upper and lower GI disorders Flashcards
what are the different types of vomiting ?
vomiting with retching
projectile vomiting
bilious vomiting
effortless vomiting
what can stimulate the vomiting centre ?
enteric pathogens intestinal inflammation metabolic derangement infection head injury visual stimuli middle ear stimuli
what are features of pyloric stenosis ?
babies 4-12 weeks
M>F
projectile non-bilious vomiting
weight loss
dehydration and shock
electrolytes
alkalosis
hypochloraemia
hypokalaemia
how do you manage pyloric stenosis ?
fluid resuscitation
Ramstedts pyloromyotomy
what causes bilious vomiting ?
intestinal atresia - newborns only malrotation +/- volvulus intussusception - telescopes inside ileus - no movement Crohn's with stricture
what is the investigation for bilious vomiting ?
abdominal Xray
contrast meal
exploratory laparotomy
what are features of effortless vomiting ?
almost always reflux
very common
self-limiting in vast majority
what are some serious causes of effortless vomiting ?
cerebral palsy
progressive neurological problems
oesophageal atresia +/- TOF operated
generalised GI motility problem
what is Sandifer’s syndrome ?
reflux
spastic and dystonic body movements
what problems can be identified with a barium swallow ?
dysmotility hiatus hernia reflux gastric emptying strictures
what are potential problems with barium swallows ?
aspiration
inadequate contrast taken
what are different aspects of feeding advice ?
thickeners for liquids
appropriateness for foods - textures, amounts
behavioural programme - oral stimulation, remove aversive stimuli
feeding position
what are options for nutritional support ?
calorie supplements
exclusion diet - milk free
NG tube
gastrotomy
what are options for medical treatment ?
feed thickener - gaviscon
prokinetic drugs
acid suppressing drugs - H2 receptor blockers, PPI
what are indications for surgery ?
persistent;
failure to thrive
aspiration
oesophagitis
what is the definition of chronic diarrhoea ?
4 or more stools per day
more than 4 weeks
<1 week - acute diarrhoea
2-4 weeks - persistent diarrhoea
>4 weeks - chronic diarrhoea
what are causes of diarrhoea ?
motility disturbance - toddler diarrhoea, IBS
active secretion - acute infective, IBD
malabsorption of nutrients - food allergy, coeliac, CF
what are features of osmotic diarrhoea ?
generally accompanied by macroscopic and microscopic intestinal injury
remission with removal of causative agent
usually enzyme/transport defects
how do you differentiate osmotic and secretory diarrhoea ?
osmotic - small volume
secretory - large volume > 200 ml
Os - stops when fasting
Se - continues in fasting
what are symptoms of coeliac disease ?
abdo bloatedness diarrhoea failure to thrive short stature constipation tiredness dermatitis herpatifromis
how do you screen for coeliac disease ?
serology anti-tissue transglutaminase anti-endomysial anti-gliadin IgA deficiency
duodenal biopsy
genetic HLA DQ2, DQ8
what is seen on duodenal biopsy in coeliac disease ?
lymphocytic infiltration of surface epithelium
partial/ total villous atrophy
crypt hyperplasia
what is the ESPGHAN guidelines for diagnosing coeliac without a biopsy ?
symptomatic
anti-TTG >10x upper limit
positive anti-endomysial Abs
HLA DQ2, DQ8 positive
how do you treat coeliac disease ?
gluten-free for life
cannot removes gluten prior to diagnosis
rechallenge warranted if <2
increased risk of small bowel lymphoma in untreated
