Upper and Lower GI Disorders Flashcards
What is included in the pre-ejection phase of vomiting ?
Pallor
Nausea
Tachycardia
What is included in the ejection phase of vomiting?
Retch
Vomit
What is included in the post ejection phase of vomiting ?
Phase of weakness, shivering and lethargy.
What are some examples of stimulants to the vomiting centre?
Enteric pathogens Intestinal inflammation Metabolic derangement Infection Head injury Visual stimuli Middle ear stimuli
What is the age bracket for pyloric stenosis?
Babies ~4-12 weeks
What are the signs and symptoms of pyloric stenosis?
Projectile non-bilious vomiting
Weight loss
Dehydration +/- shock
Electrolyte disturbance
What kind of electrolyte disturbance would you expect in pyloric stenosis?
Metabolic alkalossis (Increased Ph)
Hypochloraemia (Decreased Cl)
Hypokalaemia (Decreased K)
What is the common cause of Bilious Vomiting in the new born ?
Intestinal obstruction
What are the causes of intestinal obstruction in the new born/infants ?
Intestinal atresia (New borns only)
Malrotation
Ileus
Crohn’s disease with strictures
What investigations would you carry out to diagnose an intestinal obstruction ?
Abdo x-ray
Consider contrast meal
Surgical exploration
What is commonly diagnosed in a child who has effortless vomiting?
Gastro-oesophageal reflux
What is the treatment for a child who has effortless vomitting ?
Self-limiting and resolves spontaneously in the majority of cases.
Exceptions:
Cerebral palsy
Oesophageal atresia
Generalised GI motility problem
What is Sandifer’s syndrome ?
The association of gastro-oesophageal reflux disease with spastic terticollius and dystonic body movements.
What kind of medical assessments would you carry out if a child has gastro-osaephageal reflux ?
Radiological investigations i.e. Video fluroscopy
Barium swallow
pH study
Endoscopy
What type of conditions would be shown by a Barium Swallow ?
Dysmotility Hiatus hernia Reflux Gastric emptying Strictures
What is the treatment for gastro-osaephageal reflux in children?
Feeding advice
Nutritional support
Medical treatment
Surgery
What would be the feeding advice given for children with gastro-oasophageal reflux ?
Thickeners for liquids
Appropriateness of foods (texture and amount)
Feeding position
What kind of nutritional support would be suggested for children who suffer from GOR ?
Calories supplements
Exclusion diet (milk free)
NG tube
Gastrostomy
What would be the chosen medical treatment for those with GOR ?
Gaviscon
Prokinetic drugs
Acid suppressing drugs (H2 receptor blockers and PPIs)
What are the indications for surgery in children with GOR ?
Failure to thrive
Aspiration
Oesophagitis
Children with cerebral palsy are more likely to have what kind of symptoms after surgery ?
Complications of bloat, dumping and retching after surgery
What is the surgical procedure which is suggested for GOR ?
Nissen Fundoplication
What is the definition of chronic diarrhoea ?
4 or more stools per day.
For more than 4 weeks.
<1 week of diarrhoea is defined as what ?
Acute diarrhoea
2-4 weeks of diarrhoea is defined as what ?
Persistant diarrhoea
What type of motility disturbance causes diarrhoea ?
Toddler diarrhoea
IBS
What kind of active secretion disorders causes diarrhoea ?
Acute infective diarrhoea
IBS
What kind of malabsorption conditions cause diarrhoea ?
Food allergies
Coeliac disease
CF
Define osmotic diarrhoea
Movement of water into the bowel to equilibrate osmotic gradient.
What is osmotic diarrhoea a feature of ?
Malabsorption (Enzymatic defect or transport defect)
How is osmotic diarrhoea resolved ?
Clinical remission with removal of causative agent
Define secretory diarrhoea
Intestinal fluid secretion predominantly driven by active Cl secretion via CFTR
What is secretory diarrhoea commonly associated with ?
Toxin production from Vibrio cholerae and enterotoxigenic Escherichia coli
Define motility diarrhoea
Classically called toddlers diarrhoea ?
Causes of motility diarrhoea ?
IBS
Congenital hyperthyroidism
Chronic intestinal pseudo-obstruction
Define inflammatory diarrhoea
Malabsorption due to intestinal damage, accelerated transit time in response to inflamation.
What are the pancreatic causes of fat malabsorption ?
Diarrhoea due to lack of lipase and resultant steatorrhoea.
CF
What are the hepatobilliary causes of of fat malabsorption ?
CLD
Cholestasis
Define coeliac disease
Gluten sensitive eneteropathy
What are the signs and symptoms of coeliac disease?
Abdominal bloatedness Diarrhoea Failure to thrive Short stature Constipation Tiredness Dermatitis herpatiformis
What are the screening tests for coeliac disease ?
Serological screens
Duodenal biopsy
Genetic testing
What is the treatment for coeliac disease ?
Gluten-free diet for life
Gluten must not be removed prior to diagnosis as serological and histological features will resolve
In very young <2yrs, re-challenge and re-biopsy may be warranted
What is the risk to children if coeliac is left untreated ?
Increased risk of rare small bowel lymphoma if untreated
