Paeds - GI + liver Flashcards
Cow’s milk protein allergy (CMPA) pathophysiology
Immune-mediated allergic response to CASEIN and WHEY.
Can be IgE-mediated; non-IgE-mediated, and mixed
One of most common childhood food allergies (7% of formula/mixed-fed infants have)
CMPA Pathophys
IgE-mediated = type-I hypersensitivity reaction
- CD4+ TH2 cells stimulate B cells to produce IgE antibodies against cow’s milk protein which trigger the release of of histamine and other cytokines from mast cells and basophils
Non-IgE-mediated = T cell activation against cow’s milk protein.
CMPA RFx
Personal or family Hx of ATOPY
Exclusive breaastfeeding is possibly protective
Presentation of CMPA
IgE-mediated:
- Acute/rapid onset:
- Pruritis, Erythema, Urticaria, Acute angio-oedema on face
- Oral pruritis + angio-oedema; Nausea/vomiting; Diarrhoea; colicky abdo pain
- Lower and upper resp tract Sx
Non-IgE mediated:
- Non-acute (48hrs - 1 week after ingestion)
- Pruritis, erythema, ECZEMA
- GORD, Loose or frequent stools, Blood and/or mucus in stools, Abdominal pain, Infantile colic, Food refusal or aversion, Constipation, Perianal redness, Pallor and tiredness, Faltering growth
- Lower resp Sx only
Dx of CMPA
Allergy-focussed Hx:
- Personal and family history of atopy
- Diet and feeding history of infant
- Mother’s diet if breastfed
- Any previous management used for symptoms
- Which milk/foods
- Age of onset
- Speed of onset following exposure
- Duration
- Severity and frequency of occurrence
- Setting of reaction
- Reproducibility of symptoms
GI exam; review GROWTH CHART; signs of atopic co-morb
Bloods: RAST (specific IgE antibodies)
- sensitive but non-specific (false +ves)
- fbc + iron study if concerned about anaemia
CMPA DDx
- Food intolerance
- Allergy to other things
- Chronic GI disease (GORD, coeliac, IBD, gastroenteritis, constipation)
- Pancreatic insufficiency (cystic fibrosis)
- UTI
When to refer for RAST test
- Faltering growth with at least of the above symptoms
- One or more acute systemic or severe delayed reactions
- Confirmed IgE-mediated food allergy with asthma
- Persistent parental suspicion of a food allergy despite lack of clear history
- Clinical suspicion of multiple food allergies, especially with concomitant significant eczema
CMPA Mx
Eliminate cow’s milk from diet
If formula fed -> hypoallergenic:
- Extensively hydrolysed formula
- Amino acid formula (more expensive, for kids who keep having Sx from hydrolysed, or v severe Sx)
Soya-based formulas not recommended under 6 months
Why are soya based formulas not recommended in < 6 months
Isoflavones have weak oestrogenic effect, and absorption of minerals and trace elements may be inhibited by phytate found in this milk
Complications of CMPA
- MALABSORPTION or reduced intake
- Rarely anaphylaxis
Kwashiorkor vs Marasmus
- Marasmus is a deficiency of all macronutrients
- Emaciated, no oedema - Kwashiorkor is a deficiency in protein specifically (typically in people who have access to carbs but less protein).
