Conditions part 1 Flashcards
What is GOR?
Gastroesophageal Reflux
- due to inappropriate relaxations of the LOS -> most resolves by 12 months
Investigations for GOR?
Clinical diagnosis
o 24hr LOS pH monitoring (should remain mostly above 4)
o OGD
Management for GOR?
Referral - same day if haematemesis, melaena or dysphagia
by paediatrician if:
- red flag symptoms present
- unexplained distress
- feeding aversion
- poor growth
- IDA
Complications: - recurrent aspiration pneumonia epileptic seizure like events dental erosio upper airway inflammation
Treatment for GOR?
reassure - common
breast-fed:
- assessment
- alginate - reflux
- pharmacological
formula:
- smaller, frequent feeds
- thickened formula
- alginate therapy
Pharmacological management
- 4 week PPI, H2 antagonist trail
- Gaviscon, Omeprazole, Ranitidine, Dunno (GORD)
PACES counselling + safety net.
What is pyloric stenosis?
hypertrophy of the pyloric muscle causing gastric outlet obstruction
2-8 weeks, boys > girls
associated with turner’s syndrome
Signs and symptoms of pyloric stenosis?
Projectile vomiting 30 mins after feed non-bilious olive mass in RUQ visible peristalsis
Dehydrated baby due to poor feeding
Hypochloraemia Hypokalaemia metabolic alkalosis
Investigations into Pyloric stenosis?
Test feed -> watch gastric peristalsis
USS confirmation
Management of pyloric stenosis?
IV slow fluid resuscitation + correct imbalances
Laparoscopic Ramstedt pyloromyotomy
What is infant colic?
40% babies complex symptoms - inconsolable crying + drawing up hands and feet
Causes: GI, over/underfeeding, protein allergy, exposure to smoke, LBW
Management of infant colic
soothe infant - hold with gentle motion, winding technique
if persistent consider milk protein allergy
Support groups - or health visitor, family and freinds
What is appendicitis?
inflammation of the inner lining of the vermiform appendix that spreads to its other parts.
Rare in under 3’s. Faecolith and/or perforation more common
Signs and symptoms of appendicitis?
Anorexia, vomiting, nausea, umbilical to RIF pain, fever, tenderness
Investigations for appendicitis?
FBC
pregnancy test (female)
Clinical watchful waiting
AXR + CTAP
Managmenet for appendicitis?
G - Group and Save
A - Abx iv
M - MRSA screen
E - Eat and Drink, must be NBM
What is Intussusception?
invagination of proximal bowel into distal component - 95% = ileum through caceum at the ileocaecal valve
Stretch/constrict of mesentery -> venous obstruction -> engorgmeent and bleeding - > bowel perforation, peritonitis and gut necrosis
Causes of intussusception?
3 months to 2 years
idiopahtyic, enlarged peyer’s patchers, lead points, hypertrophy (seen in CF)
Signs and symptoms of intussusception?
Colic
vomit - may be bile stained
redcurrant jelly stool
abdominal distension
Investigations for intussusception?
abdominal USS - target mass
abdominal XRAY - less air in RUQ, dialled small bowel loops
barium/gastrograffin enema
Management for intussception?
drip and suck
recital air insufflation/barium/gastrograffin enema
broad spectrum antibiotics
recurrence risk of 5%
What is Meckel’s Diverticulum?
Very common between 1-2 years
Ileal remnant of the vitello-intestinal duct containing gastric mucosa or pancreatic tissue
Signs and symptoms of meckel’s diverticulum?
Painless massive PR bleeding (dark)
bilious vomiting
dehydration
constipation
Investigations for meckel’s diverticulum
Technetium scan -
AXR or abdominal USS
