GI Disorders Flashcards
How much milk should children be fed?
150ml/kg/day
What blood results are seen in pyloric stenosis and what other investigations should be done?
Alkalosis, hypochloraemia and hypokalaemia
Abdominal US to show pyloric thickening
What is the presentation of pyloric stenosis?
Usually in 3-6 week old males Non bilious projectile vomiting Olive abdominal mass Gastric peristalsis Signs of dehydration Failure to thrive or weight loss FH of pyloric stenosis
What is the management of pyloric stenosis?
Fluid resuscitation
Electrolyte rebalance
Laparoscopic or open pyloromyotomy
What kind of vomiting is seen in Intestinal atresia, malrotation +/- volvulus, intussusception, ileus?
Bilious vomiting
What investigations should be done in a possible intestinal blockage?
Abdominal x-ray
Consider contrast meal
Surgical opinion re exploratory laparotomy
In what circumstances can GOR continue on into adolescence?
Cerebral palsy
Progressive neurological problems
Oesophageal atresia +/- TOF operated
Generalised GI motility problem
What is the presentation of GOR in infants?
Vomiting Haematemesis Feeding problems Failure to thrive Apnoea Cough Wheeze Chest infections
What is Sandifer syndrome?
Sandifer’s syndrome is the association of gastro-oesophageal reflux disease with spastic torticollis and dystonic body movements. Nodding and rotation of the head, neck extension, gurgling sounds, writhing movements of the limbs, and severe hypotonia have been reported. If the reflux is treated then the neurological symptoms also dissipate
What investigations can be done in GOR?
Radiological investigations Videofluoroscopy Barium swallow pH study Oesophageal impedance monitoring Endoscopy
What are the treatments for GOR?
Feeding advice- use caraval to thicken the liquid, feeding position
Nutritional support-Calorie supplements, exclusion diet (milk free), nasogastric tube, gastrostomy
Medical treatment-Prokinetic drugs, acid suppressing drugs
Surgery
What are indications for surgery in GOR and what is the surgery that is done?
Persistent:
Failure to thrive
Aspiration
Oesophagitis
Nissen Fundoplication
What is the definition of chronic diarrhoea?
4 or more stools per day
For more than 4 weeks
What are the types of diarrhoea?
Active secretion (secretory)
- Acute Infective Diarrhoea*
- Inflammatory Bowel Disease
Malabsorption of nutrients (osmotic)
- Food Allergy*
- Coeliac Disease*
- Cystic Fibrosis
Motility disturbance
- Toddler Diarrhoea
- Irritable Bowel Syndrome
What is the presentation of coeliac disease?
Abdominal bloatedness Diarrhoea Failure to thrive Short stature Constipation Tiredness Dermatitis herpetiformis
What tests should be done in coeliac disease?
Serological Screens -Anti-tissue transglutaminase -Anti-endomysial -Anti-gliadin -Concurrent IgA deficiency in 2% may result in false negatives Gold standard- duodenal biopsy Genetic testing -HLA DQ2, DQ8
What are the causes of constipation?
Poor diet Insufficient fluids Excessive milk Potty training Current illness Medications (opiates, Gaviscon) Family history Psychological Anorectal malformations Hypothyroidism
What is the management of constipation?
Movicolon is used to remove impaction over a number of days or can give high dose stimulant laxatives, or give enemas (prefer not to as psychological effect).
Dietary- increase fibre, fruit, fluid and veg intake, reduce milk intake
Make going to toilet a pleasant experience (right height etc)
Avoid punitive behaviour from parents and reward good toilet behaviour with praise or incentives.
Medications- use lactulose or movicol (osmotic laxative which fights the bowel for the water), lactulose can cause wind, distension and abdominal pain so movicol better. Stimulant laxatives aggravate the colon and make it notice the stool (senna, picosulphate)-child will have a lot of liquid stools. Will need to see families frequently so can adjust dose.
Generally, however long constipation has lasted is how long treatment will need to last to fix the problem