- Develop oedema which counterbalances fat + muscle loss
- Higher risk of death
- Develop oedema which counterbalances fat + muscle loss
Both are life threatening
Biliary atresia
Bile duct narrowed or absent (prevents excretion of conjugated bilirubin)
Biliary atresia Px
Neonates with significant, persistant jaundice (14 days if term; 21 terms if prem)
Bilary atresia Ix
Conjucgated + uncong bilirubin in blood
- high conj = liver processing bilirubin but unable to excrete
Biliary atresia Mx
‘Kasai portoenterostomy’ surgery
- section of small intestine is attached to liver opening
Oft full liver transplant needed to resolve condition
Choledochal cyst
Congenital swelling of bile duct which can cause blockage and lead to significant, prolonged neonatal jaundice (conjugated bilirubin)
Hirschspurng’s disease
Congenital:
- ABSENCE of PARASYMPATHETIC ganglionic cells of the MYENTERIC (Auerbach’s) PLEXUS in large bowel + rectum
Subtypes of Hirschsprung’s
- Short-segment (recto-sigmoid only - most common)
- long-segment (till splenic flexure)
- total colonic agangliogenesis
Most common site is actually at ileocolonic junction
Which gene has strongest association with Hirschsprung’s + other associations
Receptor Tyrosine Kinase (RET) gene
Also associated with:
- Down’s
- Neurofibromatosis
- Waardenburg syndrome (genetic: pale blue eyes, hearing loss, patches of white skin/hair)
- Multiple endocrine neoplasia type 2
+ more common in MALES
Hirschsprung’s pathophys
The neuroblast which would develop into the enteric nervous system, is arrested in its migration from the vagal segment of neural crest
(or it gets there but doesn’t develop
- apoptosis, bad differentiation, failure to proliferate)
Aganglionic segment = TONIC STATE -> FAILURE of PERISTALSIS + bowel movements
- the internal anal sphinter is not relaxed by presance of faeces
-> FUNCTIONAL OBSTRUCTION
-> Proximal bowel DILATION -> distension
What is a complication of Hirschsprung’s
Increased intraluminal pressure -> reduced mural blood flow -> stasis + BACTERIAL PROLIFERATION
-> At risk for HIRCHSPRUNG’S ASSOCIATED ENTEROCOLITIS
- fluids, bowel decompression, broad-spectrum IV Abx
Esp likely in year after surgery
Also rupture
RFx for Hirschsprung’s
- Males
- Chromosomal abnormalities (esp Down’s)
- FHx - tho usually genetically sporadic
Hirschsprung’s Px
Classical triad:
- Failure to pass MECONIUM within 48 hrs of birth
- Abdo DISTENSION
- BILIOUS VOMITING
Also:
- palpable faecal mass in left lower abdo
- sometimes tympanic
Rectal examination -> EMPTY RECTAL VAULT
- oft results in forceful discharge of gas + fecal material
DDx of Hirchsprung’s
- Meconium plug syndrome
- Meconium ileus
- Intestinal atresia
- DUODENAL ATRESIA PARTICULARLY ASSOCIATED WITH DOWNS
- Double bubble sign
- NG decompression + nil by mouth
- DUODENAL ATRESIA PARTICULARLY ASSOCIATED WITH DOWNS
- Intestinal malrotation (midgut volvulus)
- Anorectal malformation (found on exam)
- Constipation (if it’s nothing else)
Hirschsprung’s Ix
- Plain abdo radiograph
- Contrast/barium enema (CI if there’s perforation)
- short transition zone +/- rectal diameter similar to sigmoid colon
Gold: rectal suction biopsy (bedside, high acurracy. Need antibiotic cover + good decompression as can’t washout for 48hrs after.)
-> stained for acetylcholinesterase
- risk of perforation, bleeding + inadequate sample
- NICE says try to avoid
When should a rectal suction biopsy be considered?
- Delayed passage of meconium (more than 48 hours after birth in term babies)
- Constipation since first few weeks of life
- Chronic abdominal distension plus vomiting
- Family history of Hirschsprung’s disease
- Faltering growth in addition to any of the previous features
Management of Hirschsprungers
Symptomatic relief:
- IV Abx
- NG tube
- Bowel decompression
Liase with paeds surgeon
Surgery is only definitive Tx (in first few months)
- resecting the aganglionic section of bowel and connecting the unaffected bowel to the dentate line (pull through)
Complications of surgery for Hirschsprunger’s
