RED FLAG

Question 1

What do these symptoms indicate?

bile-stained vomit

haematemesis

projectile vomit

vomit at the end of the paroxsymal cough

abdominal tenderness

abdominal distension

hepatosplenomegaly

blood in stool

severe dehydration/shock

bulging fontanelle/seizures

failure to thrive

Answer 1

Bile-stained vomit : Intestinal obstruction (intussusception, malrotation, strangulated inguinal hernia)

Haematemesis: Oesophagitis, peptic ulcer

Projectile vomit at 2-7-week-old: Pyloric stenosis

Vomiting at end of paroxysmal coughing: Whooping cough

Abdo tenderness / abdo pain on moving: Surgical abdomen

Abdo distension: Intestinal obstruction, strangulated inguinal hernia

Hepatosplenomegaly: Chronic liver disease, inborn error of metabolism

Blood in stool: Intussusception, gastroenteritis (salmonella, campylobacter)

Severe dehydration/shock: Systemic infection, DKA

Bulging fontanelle/seizures: Increased ICP

Failure to thrive: GORD, Coeliac, chronic GI

Question 2

Causes of vomiting?

Answer 2

infant: GO reflux, feeding problems, obstruction, renal failure, infection, congenital adrenal hyperplasia

pre-school: gastroenteritis, increased ICP, testicular torsion, appendicitis, coeliac, intestinal obstruction, renal failure

school age: gastroenteritis, appendicitis, coeliac disease, alcohol/drugs, pregnancy, infection, migraines, testicular torsion, peptic ulcer, increased ICP, anorexia, DKA

Question 3

Causes of constipation?

Answer 3

Babies → Hirschsprung’s, anorectal abnormality, hypothyroid, hypercalcemia, idiopathic

Older → toilet training issues, stress, following acute febrile illness

Question 4

Complications of constipation?

Answer 4

rectum –> overdistended

loss of feeling the need to defecate - involuntary soiling

Question 5

Management of constipation?

Answer 5

Stool softeners

Stimulant Laxative

Maintenance therapy

increased fibre and fluids

Question 6

What causes GOR? Investigations into GOR?

Answer 6

Gastroesophageal Reflux

due to inappropriate relaxation of Lower Oesophageal Sphincter - most resolves by 12mnths

Clinical diagnosis
OGD

Question 7

Management for GOR?

Answer 7

Referral - same day if haematemesis, melena, dysphagia

Question 8

Treatment for GOR?

Answer 8

Reassure

review if - bile stained or haematemesis, faltering growth or poor feeding

assess breast feeding -> pharmacological

assess forumla feed routine -> pharmacological

pharmacological 4 week PPI/H2 antagonist

Question 9

What is pyloric stenosis?

signs and symptoms?

Answer 9

hypertrophy of the pyloric muscle causing gastric outlet obstruction

presents 2-8 weeks

projectile vomiting 30 mins after feed
non-bilious
visible peristalsis in upper abdomen
hunger -> dehydration -> no interest in feed -> weight loss and depressed fontanelle

Question 10

Investigations into Pyloric Stenosis?

Answer 10

Test feed à observe for gastric peristalsis

o USS confirmation – target lesion, >3mm thickness

Question 11

Management into Pyloric Stenosis?

Answer 11

IV slow fluid resuscitation

laproscopic ramstedt pyloromyotomy

Question 12

What is Infant Colic?

Answer 12

Common

Inconsolable cryng and drawing up of hands and feet, resolves by 3-12 months

Question 13

How is it managed?

Answer 13

soothe infant -

consider cow’s milk protein allergy or reflux
Supportive

Question 14

What is appendicitis?

Signs and symptoms?

Answer 14

Most common cause of abdominal pain in childhood (but rare in <3yo)

· Feacolith more common in pre-school children (see on AXR) and perforation more common

anorexia, vomiting, nausea, umbilical -> RIF pain

fever, tenderness

Question 15

Management of appendicitis?

Answer 15

G - group and save
A - antibiotics IV
M - MRSA screen
E - must be NBM

Question 16

What is intussusception?

Answer 16

Invagination of proximal bowel into distal component; 95% ileum through to caecum through ileocecal valve (ilio-colic)

• stretching and constriction of the mesentery
• venous obstruction
• engorgement