Diarrhoea and Vomiting Flashcards
What are the physical features of dehydration in an infant?
- Sunken anterior fontanelle
- Dry mucous membranes
- Tachycardia
- Reduced CRT
- Reduced skin turgor
What are the 2 most common viruses causing gastroenteritis in young children?
- Rotavirus
- Adenovirus
What are the red flag features associated with vomiting in children?
- Haematemesis
- Bile in the vomit
- Projectile vomit
- Abdominal distention/tenderness
- Blood in the stool
- Bulging fontanelle
What are the possible causes, in paediatrics, of; bile stained vomit?
Intestinal obstruction
What are the possible causes, in paediatrics, of; haematemesis?
- Oesophagitis
- Gastric ulcer
- Oral/nasal bleeding
- Vomiting swallowed blood
What are the possible causes, in paediatrics, of; Projectile vomiting (<2/12 old)?
- Pyloric stenosis
What are the possible causes, in paediatrics, of; abdominal distention/tenderness?
- Intestinal obstruction
- Strangulated inguinal hernia
- Surgical abdomen
What are the possible causes, in paediatrics, of; Blood in stool?
- Gastroenteritis (salmonella or campylobacter)
- Intussusception
What are the possible causes, in paediatrics, of; severe dehydration and shock?
- Severe gastroenteritis
- Systemic infection e.g. UTI, meningitis, DKA
What are the possible causes, in paediatrics, of; bulging fontanelle/fits?
- Raised intracranial pressure due to a. meningitis b. hydrocephalus
What are the possible causes, in paediatrics, of; faltering growth (failure to thrive)?
- GORD
- Coeliac disease
- Chronic gastrointestinal conditions
What are the possible causes, in paediatrics, of; vomiting with paroxysmal cough?
- Whooping cough
What characteristics put children at higher risk of dehydration?
- Low BW
- <1 year old
- > 2 vomiting episodes and >5 diarrhoea episodes in 24 hours
How do we manage paediatric patients that are dehydrated?
- Encourage oral fluid intake
- Use of oral rehydration solution (ORS) - frequently in small amounts
- ORS may have to be given by NG tube or IV if the patient is very ill
What percentage of children under the age of 5 years present to the NHS annually with gastroenteritis?
10%
What is the most common bacteria that causes gastroenteritis in chidlren?
Campylobacter jejuni
What is isonatraemic dehydration?
Where the loss of sodium and water are proportional and the plasma sodium is at normal levels.
What is dehydration?
Excessive water loss from the body. This is when fluid loss>fluid intake.
When does dehydration become fatal?
When >15% of the body’s total water is lost
What is hyponatraemic dehydration?
Where there is a greater net loss of sodium than water. This happens when large quantities of water/hypotonic fluids are taken in. This leads to a shift in water from extracellular to intracellular causing brain oedema, extracellular dehydration and shock.
What is hypernatraemic shock?
Water loss exceeds the sodium loss with resultant increase in plasma sodium. This can happen with insensible water loss (diarrhoea and vomiting).
What are the signs of hypernatraemia?
- Jittery movements
- Increased muscle tone
- Hyperreflexia
- Convulsions
- Drowsiness/coma
When is a stool culture indicated in someone with diarrhoea?
- Recent travel abroad
- No improvement by day 7
- Suspected septicaemia
- Blood and/or mucus in the stool
- Immunocompromised child
What are the indications for commencing and IV fluid regime in dehydrated children?
- Hypovolaemic shock
- Red Flag Sx
- Persistent vomiting
- Hypoglycaemia
What is the fluid regime to follow when treating a child with hypovolaemic shock?
1st fluid bolus = 20ml/kg of 0.9% NaCl by rapid IV infusion
2nd fluid bolus = 20ml/kg of 0.9% NaCl by rapid IV infusion
Which D+V causing bacteria are treated with Abx?
- Campylobacter
- C. Diff
- Non-typhoid salmonella
- Shigella
- Vibrio cholerae
- Giardia
- Yersinia
- Cryptosporidium
