Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Paediatrics > Diarrhoea and Vomiting > Flashcards

Diarrhoea and Vomiting Flashcards

1
Q

What are the 4 types of vomiting?

A

Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the stages of vomiting with retching?

A

Pre-ejection - tachycardia, pallor, nausea
Ejection - retching, vomiting
Post-ejection - floppy, weak, lethargic, shivering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What can stimulate the vomiting centre?

A 
Enteric pathogens 
Visual stimuli 
Middle ear stimuli 
Metabolic derangement 
Infection (UTI, encephalitis/meningitis)
Head trauma 
Intestinal inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you test for pyloric stenosis?

A

Test feed - visible gastric peristalsis, palpation of olive tumour
Blood gas - should show metabolic alkalosis, low K and Cl
USS - shows thickening of pylorus and narrowing of lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you manage pyloric stenosis?

A

Fluid resus

Ramstedts pyloromyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What age group and gender is pyloric stenosis most common in?

A

4-12 weeks

Boys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a typical presentation of pyloric stenosis?

A

Projectile non-bilious vomiting
Weight loss
Dehydration +/- shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What should bilious vomiting raise alarm bells for?

A

Intestinal obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What things can cause intestinal obstruction?

A 
Intestinal atresia (newborns only) 
Malrotation +/- volvulus
Intussception 
Ileus (slowing of gastric motility due to infection)
CD with strictures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What investigations should you do in bilious vomiting?

A

Abdominal XRay
Consider contrast meal
Surgical exploration via laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is effortless vomiting normally due to?

A

Gastro-oesophageal reflux

Usually self-limiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is GOR a problem?

A

In cerebral palsy, progressive neurological problems, oesophageal atresia +/- TOF operated
Generalised GI motility problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why is reflux especially common in the first few months –> years?

A

LOS not matured yet and is a lot more laxed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the symptoms of GOR?

A

GI - vomiting/haematemesis
Nutritional - FFT/feeding problems
Respiratory - apnoea, wheeze, chest infections, cough
Neurological - Sandifer’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Sandifer’s syndrome?

A

GOR & spastic movements etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you investigate GOR?

A 
Usually just Hx and Ex 
May need:
Video fluoroscopy/barium swallow
pH study 
Oesophageal impedance monitoring
Endoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What might you be able to see in a barium swallow with someone with GOR?

A

Dysmotility, hiatus hernia, reflux, gastric emptying, strictures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you do a pH study?

A

Monitor at 5cm above LOS to measure reflux

Should correlate with symptom diary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you do impedance monitoring?

A

Several sensors from proximal to distal oesophagus which monitor bile, air and acid reflux and how far it comes up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What might you see on endoscopy?

A

Ulcerated oesophagus

Best test to diagnose oesophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a trial of feeding test?

A

Maybe best to see if child needs surgery
NG tube req and needs a few days in hospital
given antireflux meds and NG feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you Rx GOR?

A

Feeding advice - keep upright, avoid aversive behaviours, eat little and often, oral stimulation
Nutritional support
Medical Rx
Surgery

23
Q

What is involved in medical Rx of GOR?

A

Feed thickener - Gaviscon, thick and easy
Prokinetic drugs
Acid supressing drugs - H2 receptor blockers, PPI

24
Q

What are the indicators for surgery in GOR?

A

Persistent FFT, aspiration, oesophagitis

25
What is the surgical Rx for GOR?
Nissen fundoplication | Children with cerebral palsy more likely to have bloating, dumping, retching and other problems after surgery
26
How must fluid is lost in faeces per day?
<200ml
27
What secretory functions does the small bowel carry out?
Water for fluidity/enzyme transport/absorption Irons, e.g. duodenal HCO3- Defence mechanisms against pathogens/antigens/harmful substances
28
Where do stem cells come from in the small intestine mucosa?
Crypts of Leiberkhuns - they move up and are shed into the lumen
29
Define chronic diarrhoea
4+ stools/day for more than 4 weeks
30
Define acute diarrhoea
<1 week
31
Define persistent diarrhoea
2-4wks
32
What are the three categories of diarrhoea?
Motility disturbance - toddler's diarrhoea, IBS Active secretion - acute infective diarrhoea, IBS Malabsorption of nutrients (osmotic) - food allergy, coeliac disease, CF
33
What is the mechanism of osmotic diarrhoea?
Food not being absorbed so stays in lumen and pulls water from the cells --> diarrhoea All to try and equilibrate the osmotic balance Usually due to enzymatic defect (lactase) or transport defect (CF) Generally accompanied by macroscopic and microscopic intestinal injiury
34
How can we nutritionally support children with chronic diarrhoea?
Calorie supplements Exclusion diets (e.g. milk free) NG tube Gastrostomy
35
Name two osmotic laxatives
Lactulose, movicol
36
What is secretory diarrhoea often assoc with?
Toxin production from vibrio cholerae and enterotoxigenic Escherichia coli Active Cl secretion via CFTR
37
Bloody diarrhoea in a child here in Aberdeen is what until proven otherwise?
E. coli
38
What are the causes of motility problem associated diarrhoea?
Usually toddler's diarrhoea | Others: IBS, congenital hypothyroidism, chronic intestinal pseudo-obstruction
39
What is inflammatory diarrhoea due to & what does it result in?
Malabsorption due to intestinal damage Secretory effect of cytokines Accelerated transmit time due to inflammation Protein exudate across inflamed epithelium
40
What do you want to gather in your history of a child with diarrhoea?
``` Age at onset Gradual/abrupt onset FH Nocturnal defaecation always pathological Consider wt and height of child ```
41
What do you want to do with the faeces of a child with diarrhoea?
Observe appearance Stool culture Determine whether secretory/osmotic
42
What are the differences in the stool from osmotic and secretory diarrhoea?
Osmotic - smaller, fasting --> diarrhoea stops, high stool osmolality & osmotic gap Secretory - higher volume, diarrhoea continues despite fasting, lots of electrolytes in secretory diarrhoea
43
What can cause fat malabsorption leading to diarrhoea?
Pancreatic disease (e.g. CF) - lack of lipase --> steatorrhoea Hepatobiliary dx (e.g. chronic liver dx/cholestasis) - don't have bile salts to dissolve fat
44
What is coeliac disease?
Gluten sensitivity enteropathy | Only 30% with genetic potential to get it, will end up with it
45
What are the symptoms/signs of coeliac disease?
Abdominal bloatedness, diarrhoea, FFT, short stature, constipation, tiredness, dermatitis herpatiformis
46
What are the screening tests for coeliac disease?
Anti-tissue transglutaminase Anti-endomysial Anti-gliadin Check IgA levels (as 2% of population have low levels and may get false -ve)
47
What is the gold standard for diagnosis of coeliac disease?
Duodenal biopsy | Can also do genetic testing
48
What are the HLA genotypes most prone to coeliac disease?
HLA DQ2 and DQ8
49
What findings may you see on endoscopy with coeliac disease?
Red, inflamed, scalloped
50
What findings might you find on endoscopy with coeliac disease?
Villous atrophy Crypt hyperplasia Lymphocytic infiltration of surface epithelium
51
Under what circumstances can you diagnose coeliac disease without biopsy?
Symptomatic children with anti-TTG >10x upper limit normal Positive anti-endomysial antibodies HLA DQ2/8 +ve
52
How do you Mx coeliac disease?
Gluten free diet for life | If v. young (,2y) can re-challenge later
53
What are people with coeliac disease at risk of if they don't receive Rx?
Small bowel lymphoma

Paediatrics (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions