Paeds GI Flashcards
CASE
A baby who keeps vomiting
O/E - looks fine, putting weight on well
Diagnosis?
GORD
What is the pathophysiology of vomiting in GORD?
Functional immaturity of the oesophageal sphincter
Lying down loads (cause they’re a baby)
Predominantly liquid food
Short intra-abdominal length of the oesophagus
What are the risk factors for developing GORD?
Cerebral palsy
Pre-term - especially if broncho-pulmonary dysplasia
After surgery for oeseophageal atresia or diaphragmatic hernia
How would you investigate a baby with GORD?
Clinical diagnosis basically
But then if they fail to respond to treatment or complications - oesphageal pH monitoring (degree of acid reflux) and endoscopy + oesophageal biopsies for oesphagitis + other causes
How would you treat a baby with mild GORD?
Reassurance
Add thickening agent to feeds
Small frequent meals
Avoid food before sleep
Avoid fatty foods, citrus, caffeine, carbonated drinks
Position with head at 30 degrees prone after feeds
How would you treat a child with significant GORD?
H2 receptor antagonist eg Ranitidine
PPI eg omprazole
If complications - Nissen fundoplication
What are the complications of GORD?
Oesophageal stricture Oesophagitis Recurrent pulmonary aspiration Barrett's oesophagus Failure to thrive Anaemia
CASE
Baby that is vomiting after feeds, is getting worse and is now projectile
Differentials?
Pyloric stenosis
Really bad GORD
Obstruction - malrotation
Duodenal atresia
What would you see in the bloods of a patient with pyloric stenosis / recurrent vomiting?
Hypochloraemic, hypokalaemic metabolic acidosis
So low chloride, potassium (and sodium)
And low bicarb, low base excess, low pH and probably low CO2 cause of respiratory compensation
How would you investigate a baby with suspected pyloric stenosis?
Immediate resuscitation if needed ABG Test feed Visible gastric peristalsis - left to right Palpable OLIVE SHAPED MASS in the RUQ
What could you do to help you to examine (with palpation) a baby with pyloric stenosis?
Feed - milk calms a hungry baby
NG tube to get rid of air in the stomach if its overdistended
How would you manage a child with pyloric stenosis?
Rehydration - 0.45% saline and 5% dextrose and potassium supplementation
Pyloromyotomy - feed after 6 hours, discharge after 2 days
What are the symptoms and signs of appendicitis?
Abdominal pain - colicky, initially central and then localised to RIF
Anorexia
Vomiting
Flushed face Oral fetor Low grade fever Abdo pain worse on movement Tenderness and guarding at McBurney's point
How would you investigate a child with suspected appendicitis?
Bloods - neutrophilia
USS to exclude other things
CT
Laparoscopy
What might you see on abdominal X ray in a child with appendicitis?
Faecoliths