constipation,
enterocolitis,
perianal abscess,
faecal soiling
adhesions
Difference in appearance between vomit after repeated vomiting and bilious vomiting
Bile only turns green after mixing with stomach acid (hence green = obstruction)
If repeated vomiting -> bile from gall bladder coming up = more golden
Big complication of bowel obstruction
Necrosing bowel
Malrotation
Umbrella term but most common:
- Lack of fixation to retro-peritoneum (-> volvulus + obstruction)
- Narrow midgut mesenteric base
- Can get abnormal attachment of caecum to right UPPER peritoneal cavity (Ladd bands) -> partial obstruction
Malrotation Sx
- Bilious vomiting in neonate/infant < 1 y/o
- Abdo pain
- Distension + tenderness
Present earlier if more proximal ie in duodenum
When upper mesenteric artery gets compressed by Ladd bands -> tend to present at older age with malneutrition
Malformation Dx
- Upper gastrosintestinal CONTRAST series
- CT abdomen (with oral + IV contrast)
- Abdo X-ray
- FBC
Consider:
- USS
- Lower GI contrast
- ABG
Malformation Tx
Urgent or timely surgery depending on if it has gone ischaemic or not
- Open Laprotomy + Ladd band procedure
Pre op:
- NG tube
- Abx for gram -ve (cefotaxime)
- IV fluid resuscitation
Post op: Bowel rest until activity resumes
Malformation complication
Volvulus -> Acute ischaemia -> Necrosis within a few hours
Pathophys of why bicarb increases in excess vomiting
Bicarb secreted from blood into intestine after acid leaves stomach
When acid can’t leave stomach - bicarb not secreted so get build up of bicarb in blood while acid is projectile vomited
Intussusception
Invagination (telescoping) of proximal bowel into diatal bowel (usually ileum into caecum)
Intussusception Epid
- Primarily in 3 months - 2 YRS
Intussusception aet
- can be triggered by recent/recurrent viral infection as bowel becomes hypermobile + enlargement of Payer’s patches
- Lymphoid hyperplasia (acts as lead point for bowel to telescope)
- Meckel’s diverticulum
- Polyps (esp larger ones)
- CF (increased viscosity -> blockage -> lead point)
- Henoch-Schonlein Purpura (inflam)
- Rotavirus vaccination
Can be idiopathic
Intussusception Sx
- Severe, paroxysmal, COLICKY PAIN (child draws up leg to improve)
- Lethargy + decreased activity inbetween
- Refusing feeds
- Vomiting - may be bilious
- REDCURRENT JELLY (almost black) stool
- DISTENSION
- Susage shaped mass in RIF on palpation (not always)
Intussusception Ix
-
Abdo USS - Target sign (concentric echogenic + nonechogenic bands)
- can also show free air or gangrene if present
Intussusception Mx
- Rectal air inflation +/- contrast enema (can sometimes resolve in this way)
- only if child is stable as if there is ischaemia - air inflation can cause perforation - Operative reduction if:
- non-op failed
- Child has PERITONITIS or PERFORATION
- HAEMODYNAMIC INSTABILITY
DDx for RIF pain
GI:
- Appendicitis
- Intussusception
- Inflamed Meckel’s diverticulum
- Diverticulitis (more common in LIF)
- IBD (esp CROHN’S - terminal ileitis)
- Mesenteric adenitis
Gynae:
- Ectopic preg (if gone through puberty)
- Ovarian torsian
- Ovarian cyst (torsion or rupture)
- Pelvic Inflam Disease (lower abdo pain, fever, abnormal vaginal discharge - less common in kids)
Urology:
- Pyelonepritis
- Uretric colic (kidney stones related usually; can also get blood clots in PKD)
Meckel’s diverticulum
Outpouching in the distal ileum caused by persistance of VITELLINE DUCT during embryo development.
May contain ECTOPIC gastric / pancreatic tissue which can secrete acid.
Meckel’s Px
Oft asymp + found incidentally
- Painless rectal bleeding from ulceration of surrounding tissue if it contains ectopic gastric tissue which is secreting acid
- Abdo pain from inflam
- Intussusception
- Obstruction (if herniated)
- Perforation by foreign body (unusual)
Meckel’s epid
Typically presents in infants / TODDLERS
Meckel’s Ix
- CT scan
- 99mTC (technetium 99) scan
- technetium injected IV -> highlights areas of gastric tissue on x-ray - Small bowel enema (not really done)
