Peads- Reflux And Gord Flashcards
How is regurgitation defined in paedriatic enterology:
Gastric contents effortlessly brought back up to oro-pharynx via oesophagus.
How is vomitting defined in paedriatic enterology:
The forceful expulsion of gastric contents through mouth and nose.
How is GORD defined in paedriatic enterology:
Effortless passing of the gastric contents to the oesophagus
Describe the anti-reflux mechanisms in the body, dividing them into Extrinsic and intrinsic mechanisms:
Extrinsic
- Angle of his:
Acute angle between the cardia and entrance to stomach
- Crural diaphragm
Intrinsic
- Lower oesophageal sphincter.
- Increased tone
Why do babies have GORD?
Angle of his is wider
Shorter oesophagus
Babies take in almost twice the volume in food, in comparison to adults
Babies are constantly in the supine position
Higher frequency of feeding
Delayed gastric emptying
Which conditions predispose a baby to GORD?
Cerebral palsy, CNS Impairment Sliding hiatus hernia Structural abnormalities i.e oesophageal atresia Celiac disease Genetic predisposition i.e. Severe Barrett’s, GORD. Tubes in seriously ill patients Neuromuscular disease Increased BMI Genetic syndrome T12
What is the clinical presentation of simple regurgitation?
- Gastric contents effortlessly brought back up to oro-pharynx via oesophagus.
- No treatment
What is the clinical presentation of overt regurgitation with failure to thrive?
Calorie loss
What is the clinical presentation of regurgitation with respiratory symptoms?
Recurrent pneumonia Apnoea attacks Stridor Wheezing Persistent coughing Reactive airways Sandifer syndrome
What is the clinical presentation of regurgitation with complications?
Oesophagitis
Bleeding and Anaemia
Dysphagia or stricture formation
What are the presenting symptoms of GORD in infants?
Irritability Vomitting Poor weight gain Feeding refusal or dysphagia Recurrent pneumonia Asthma and upper airway symptoms Apnoea
What are the presenting symptoms of GORD in Children?
Regurgitation Heartburn/ retrosternal chest pain. Asthma or chronic cough Recurrent pneumonia Anaemia or haematemesis.
What is Sandifer syndrome?
Sandifer syndrome is a rare complication of gastroesophageal reflux disease
Characterized by irritability and abnormal movements of the body and contortions of the neck.
Associated with feeds
- Children are neurologically intact
What are the symptoms of Sandifer syndrome?
- Irritability
- Torticollis
- Extensor spasm
- Dystonic posture
How is a diagnosis of paedriatic GORD made?
History
Examination
Focused diagnostic testing.
Name 5 diagnostic focused testing investigations for GORD?
Barium swallow. Endoscopy. Oesophageal impedance monitoring. Oesophageal PH monitoring. Radionucleotide scintigraphy- Milk scan.
Explain the process of Barium swallowing in diagnostic focused testing for GORD:
Used to asses swallowing ability and asses for any blockages or abnormalities in the oesophagus
- Anatomical abnormalities
- Pyloric stenosis
- Malrotation
- Hiatal hernia
- Stricture
What is the gold standard testing for GORD diagnosis?
PH metry
What are the 4 processes involved in a milk scan in diagnostic focused testing for GORD:
- Oesophageal transit
- Reflux
- Gastric emptying
- Pulmonary aspiration
Explain the process of a milk scan in diagnostic focused testing for GORD:
Used to determine if you’ve child has GORD and the rate at which the stomach empties.
Radio pharmaceutical is mixed with milk and given to the child
- Tracer has radioactive material combined to it
- Travels to the area in the UGIT that needs to be imaged by a gamma camera.
Note: Non invasive and low radiation
What does a milk scan monitor?
Oesophagus motility
Oesophagus emptying
Oesophagitis
Aspiration
Explain the process of an endoscopy in diagnostic focused testing for GORD:
A small flexible tube with a tiny camera on the end is insert3 in to the oesophagus and stomach allowing physician to make a diagnosis:
- GORD
- Oesophagitis
- Inflammation
- Ulceration
During an UGIT endoscopy, tissue samples (biopsies) are taken from the lining of the oesophagus
What can a endoscopy biopsy help with diagnosis by?
Barre oesophagitis
CMV
Candida
H. Pylori
What is the management of GORD in paedriatics ?
- Change feeding schedule: Smaller quantities, more frequent feeds.
- Feeding and Post-feeding position: Prone, elevate
- H2 receptor antagonists: proton pump inhibitors, antacids
- Prokinetic agents: Cisapride, erythromycin, metaclopramide before meals
