vomiting and diarrhoea

Question 1

ddx for infant/newborn vomiting

Answer 1

overfeeding
GORD
pyloric stenosis 
SBO 
whooping cough 
systemic infection 
UTI

Question 2

ddx for older children/adolescent vomiting

Answer 2

gastroenteritis
migraine 
raised ICP 
bulimia
pregnancy

Question 3

why is GORD common in infants

Answer 3

slow gastric emptying
liquid diet
horizontal posture
low lower oesophageal sphincter pressure

Question 4

RF for GOR/D

Answer 4

premi
cp 
downs 
cf
upper git malformation (hiatus hernia, pyloric stensis)

Question 5

sx of GOR/D

Answer 5

vomtitng 
refusal to feed
\++ irritability and arching 
FTT/poor gains
haematemesis

Question 6

mx of GOR/D

Answer 6

• continue to breast feed
• refer if ++ sx
• exclude other causes
• reassure parents

prone feeding
milk thickening agents (rice cereal)
no evidence but - no smoking, no overfeeding, reduce air swallowing, smaller more frequent feeds

omeprazole

failure of aggressive medical mx - surgery nissen fundoplication

Question 7

aetiology of pyloric stenosis

Answer 7

2-6wks, rare >12wks

progressive thickening of pylorus muuscle, gastric outlet narrowing

Question 8

RF for pyloric stenosis

Answer 8

first born
white
male
fam hx

Question 9

CF of pyloric stenosis

Answer 9

projectile non-billious vomiting (+/- blood = coffee ground)
hungry after vomit
constipation due to dehydration 
ftt/poor gains 
\+/- jaundice in a small %

Question 10

ix for pyloric stenosis

Answer 10

test feed - feel for gastric peristalis
feel fir pyloric mass in RUQ - olive
best felt after feeding
USS abdo

FBC, UEC, VBG
hypochloremic hypokalemi metabolic alkalosis

Question 11

mx for pyloric stenosis

Answer 11

1. IVF resus 10-20ml/kg/hr bolus
2. IVF NS + 5% dextrose + KCl
3. stop feeds
4. +/- NG tube
5. monitor UEC and VBG
6. replace electrolytes
7. once stable for theatre

Question 12

what conditions are predisposed to a SBO

Answer 12

downs - duodenal atresia
CF - meconium ileus
Hirschsprungs

Question 13

ddx for acute diarrhoea

Answer 13

gastroenteritis
abx induced
food poisoning
any infective/febrile illness

Question 14

ddx for chronci diarrhoea >14 days

Answer 14

non pathological 
- toddler diarrhoea
- non specific diarrhoea 
infective 
- parasititc (giardia)
inflammatory rare 
- UC
- Chronic 
- cows milk intolerance 
malabsorption
- CF
- Coeliac
functional diarrhoea

Question 15

what is toddler diarrhoea

Answer 15

loose stools with undigested food 
\++ fluid intake 
fast gut transit time 
THRIVING 
reassurance

Question 16

what is non specific diarrhoea

Answer 16

loose watery stools
thriving child
can follow acute gastroenteritits

Question 17

CF of infectious diarrhoea

Answer 17

giardia lambalis
watery fould smelling stools
wt loss, abdo pain
stool mcs + pcr

Question 18

aetiology of CF

Answer 18

autosomal recessive
CFTR abnormality on chromosome 7
85% delta F508

Question 19

how can CF initially present

Answer 19

meconium ileus
recurrent chest infection
FTT
chronic diarrhoea

Question 20

what systems does CF affect

Answer 20

lungs, liver, pancreas, clubbing, fertility

Question 21

common problems of CF

Answer 21

recurrent chest infection
- thick viscous mucus, poor ciliary clearance
- colonised with pseudomonal aeruginosa or burkhodera cepcacia
mx - chest physio, broonchodilators, abx, immunisation

malabsorption 
pancreatic insufficiency 
steatorrhoea 
malnurtition and fat soluble vitamin deficiency 
mx - creon and vitamin suplements 

diabetes

FTT/poro gains
high calorie diet
supplemental feeds may be necessary

liver disease
- sluggish bile flow -> biliary disease -> cirrhosis -> portal HTN

salt loss
NaCl replacement
can go into salt loosing crisis in hot weather

subfertility
males - absense fo vas deference

Question 22

ix of CF

Answer 22

infant - blood spot test (raised levels of immunoreactive trypsin)
sweat test
genetic testing

Question 23

what is the best indicator of disease progression in CF

Answer 23

FEV1