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3: Paeds Y3/4 - Paediatrics [15] > [22] Gastro-oesophageal Reflux > Flashcards

[22] Gastro-oesophageal Reflux Flashcards

1
Q

What is gastro-oesophageal reflux?

A

The involuntary passage of gastric contents into the oesophagus

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2
Q

Is gastro-oesophageal reflux usually a problem?

A

No, it is usually a benign self-limiting problem

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3
Q

When does gastro-oesophageal reflux become more serious?

A

When it progresses to GORD and requires treatment

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4
Q

When is gastro-oesophageal reflux common?

A

In infancy

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5
Q

When should infantile gastro-oesophageal reflux usually resolve by?

A

12 months of age

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6
Q

What can cause the development of gastro-oesophageal reflux?

A
  • Inappropriate lower oesophageal sphincter relaxation - Predominantly fluid diet - Mainly horizontal posture - Short intra-abdominal lenght of oesophaus
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7
Q

What are the risk factors for gastro-oesophageal reflux?

A
  • Cerebral palsy - Other neurodevelopmental disorders - Pre-term - Following surgery for oesophageal atresia or diaphragmatic herniation
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8
Q

What are the symptoms of gastro-oesophageal reflux?

A

Recurrent regurgitation or vomiting

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9
Q

How would you expect gastro-oesophageal reflux to affect the infant systemically?

A

Putting on weight and otherwise well

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10
Q

How is gastro-oesophageal reflux typically diagnosed?

A

Clinically

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11
Q

When may further investigations be indicated?

A
  • Atypical history - Complications present - Treatment failure
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12
Q

What investigations can be used in assessment of gastro-oesophageal reflux?

A
  • 24 hours oesophageal pH monitoring - Endocsopy with biopsy - Contrast studies
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13
Q

What is a 24 hour oesophageal pH monitoring test used for?

A

To assess the degree of reflux

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14
Q

What is the purpose of endoscopy and biopsy?

A

To assess for oesophagitis and exclude other causes of vomiting

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15
Q

What is the purpose of contrast studies?

A

To exclude underlying anatomical abnormalities in the oesophagus, stomach and duodenum

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16
Q

What are the differentials for gastro-oesophageal reflux?

A
  • Upper GI tract disorders - Cows milk intolerance - Metabolic disorders - CNS disorders - Urinary tract disorders
17
Q

What upper GI tract disorders may present like gastro-oesophageal reflux?

A
  • Pyloric stenosis - Malrotation - PUD
18
Q

What metabolic disorders may cause recurrent vomiting?

A
  • Renal tubular acidosis - Urea cycle defects
19
Q

What CNS disorders may present with recurrent vomiting?

A
  • Hydrocephalus - Meningitis
20
Q

What urinary tract disorders may present with recurrent vomiting?

A
  • Infection - Obstruction
21
Q

How is uncomplicated gastro-oesophageal reflux usually managed?

A

Conservatively

22
Q

What conservative management techniques can be used in gastro-oesophageal reflux?

A
  • Parental reassurance - Adding inert thickening agents to feeds - Giving smaller, more frequent feeds
23
Q

What type of treatment does significant GORD require?

A

Medical management and - possibly surgical management

24
Q

What types of medications can be used in the treatment of GORD?

A
  • H2 antagonists - PPI’s
25
Q

Give an example of a H2 antagonist

A

Ranitidine

26
Q

Give an example of a PPI

A

Omeprazole

27
Q

What should failure to respond to medical management prompt?

A

Reconsideration of diagnosis

28
Q

When should surgical management be considered?

A

In children with complications unresponsive to medical treatment or oesophageal stricture

29
Q

What surgical procedure is used in the correction of gastro-oesophageal reflux?

A

Nissen fundoplication

30
Q

What are the potential complications of gastro-oesophageal reflux?

A
  • Faltering growth due to severe vomiting - Oesophagitis - Recurrent pulmonary aspiration - Dystonic neck posturing
31
Q

What are the symptoms of oesophagitis?

A
  • Haematemesis - Heartburn on feeding - Iron-deficiency anaemia
32
Q

What are the symptoms of recurrent pulmonary aspiration?

A
  • Recurrent pneumonia - Cough - Wheeze

3: Paeds Y3/4 - Paediatrics [15] (115 decks)

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