Gastroenterology and Nutrition Flashcards
What are the causes of vomiting in an infant?
- Reflux/GORD
- Overfeeding (common in bottle fed infants)
- Pyloric stenosis
- Infection, e.g. gastroenteritis, UTI, meningitis
- Intestinal obstruction
- Cow’s milk protein allergy
Describe the epidemiology of gastro-oesophageal reflux
When does this typically resolve for most infants?
Extremely common in first year of life
Usually resolves by 1 year in vast majority of cases
Describe the investigation of gastro-oesophageal reflux
Diagnosis is usually clinical, therefore investigations are not usually required
If investigations are required:
- 24 hour oesophageal pH monitoring
- Endoscopy
Describe the management of gastro-oesophageal reflux and GORD (conservative, medical and surgical)
Conservative:
- Smaller, more frequent feeds
- Feed thickening agents
Medical:
- Acid suppression, either with H2 receptor antagonist (e.g. ranitidine) or PPI (e.g. omeprazole)
Surgical:
- Very rarely, surgical intervention is required (fundoplication)
Give 2 examples of complications of GORD in infants/children
- Faltering growth
- Recurrent chest infections
Describe the pathophysiology of pyloric stenosis
Hypertrophy of the pyloric muscle causing gastric outlet obstruction
When does pyloric stenosis usually present?
2-8 weeks
What is the main symptom of pyloric stenosis?
Projectile vomiting
a) Describe the initial investigation of pyloric stenosis
b) What may bloods show?
c) What type of imaging is used to confirm the diagnosis?
a) Test feed = visible peristalsis and “olive” shaped mass in RUQ
b) Hypochloraemic, hypokalaemic metabolic alkalosis
c) USS to confirm diagnosis
Describe the definitive management of pyloric stenosis
Surgery (pyloromyotomy)
What is faltering growth?
- Sub-optimal weight gain
- Sustained drop down 2 centile spaces
How are the causes of faltering growth classified?
- Inadequate intake
- Inadequate retention, e.g. GORD
- Malabsorption, e.g. coeliac
- Increased requirements, e.g. congenital heart disease
In most cases, the cause of faltering growth is…
Inadequate intake of food
Describe the vomiting in an infant with suspected intestinal obstruction
Bilious (green) vomit = intestinal obstruction until proven otherwise
What are the causes of intestinal obstruction in infants/children?
- Intussusception
- Malrotation
- Meckel’s diverticulum
Describe the pathophysiology of intussusception
Most commonly involves the ileum passing into the caecum through the ileocaecal valve (invagination of the bowel)
What are the textbook signs of intussusception?
- ‘Sausage’ shaped mass on abdominal exam
- ‘Redcurrant jelly’ stool
In intussusception, what may be visible on imaging?
- USS may show characteristic ‘target’/’donut’ sign
- XR may shows signs of obstruction, e.g. distended small bowel
Describe the definitive management of intussusception
Rectal air insufflation (unless there are signs of peritonitis, in which case surgery is required)
Describe the pathophysiology of malrotation
When does this usually present?
Abnormality of midgut rotation during embryological development
Usually presents in first few days of life
Describe the investigation of suspected malrotation
Urgent upper GI contrast study
Describe the management of malrotation
Surgery
Describe the pathophysiology of appendicitis
Appendix becomes obstructed, allowing bacteria to multiply
What are the clinical features of appendicitis
- Acute abdominal pain (tenderness +/- guarding) starting generalised then localising to RIF
- Fever
- Vomiting
Describe the investigation of appendicitis
Abdominal USS
Describe the management of appendicitis
Appendicectomy
Describe the epidemiology of constipation in infants/children
Very common
What are the causes of constipation in infants/children?
- Usually caused by dehydration/lack of fibre
- Can be caused by other conditions, e.g. hypothyroidism, cystic fibrosis, Hirschsprung disease (rare)
What may happen in children when there is long-standing constipation?
Overflow soiling
Describe the management of constipation (conservative/medical)
Conservative:
- Adequate fluid/fibre intake
- Encourage good toileting habits
Medical:
- Mild/moderate = osmotic laxatives, e.g. movicol
- Severe cases = disimpaction regimen required (osmotic + stimulant laxative, e.g. sodium picosulphate or senna)
Describe the pathophysiology of Hirchsprung disease
When does it usually present?
Congenital disorder in which there is an absence of ganglion cells in part of the bowel, which prevents peristalsis in that section of bowel (usually affects rectum and sigmoid colon)
Usually presents in neonatal period, with failure to pass meconium within 48 hours of life
Which test is done to confirm a diagnosis of Hirschprung disease?
Rectal biopsy
Describe the management of Hirschprung disease
Surgical (anorectal pull-through)
Describe the textbook sign of Meckel’s diverticulum
Massive rectal bleeding
Describe the definitive management of Meckel’s diverticulum
Surgery
How much formula should bottle fed infants be having in a day?
150ml/kg per day
What are the common causes of gastroenteritis?
- Norovirus
- Roatvirus
What is the main concern in a child presenting with gastroenteritis?
Dehydration
Post-gastroenteritis, patients may develop…
Transient lactose intolerance