Oft found incidentally in surgery for something else
Meckel’s rule of 2
- male:female = 2:1
- 2 feet proximal to caecum
- oft ~ 2 inches long
- ~2% of population
Complications of Meckel’s
- Intussusception / volvulus
- Obstruction (in Littre’s hernia)
- Perforation
- Diverticulitis
HAEMORRHAGE
Meckel’s Mx
Oft nothing needed but if presenting acutely:
- Treat clinical issue e.g. obstruction or infection
- Resect diverticulum (surgery)
Pyloric stenosis
Hypertrophy of pyloric sphincter muscles -> narrowing + obstruction of gastric outlet
Typically progresses from birth so presents with projectile vomiting at ~6-8 WKS when the hypertrophy is significantly blocking
Pyloric stenosis epidem
- 1-3 per 1000 babies
- Mainly in infants 6-8 WKS olds
- as the hypertrophy progresses from the point of birth - More prevalent in MALES
Pyloric stenosis RFx
- FHx
- MALE SEX
- PREMMIES
Pyloric stenosis Px
-
Post-prandial vomiting 6-8wks after birth
- Usually PROJECTILE
- Can increase in intensity as obstruction worsens - Palpable SMOOTH, OLIVE-SIZED mass in RUQ or Epigastric
- Baby seems hungry + FAILING TO THRIVE
Complications of pyloric stenosis
- Metabolic ALKALOSIS (from loss of gastric acid + build up of bicarb)
- Hypochloremic + Hypokalaemic - DEHYDRATION
What causes the projectile vomiting in pyloric stenosis
Increasingly powerful peristalsis due to + combined with the pyloric hypertrophy
Pyloric stenosis Ix
- ABDO USS
- Length >16-18mm and muscle wall thickness > 3-4 mm = pyloric stenosis
Pyloric stenosis Mx
Supportive:
- NIL by mouth + IV FLUIDS (may need fluid resus if very dehydrated)
Definitive:
- Laproscopic PYLOROMYOTOMY - cuts hypertrophic smooth muscle + widens gastric outlet
- good prognosis
Toddler’s diarrhoea
Chronic diarrhoea of infancy
- Passing 3 or more loose/watery bowel movements a day for 2-4 wks or more
Typically in kids 1-5 y/o - more common in MALES
Toddler’s diarrhoea Sx
- Change in stool frequency/consistancy
- Chills / Fever
- Abdo pain / Cramping
- Nausea / Vomiting
May see undigested food / Mucus in stools
Kids will usually seem well in themselves: normal weight, appetite + activity levels
More serious:
- Bloody stools; Greasy stools
- Weight loss
- Severe abdo pain
Complications of toddler’s diarrhoea
- Malabsorption
- Dehydration
Toddler’s diaerrhoea aet
- Underdeveloped digestive tract - food doesn’t stay in tract long enough for water to be sufficiently absorbed
- Imbalanced diet - Excess fibre (shortens amount of time food is in tract) OR Low fat (fat normally slows food down in tract)
- Inability to absorb carbs (typically those found in fruit juice)
- CF
- Coeliac’s
- Food allergy
- Acrodermatitis enteropathica (can’t absorb zinc)
Rare in neonates but can be caused by Congenital diarrhoea and Enteropathies (CODEs) - genetic mutations causing severe diarrhoea -> malabs, poor feeding + failure to thrive
Toddler’s diarrhoea Ix
Examine + check BP/HR for signs of dehydration
- Stool samples: blood?; MS+C
- Bloods: Inlfam markers + cultures
- X-rays: GI causes - anatomy?
- Endoscopy/colonoscopy - location of inflam
- BREATH HYDROGEN TEST - sugar intolerance
- could be due to small intestinal bacterial overgrowth
Genetic testing for CODEs
Toddler’s diarrhoea Mx
- Diet managment: balanced diet, reduce fruit sugars + gluten
- Oral rehydration if needed (sodium + 2% glucose)
- Zinc supplementation
Common sites of hernias in kids
Inguinal (typically indirect due to processus vaginalis remaining patent) + umbilical
Main complication of hernias
Strangulation -> Ischaemia -> Necrosis -> sepsis + bowel perforation
- surgical emergancy
Strangulated hernias epid
- less common in children
- typically tend to be small hernias that go mostly unnoticed that tend to strangulate
Strangulated hernia Px
- Severe abdo pain (previously intermitant pain/bulging when hernia was reducible)
- Vomiting
- SIgns of bowel obs - distension, not passing stools
Incarcerated vs Strangulated hernia
