Gastroenterology Flashcards
What does blood in the stool of a vomiting child indicate?
Intussusception, gastroenteritis - salmonella or campylobacter
What does bile stained vomit indicate in the vomiting child?
Intestinal obstruction
What does haematemesis indicate in the vomiting child?
Oesophagitis, peptic ulceration, oral/nasal bleeding
What does projective vomiting in the first few weeks of life indicate?
Pyloric stenosis
What does vomiting at the end of paraoxysmal coughing indicate?
Whooping cough
What does abdominal tenderness or abdominal pain on movement in the vomiting child indicate?
Surgical abdomen
What does abdominal distension in the vomiting child indicate?
Intestinal obstruction, including strangulated inguinal hernia
What does hepatosplenomegaly in the vomiting child indicate?
Chronic liver disease
What does severe dehydration or shock in the vomiting child indicate?
Severe gastroenteritis, systemic infection (UTI, meningitis), DKA
What does a bulging fontanelle or seizures in a vomiting child indicate?
Raised intracranial pressure
What does failure to thrive in a vomiting child indicate?
Gastro-oesophageal reflux, coeliac disease and other chronic gastrointestinal conditions
What is posseting?
The non-forceful return of small amounts of milk which often accompany the return of swallowed air (‘wind’).
What is regurgitation?
The non-forceful return of larger (than posseting), losses of milk. Regurgitation may indicate the presence of more significant gastro-oesophageal reflux
When would serious disorders need to be excluded with vomiting?
If vomiting is bilious or prolonged, or if the child is systemically unwell or failing to thrive. In infants, vomiting may be associated with infection outside the GI tract, especially a UTI or CNS infection.
When is vomiting not bile-stained in intestinal obstruction?
When the obstruction is proximal to the ampulla of Vater.
What is gastro-oesophageal reflux?
The involuntary passage of gastric contents into the oesophagus. It is extremely common in childhood.
What causes gastro-oesophageal reflux?
Inappropriate relaxation of the lower oesophageal sphincter as a result of functional immaturity. A predominantly fluid diet, horizontal posture and a short intra-abdominal oesophagus all contribute
When should symptomatic reflux resolve spontaneously?
By 12 months of age
What are some complications of gastro-oesophageal reflux?
Failure to thrive
Oesophagitis (haematemesis, discomfort on feeding or heartburn, iron deficiency anaemia)
Recurrent pulmonary aspiration (recurrent pneumonia, cough or wheeze, apnoea in preterm infants)
Dystonic neck posturing
Apparent life threatening events
In which children in severe reflex more common?
Cerebral palsy or other neurodevelopmental disorders
Preterm infants
Following surgery for oesophageal atresia or diaphragmatic hernia
How would you manage gastro-oesophageal reflux?
Parental reassurance, adding inert thickening agents to feeds and positioning in a 30 degree head-up prone position after feeds. Occasionally, ranitidine or omeprazole or domperidone
What is pyloric stenosis?
Hypertrophy of the pyloric muscle causing gastric outlet obstruction.
When does pyloric stenosis present?
Between 2 and 7 weeks of age, irrespective of gestation
Is pyloric stenosis more common in boys or girls?
Boys: 4:1