Paediatric Gastroenterology Flashcards
What is abdominal migraine?
Episodes of central abdominal pain lasting more than 1 hour
Intense and acute pin
Interferes with normal activity
Associated N+V, headache, photophobia, aura
How can abdominal migraine be treated?
Dark, quiet room
Paracetamol
Sumatriptan
Propylaxis –> Pizotifen
What is classed as constipation in children?
<3 stools per week (does not apply to exclusively breastfed babies)
Rabbit dropping stools
How can you differentiate between primary and secondary constipation?
Secondary constipation is from birth
If meconium takes longer than 48 hours to pass, ribbon stools, faltering growth, or vomiting - referral needed
How is primary/idiopathic constipation treated?
First line in children is an osmotic laxative e.g. Movicol
If no response can add a stimulant e.g. Senna +/Lactulose
What is the main cause of reflux in babies?
Immaturity of the lower oesophageal sphincter
How can reflux in babies be managed?
Small, frequent feeds
Burp regularly
Keep baby upright after feeding
If still problematic can mix Gaviscon with feeds
What is pyloric stenosis?
Hypertrophy and narrowing of the pyloric sphincter (the ring of muscle between the stomach and duodenum)
How does pyloric stenosis present?
Usually presents in 2nd-4th week of life
Peristalsis tries to push food down to the duodenum but it instead ejects upwards
Projectile vomiting (non-bilious)
May be constipation/diarrhoea
May be a palpable mass due to hypertrophied pyloric sphincter (often mentioned as olive shaped mass)
What blood gas results are seen in pyloric stenosis?
Low chloride
Low potassium
Alkalosis
Due to baby vomiting hydrochloric acid from stomach
What are signs of clinical dehydration in children?
Decreased urine output
Sunken eyes
Dry mucuous membranes
Tachycardia
tachypnoea
Reduced skin turgor
What are signs of clinical shock in children?
Decreased consciousness
Cold extremities
Pale/mottled skin
Tachycardia
Tachypnoea
Weak peripheral pulses
Prolonged cap refill
Hypotension
How to calculate replacement fluids in children?
(% dehydration x kg x 10) = mls of fluids
How to calculate maintenance fluids in children?
First 10kg = 100ml/kg
Next 10kg = 50ml/kg
After that = 20ml/kg
How to calculate resuscitation fluids in children?
Resuscitation fluids = 20ml/kg
EXCEPT IN….
neonates, DKA, septic shock, trauma, cardiac pathology (heart failure) = 10ml/kg