Paeds GASTRO Flashcards
What is the commonest cause of vomiting in infancy?
Gastro-oesophageal reflux
What is the cause of GOR in babies?
Inappropriate relaxation of the LOS (functional immaturity)
= a normal physiological process in infancy
Affects >40% infants
When does GOR present? By when does GOR usuallly resolve?
Usually develops before 8w
12 months: if persistent, may be due to GORD
How does GOR present?
Vomiting/ regurgitation: milky vomits after feeds
Vomiting may occur after being laid flat
Excessive crying, esp. while feeding
How is GOR diagnosed?
Clinical dx
24h LOS pH
What are 6 symptoms are considered red flags suggesting disorders other than GOR?
Projectile vomiting
Bilious vomiting
Onset after 6m/ persisting after 1y
Abdo distension/ mass
Chronic diarrhoea
Rapidly increasing head circumference
Which 3 symptoms warrant same day referral in GOR?
Haematemesis
Melaena
Dysphagia
Recall 6 factors prompting referral for paediatric assessment for GOR
Red flags
Faltering growth
Unexplained IDA
No improvement after 1y
Feeding aversion
Suspected Sandifer’s syndrome
What is Sandifers syndrome?
GORD
+
Paroxysmal dystonia: head, neck, back- Torticollis + Opisthotonus
Recall the general advice for GOR
- Reassure
- Review feeding hx
- Reduce feed volumes if excessive for infant’s weight
- Must sleep on back
For formula fed infants, what other management strategies should be used for GOR
Smaller more frequent feed
Offer thickened formula
Trial alginate 1-2w e.g. Gaviscon infant
For breastfed infants, what other management strategies should be used for GOR
Assess breast feeding- position, frequency
Trial Alginate 1-2w
What pharmacological treatment can be used if conservative management is ineffective for GOR?
PPI e.g. Omeprazole suspension
H2 receptor antagonists
What safety net should you watch out for when assessing GORD?
Monitor vomit: if bloody or green seek medical attention
What is necrotising enterocolitis?
Ischaemic necrosis of intestinal mucosa a/w severe inflammation, invasion of enteric gas forming organisms + dissection of gas into bowel wall
What is the major risk factor for necrotising enterocolitis?
Prematurity
Give 4 signs/ symptoms of necrotising enterocolitis
Abdo distension + erythema
Bloody stools
Bilious vomiting
Feeding intolerance
Give 2 complications of necrotising enterocolitis
Perforation + Peritonitis
What investigation is used to diagnose necrotising enterocolitis? What is seen?
Abdo XR
Intramural gas (pneumatosis intestinalis)
Pneumoperitoneum (perforation)
Air inside + outside bowel wall (Rigler sign)
Sentinel bowel loops
What is the treatment of necrotising enterocolitis?
Total bowel rest + TPN
Gastric decompression
Abx
Surgery: laparotomy for perforation
What causes pyloric stenosis? At what age does pyloric stenosis present?
hypertrophy of the circular muscles of the pylorus.
2-8w
Is pyloric stenosis more common in girls or boys?
Boys (4 x more common)
What is the main symptom of pyloric stenosis?
Projectile, non-billious vomiting
~30m after feed
Baby remains hungry
Increases in intensity until it becomes projectile
Recall 3 symptoms of pyloric stenosis other than vomiting
Weight loss + persistent hunger
Depressed fontanelle from dehydration
Constipation/ infrequent bowel movements