Incarcerated just means the hernia has become stuck and non-reducible but the blood supply may not be compromised
- stranulation specifically refers to compromised blood supply
Strangulated hernia Ix
- CT abdo - signs of ischaemia
- Bloods: Inflam/infection
Strangulated hernia Tx
Surgical repair
- Release herniated bowel + restore blood flow
- Remove any necrotic tissue (will cause sepsis otherwise)
- Reinforce weakened area (Mesh or specific suturing technique) - to prevent recurrence
Irritable Bowel Syndrome (IBS)
Chronic GI condition characterised by abdo pain / discomfort associated with change in bowel habits - but not identifiable structural/biochem abnormalities
IBS Sx
- Recurring/persistent abdo pain
- Diarrhoea, constipation or both OR the pain is improved with defecation (pain may get worse)
May also get:
- altered passage (straining/urgency);
- bloating;
- mucus in stool
- tenesmus
- Sx worse on eating;
lethargy, nausea, back ache, headache, bladder problems etc
IBS Dx
Clinical - if Sx have been present for at least 6 MONTHS
Stricter Dx criteria = ROME IV criteria:
- Recurrent abdo pain at least 1 day per week in LAST 3 MONTHS
- Sx started at least 6 months ago
- Associated with 2 or more of following:
- Pain is related to defecation
- Change in frequency
- Change in form
IBS Ix
To rule out other causes mainly:
- Bloods: anaemia, infection, digestive issues (e.g. coeliac)
- Stool: MS+C, Fecal calprotectin
- may do rectal exam to check constipation or tenderness
If other cause suspected:
- Abdo USS
- Upper GI endoscopy + biopsy
- Colonoscopy
IBS Tx
- Balanced diet (Temporarily reduce FODMAPs)
- Mental health therapies:
- CBT
- Gut-directed hypnotherapy - Consider probiotics
Consider Meds:
- Antidepressants (SSRIs/Tricyclics)
- Antispasmodics (mebeverine, hyosine bromide)
- Peppermint oil capsules
- Fiber supps
Features of Crohn’s
Crows’ NESTS
- No blood/mucus (more common in crohn’s)
- ENTIRE tract affected
- SKIP LESIONS
- TRANSMURAL / Terminal ileum mostly
- Smoking RISK FACTOR
UC main features
U C CLOSEUP
- CONTINUOUS inflam
- Limited to COLON + RECTUM
- ONLY SUPERFICIAL
- Smoking PROTECTIVE
- Excrete BLOOD + MUCUS
- Use AMINOSALICYLATES
- PRIMARY SCLEROSING CHOLANGITIS
IBD presentation
- Perfuse DIARRHOEA
- Abdo PAIN
- BLEEDING
- Anaemia
- WEIGHT LOSS
- Systemic Sx: Fever, malaise, Dehydration
- Failure to thrive + vit ADEK + B12 def (in crohn’s)
Comes in flares (remission + exacerbation)
Extra-Intestinal manifestations of IBD
A PIE SAC
- Aphthous ulcers (More common in Crohns)
- Pyoderma gangrenosum
- Iritis/Episcleritis
- Erythema Nodosum
- Sclerosing Cholangitis (Ulcerative colitis)
- ANKYLOSING SPONDILITIS / Amyloidosis
- CLUBBING (more in crohns)
IBD Ix
- Bloods: FBC - anaemia, WCC - infection, thyroid, kidney, LFTs, CRP, ESR, Albumin, Iron studies, B12 + folate
- Faecal calprotectin (intestinal inflam)
- Endoscopy (GOLD) - only DIAGNOSTIC TEST
- Imaging - USS, CT, MRI - to check if anatomical complications suspected
FIndings on endoscopy + biopsy of Crohn’s
- Skip lesions
- Cobble stone appearances with deep fissures
- Deep transmural ulcers +/- fistulae or abscesses
- Non-caseating granulomas
- Cryptitis
Colonoscopy + biopsy of UC
- Continuous inflam
- Not transmural
- Only in colon / rectum
- Crypt abscesses + irregular crypts
- Anal abscess + perianal fissures more likely
Inducing remission in Crohn’s
- Steroids
- Add immuno suppress
- Azathioprine
- Mercaptopurine
- Methotrexate
- Infliximab
- Adalimumab
Maintaining remission in Crohn’s
- Azathioprine / Mercaptopurine
- Methotrexate / Infliximab / Adalimumab
Surgical resection (not curative in crohn’s as it affects everything)
Inducing remission in UC
- AMINOSALYCILATE (Mesalazine)
- STEROIDS
If severe (go straight to strong immunosuppres):
- IV STEROIDS
- IV CICLOSPORIN
Maintaining remission in UC
- AMINOSALICYLATE
- Azathioprine
- Mercaptopurine
Surgery - requires ILEOSTOMY or ILEOANAL ANASTOMOSIS
- curative
Coeliac disease pathophys
Autoantibodies made in response to GLIADIN (the digested product of gluten). CD8 cells also activated.
