Gastro - Oesophageal Reflux Flashcards

1
Q

Why does reflux occur in babies?

A

Immaturity of the lower oesophageal sphincter

Stomach content refluxes into oesophagus

Normal for baby to reflux, no issues if normal development
90% stop by 1 year

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2
Q

How does reflux present?

A

Normal after larger feeds

Problematic reflux:
- Chronic cough
- Hoarse cry
- Distress, crying or unsettled after feeding
- Reluctance to feed
- Pneumonia
- Poor weight gain

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3
Q

What symptoms do children over 1 experience with reflux?

A

Similar to adult symptoms
Heartburn
Acid regurgitation
Retrosternal or epigastric pain
Bloating
Nocturnal cough

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4
Q

What are some possible causes of vomiting?

A

Overfeeding
Gastro-oesophageal reflux
Pyrloric stenosis
Gastritis or gastroenteritis
Appendicitis
UTI, tonsillitis or meningitis
Intestinal obstruction

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5
Q

What red flags indicate pyloric stenosis?

A

Not keeping down any feed
Projectile or forceful vomiting

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6
Q

What are the red flags of intestinal obstruction?

A

Not keeping down any feed
Projectile or forceful vomiting
Bile stained vomit
Abdominal distension

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7
Q

What red flags can indicate meningitis or raised ICP?

A

Reduced consciousness
Bulging fontanelle
Neurological signs

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8
Q

What type of symptoms indicate aspiration and infection?

A

Respiratory symptoms

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9
Q

What can indicate a cows milk protein allergy?

A

Blood in stools
Rash
Angioedema
(other allergy signs)

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10
Q

How is reflux managed?

A

Simple cases
Provide explanation, reassurance and practical advice
- Small frequent meals
- Burping regularly to help milk settle
- Not over-feeding
- Keep baby upright after feeding

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11
Q

How is problematic reflux managed?

A

Gaviscon mixed with feeds
Thickened milk or formula
PPIs e.g. omeprazole

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12
Q

What is the last-line treatment for reflux and what investigation is done for it?

A

Surgical fundoplication if very severe

Barium meal and endoscopy

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13
Q

What is Sandifer’s syndrome?

A

Rare condition causing short episodes of abnormal movements associated with reflux in infants

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14
Q

What are the key features of Sandifer’s syndrome?

A

Torticollis
Dystonia
- Abnormal muscle contractions causing twisting movements e.g. arching of the back

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15
Q

How is Sandifer’s syndrome managed?

A

Specialist referral for assessment

Tends to resolve as reflux is treated or improves

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16
Q

What are some differentials for Sandifer’s syndrome?

A

Infantile spasms (West syndrome)
Seizures