Child or infant with vomiting or diarrhea Flashcards
Causes of vomiting in newborns and infants
Overfeeding GOR Pyloric stenosis Whooping cough SBO Constipation Systemic infection Foreign body
Causes of vomiting in children and adolescents
Gastroenteritis Migraine Raised ICP Bulimia Toxic ingestion/medications DKA Pregnancy Foreign body
Important history
Posseting vs vomiting Growth Feeding history Projectile vomiting Fever HA, photophobia Dysuria, frequency, foul smelling urine Diarrhea, sick contacts Paroxysms of cough followed by vomiting
Important examination
Hydration Palpable pyloric mass Abdominal distension Papilloedema, hypertension Evidence of meningism
Investigations
FBE UEC pH Barium swallowing Upper GI contrast study->mandatory in bile stained vomiting to exclude malrotation
What investigation is mandatory in bile stained vomiting ND what does it exclude
Upper GI contrast study->to exclude malrotation, duodenal or ileal atresia
In what group is GOR particularly common
Preterm
Investigations for severe reflux
Barium swallow
Esophageal pH monitoring for 24 hours
Management of reflux
Sit infant upright
Thicken feeds
Gaviscon before feed
Wind baby after feeds
Usually improves over time as child sits upright more and progresses to more solid feeds
Commonest indication for surgery in infancy
Pyloric stenosis
GE without diarrhea, cause
Norovirus
When is duodenal atresia more common
Down’s
Immediate management of bile stained vomiting
ABC NGT->aspirate stomach Stop feeds pending upper GI study Fluids NBM
What 2 diagnoses should always be considered in an unwell infant with vomiting
Urinary tract infection
Meningitis
Oral rehydration regime
Replace deficit over 4 hours
Add 10ml/kg for each loose stool
Amount of fluid required % loss
10%= 100ml/kg
Causes of dehydration
1) Excess fluid loss
- >Excessive sweating: fever, climate, CF
- >Vomiting
- >Acute diarrhea
- >Fluid loss: burns, surpgery
- >Polyuria: DKA
2) Inadequate intake
- >Unable to drink
- > X access to water
Causes of chronic diarrhea
1) Non pathological
- >Toddler diarrhea: well and thriving, loose w/ undigested food, +gut transit time
- >Non specific diarrhea: loose watery, thriving, may follow acute GE
2) Malabsoroption
- >CF
- >Celiac: FTT, irritable, wasted, after wheat diet, fatty stool, duodenal biopsy
- >secondary lactose intolerance: following GE
3) Infectious
- >Giardia: wt loss, abdominal pain, nurseries
4) Inflammatory
- >Crohn’s
- >Ulcerative colitis
- >Cows milk protein intolerance: may have urticaria, stridor, bronchospasm, eczema
5) Overflow constipation
Important history in chronic diarrhea
Bowel pattern: frequency, consistency, odoour, blood, mucus
Precipitating: recent GE, change in diet, foods, family members
Associated symptoms: cough, wt loss, abdominal pain
Review of symptoms
Investigations blood and outcomes in chronic diarrhea (3)
FBC->anemia due to malabsortion, chronic disease, blood loss
Celiac screen->will need confirmation with jejunal biopsy
ESR->elevated in IBD
Investigations other in chronic diarrhea and outcomes (6)
Urine culture
Sweat test
Breath hydrogen test->high H2 in carbohydrate malabsorption
Jejunal biopsy
Barium follow through->characteristic findings of crohns in small bowel
Endoscopy
Investigations stool in chronic diarrhea and outcomes (6)
Blood->colitis
OCP->parasites
Reducing substances and low pH->lactose intolerance
Fecal elastase->low in pancreatic insufficiency
Microscopy for fat globules->fat malabsorption
Fecal calprotectin->IBD
Examination in chronic diarrhea
General: Pallor, jaundice, wasted Growth percentiles Hydration Abdominal distension, tenderness Finger clubbing Does the child look ill
Jejunal biopsy findings in celiac
Subtotal villous atrophy with crypt hyperplasia