Targets gut epithelium ->
- COMPLETE VILIOUS ATROPHY
- CRYPT HYPERPLASIA
- INTRAEPITHELIAL LYMPHOCYTES
Coeliac Px
Oft asymp / vague -> low thershold to test:
- FAILURE TO THRIVE
- Fatigue
- Weight loss
- Diarrhoea / Steatorrhoea
- MOUTH ULCERS
- ANAEMIA
- DERMATITIS HERPETIFORMIS (typically on abdo)
Rarely get neuro Sx: periph neuropathy, ataxia, epilepsy
AutoAb associated with coeliac’s
- Tissue transglutaminase antibodies (anti-TTG)
- Endomysial antibodies (EMAs)
- Deaminated gliadin peptides antibodies (anti-DGPs)
Make sure to check the patients total IgA and compare these to that as some people have IgA def
Genetic associations (which tissue types)
- HLA-DQ2 gene (90%)
- HLA-DQ8 gene
Coeliac Dx
Check IgA levels first for IgA def. Then:
- Anti-TTG
- Anti-EMA
ENDOSCOPY + BIOPSY:
- Crypt hypertrophy
- Vilious atrophy
- Intraepithelial lymphocytes
All done while on a gluten including diet
Coeliac is associated with which conditions
- T1DM (always do coeliac scan for T1 diabetics even if no Sx)
- Thyroid
- Autoimmune hep
- Primary BILIARY CIRRHOSIS
- Primary sclerosing cholangitis
- DOWN’S
Complications of untreated Coeliac’s
- Vitamin deficiency
- Anaemia
- Osteoporosis
- Ulcerative jejunitis
- Enteropathy-associated T-cell lymphoma (EATL) of the intestine
- Non-Hodgkin lymphoma (NHL)
- Small bowel adenocarcinoma (rare)
Presentation of constipation
- < 3 stools / week (tho this varies depending on the person)
- Hard stool
- Straining + painful passage
- Rectal bleeding - RABBIT DROPPING stools
- Abdo pain
- Retentive posturing (to prevent defecation)
- Fecal impaction -> OVERFLOW SOILING
- particularly loose smelly stools - Palpable mass in abdo
May have lost the sensation to defecate
How can constipation cause encopresis + what are other causes
Encopresis = fecal incontinence
- the hard stool in rectum becomes impacted -> stretches rectum -> loss of sensation -> only loose stools able to bypass blockage - leak out
Also caused by:
- Neuro problems:
- spina bifida
- Hirchsprung’s
- Cerebral palsey / Learning disability
- Psychosocial stress / Abuse
Lifestyle factors that can cause constipation
- Habitually not defecating
- Low fibre diet
- Dehydration
- Sedentary lifestyle
- Psychosocial problems
Red flags of constipation
- Not passing meconium within 48hrs of birth
- Neuro signs (spinalc cord/cerebral palsey)
- Vomiting (obstruction)
- Ribbon stool (Anal stenosis)
- Abnormal anus (stenosis, IBD, abuse)
- Abnormal lower back or buttocks (spina bifida; cord lesion; sacral agenesis)
- Failure to thrive (coeliac, hypothyroid, neglect)
- Acute severe abdo pain + bloating (obs or intussusception)
Complications of constipation
- Pain
- Anal fissures
- Haemorrhoids
- Loss of sensation
- Overflow + soiling
- Psychosocial morbidity
Constipation Mx
- Correct reversible lifestyle factors e.g. diet + fluids
- LAXATIVES:
- Movicol
- Disimpaction regimen with high dose laxatives for impaction - Encourage going to loo:
- Schedule visitis, keep bowel diary + star chart
Wean of laxatives as more normal bowel habits developed
Make sure to investigate + manage potential serious underlying causes + reassure family if it is idiopathic
Gastroenteritis
Common paediatric condition - inflam of stomach + intestines -> nausea, vomiting + diarrhoea
Viral is most common + easily spread so must keep isolated
Viral causative organisms of gastroenteritis
- Rotavirus
- Norovirus
- Adenovirus (less common + more subacute)
Bacterial causes of gastroenteritis
- E coli
- Campylobacter jejuni
- Salmonella
- Shigella
- Bacillus cereus
- vomiting within 5 hrs; watery diarrhoea after 8hrs; resolves within 24hrs - Yersinia Enterocolitics
- Staph aureus enterotoxin
- Giardia
Please read the zero to finals page or your notes from last year to get info about each organism
Gasteroenteritis Mx
- Infection control + barrier nursing
- Quarantine till 48hrs after Sx finished - MS+C of stool to get cause
- Fluid challange / rehydration to keep hydrated
- May need IV if can’t drink - Light, dry diet once oral intake tolerated
Only give Abx if risk of complications + specific causative organism is known
DON’T give anti diarrhoeal or antiemetic
Possible complications post Gasteroenteritis
- Lactose intolerance
- IBS
- Reactive arthritis
- Guillain-Barre syndrome
Oesophageal atresia
Lower + upper parts of oesophagus aren’t connected
- sometimes connected to trachea
Gastroschisis vs exomphalos
Gastroschisis = bowels outside body, usually to right of belly button
Exomphalos = bowels form inside umbilical cord - will be contained within a sac
