GI (medical) Flashcards
What is the difference between reflux and reflux disease?
Reflux is just the mechanical symptom of regurgitation of feeds
GORD is when you have negative symptoms that are associated with the reflux
Why is reflux more common in babies?
They have poor tone in their LOS
Spend a lot of time lying down
They have a mostly liquid diet
They have slowed gastric emptying
What are some risk factors for developing GORD?
Pre-term
Hypotonic (for whatever reason including Down Syndrome
Male sex
Cow’s Milk allergy
What are some other common causes of GORD?
Over-feeding - probably the most common cause (parents become worried their baby’s not eating enough because they’re throwing up so they give them more but this actually makes their reflex worse)
Hiatus hernia
Food allergy
CNS disorders
How does GORD commonly present?
Vomiting and regurgitation following feeding Reduced feeding Irritation Weight loss or failure to gain weight Crying Painful swallowing Haematemesis Apnoea, cough, stridor, LRTI (aspiration)
What is Sandifer’s Syndrome?
Bizarre extension and turning of the head and baby’s hold their heads in this position - associated with GORD
What investigations should we do for GORD?
Probably none…it’s a clinical diagnosis
Consider: FBC (anaemia), LFT, 24h Oesophageal pH, Manometry (pressure monitoring), endoscopy
How should GORD be managed?
Usually will self resolve by 10-18 months (weaning children will really help)
POSITIONING really important - keeping infants upright after feeds (putting a head tilt on their cots)
Thickened feeds
Gaviscon, ranitidine and PPIs
What is a potential risk of PPIs in babies?
Small risk of NEC in babies so try and avoid if possible
What is the most common causative agent for gastroenteritis in developed countries? What are some other less common causes?
ROTAVIRUS (60% cases)
Adenovirus, norovirus and coronavirus are also possible causes
What are some common bacterial causes of gastroenteritis and what symptom would make you think it was bacterial over viral?
BLOOD IN STOOL (**in general, clinical features are poor predictors of bacterial vs. viral differentiation)
Campylobacter
Shigella and salmonella
E.coli (strain 0157 particularly associated with blood in stool)
What are some key questions you’d want to ask during the history of a child presenting with gastroenteritis?
OPERATES (onset, progression, exacerbations, relieving, associated symptoms, timing, episodes previously, severity)
Any blood or mucus?
Can you describe what the stool looks like?
How much stool is being passed (dirty nappies per day)
Any contact with infectious persons or foreign travel
Has the child been passing urine normally?
Fever, vomiting, rashes
Has the child been eating and drinking and how much?
What would be some indications for admission in children with gastroenteritis?
Basically these are assessing the dehydration risk (thats the biggest concern)
Poor feeding (<50-75%) Young age (<6m) >6 stools in 24h >3 vomitting episodes in 24h Unable to tolerate malnutrition Clinical signs of dehydration or malnutrition (sunken fontanelle, high central cap refill, sunken features, unwell looking baby, pale)
If you think the child has been considerably dehydrated by their gastroenteritis how are you likely to manage this?
Admit them
Consider NGT placement for re-feeding and fluids
Consider IV access for fluids and also obtain baseline bloods (FBC, U&E, CRP, CBG)
How do we assess the child for clinical signs of dehydration?
WEIGHT is often a really good sign - although unless they’re very young parents probably won’t know weight - weigh anyway for future reference
Assess for following CLINICAL SIGNS
- General appearance, conscious level, urine output, skin (turgor, colour, mottling), extremities (warm or cold), CRT (central), femoral pulses (weak and thready), mucus membranes, heart rate (increased in dehydration), breathing, blood pressure
Which clinical signs specifically would begin to make you worried about shock in dehydration secondary to gastroenteritis?
Pale, cold and mottled skin
Decreased consciousness
Increased CRT
Weak peripheral pulses
Children will only become HYPOTENSIVE at a very late stage (very good at compensating - don’t wait for this clinical sign before treating for shock)
What principle is important when treating children for dehydration and what is this trying to avoid?
TREAT LIKE WITH LIKE
Children can easily become hypotonic if fluid loss is not replaced with isotonic solutions
Why is hyponatraemia particularly bad?
When Na moves from extracellular to intracellular it can lead to influx of water as well meaning the brain volume swells and this can result in convulsions
What investigations should be done for children with gastroenteritis?
Usually none are needed - clinical diagnosis
Can consider doing a stool sample/culture
How should you treat gastroenteritis?
Anti-diarrhoeals not usually indicated
Rehydration therapy is the main objective (oral, NGT or IV) - consider oral rehydration salts e.g. dioralyte
Abx not routinely given only in suspected sepsis, salmonella in under 6/12 and c.diff
What common problem can occur after resolution of gastroenteritis? How should this be managed
Post-gastroenteritis syndrome
- Watery diarrhoea can recur after children return to their normal diet - can sometimes be associated with a temporary lactose intolerance
Simply returning to Oral rehydration salts for 24h should be enough for this to pass by itself
