alimentary (simplified) Flashcards
6 week old baby boy
3 week history of vomiting after every feed
Bottle fed 6 ounces 3 hourly
Vomitus- large volume, milky or curdy, mostly projectile
Irritable and crying
Not gaining weight adequately
o/e looks slightly dehydrated
What are you differentials?
how do you manage?
gastroesophageal reflux
overfeeding
pyloric stenosis
cow’s milk protein allergy
fluid resuscitation
refer to surgeon
features of pyloric stenosis:
projectile, non-bilious vomiting
weight loss
dehydration/schock
electrolyte imbalance
what is bilious vomiting?
vomit with BILE in it
should always ring alarm bells!
remember bile is green
what is the MAIN cause of bilious vomiting?
intestinal obstruction
Intussusception
the invagination or telescoping of intestine into itself
what is the difference between malrotation and intussusception?
intussusception: invagination/telescoping of a part of the intestine into itself
malrotation/volvulus: congenital anomaly when the normal sequence of rotation and fixation of bowel fails, which may result in intestinal obstruction
what is malrotation?
congenital abnormality
intestinal abnormality - it fails to form correctly/ doesn’t coil
therefore you can get intestinal obstruction
causes of bilious vomiting
intestinal atresia (in newborns only!)
malrotation (+/- volvulus)
intussusception
crohn’s disease
how do you investigate bilious vomiting?
abdo x-ray
contrast meal
exploratory laparotomy
effortless vomiting is almost always due to:
gastro-oesophageal reflux
very common in infants
barium swallow can help identify
dysmotility
hiatus hernia
reflux
gastric emptying
strictures
pH studies are useful in detecting
acid reflux!
2 types of acid suppressing drugs
H2 receptor blockers
proton pump inhibitors
nutritional support
calorie supplements
exclusion diet (milk free etc)
nasogastric tube
gastronomy
Indications for surgery
failure to thrive
aspiration
oesophagitis
nissen fundoplication
treats gord
hiatus hernia
chronic diarrhoea is more than
4 stools per day
causes of diarrhoea
active secretion: acute infective diarrhoea, IBD
malabsorption of nutrients: food allergy, coeliac disease, CF
how can you investigate diarrhoea?
appearance
stool culture
is it secretory or osmotic?
fat malabsorption causes:
pancreatic disease
hepatobiliary disease
symptoms of coeliac disease
abdominal bloatedness
constipation
diarrhoea, dermatitis herpetiformis
failure to thrive
short stature
how do you screen for coeliac disease?
serological screen
- anti-tissue transglutaminase
- anti-endomysial
- serum IgA
gold standard: duodenal biopsy
genetic testing: HLA DQ2, DQ8
what are the 3 main causes of diarrhoea in kids?
acute infective diarrhoea
coeliac disease
food allergy
when does intussuscepition occur and when does malrotation occur?
intussception is weeks old
malrotation is days old
