and symptoms of constipation ?
infrequent bowel activity
smelly wind, stool
irregular stool texture
frequent small pellets
soiling or overflow
abdo pain
distention or discomfort
poor appetitie
Lack of energy, unhappy, angry or irritable mood
What should you examinae when you’re looking on someone with constipation?
What is the management of constipation ?
- Behavioural interventions
- Scheduleing toilet times to establish regular bowel habits
- give info on constipation
- adequate fluid intake
- adequate intake of fibre, vegetables, high fibre bread, baked beans, wholegrain breakfast cereals
- use of laxatives
What is the investigation for constipation ?
abdo radiology
barium enema /rectal biopsy
blood test for coeliac disease or Hypothyroidsim -TFT
Why should we investigate about abdominal radiology ?
To show the loaded rectum
Why should you do the barium enema or rectal biopsy?
To look for Hirschprung’s disease
What is Infantile colic ?
- 2 months old constantly crying for about 3-4 hrs for the past month
- he screams while crying with his knees up against his sbdomen and appears to be in a great pain
- episodes usually late evening
How would you examine the baby with infantile colic?
Baby’s skin is pink
well perfused
Cappillary refill time <2 secs with normal fontanelle
clear chest
normal resp
RR 32
98 on room air
No organomegaly
abdo soft and non tendor
bowel sounds present
Heart sound 1+11+0
femoral palpable and equal bilateral
check for nappy area whether is normal or rash
weight 3.8 kg
What is Infantile Colic ?
It is Benighn and self limiting where is cause is unknown.
This happens more often in the first six weeks OF LIFE BOTH MALE AND FEMALE
Food allergy to cow’s milk play a role
Flatulence results from excessive air intake during feedinf/inadequate burping after feeding
Excessive intestinal gas causing abdominal distention and intestinal spasm lead to infantile Colic
Associated with postpartum deprssion
DDx of Infantile colic ?
UTI
GORD
otitis media
Anal fissure
Fracture
What is the manaegment of Infantile Colic ?
Investigation unneccsary
approp feed, uprigh position while feeding and adequate burping after feeding
advice stratergies to mothers on how to calm the crying infant
- warm baths, remove environmental stimuli, white nose. gentle motions, appropriate winding during feeds
DO NOT RECOMMEND ANY MEDS OR SUPPLEMENTS
GORD in Paeds
Uncontrolled passage of gastric contents into the oesophagus which occur often in pre term but it happens almost all the infants/
because, immature oseophageal sphincter falls to prevent reflux of gastric contents, will resolve in 95% of babies by 18 months of age
What problems could they face pathologically ?
- weight loss
- feeding or sleeping problems
- Chronic respiratory disorders
- Oesophagitis
- Hematemesis - refer to paediatrician
Who is more prevelant to GORD ?
- Pre mature birth
- parental hx of heartburn/acid regurgitation
- Obesity
- Hiatus Hernia
- Hx of congenital diaphragmatic hernia
- Hx of congenital oesophageal atresia means when the tube was never opened, so rejoin.
- Neurodisability
What is the management of GORD ?
- Dierty changes
- Look at the feeding hx and reduce the amount of voulme that is being fed each time, so that the stomach will not not have enough content to push up again.
- Reviww feeding hx
- Offer a thick formula feed ( e.g carrot, rice, corn, starch)
- Positioning - PRONE POSITION IS BETTER FOR GORD
