Upper GI Disorders Flashcards
what are the four types of vomiting ?
bilious
projectile
effortless
vomiting with retching
what is bilious vomiting associated with?
bowel obstruction
- RED FLAG
what does bilious vomiting require?
surgical opinion
state some causes of bilious vomiting ?
intestinal atresia
malrotation
intussusception
what is inturssesception?
part of the intestine folds into the section next to it
-more common in small intestine
what investigations should be done for bilious vomiting ?
abdo X-ray
contrast meal
what is projectile vomiting associated with?
pyloric stenosis
what are the three phases of vomiting ?
pre ejection
ejection
post ejection
what symptoms are felt in the pre ejaction phase of vomiting ?
pallor nausea tachycardia
what symptoms are felt in the post ejaction phase of vomiting ?
pale shivering limp
state some triggers of the vomiting centre?
enteric pathogens intestinal inflammation metabolic derangement head injury (raised ICP) middle ear stimuli
what is effortless vomiting associated with?
gastro-oesophageal reflux
what are the symptoms of pyloric stenosis ?
projectile non bilious vomiting
FTT
dehydrated
alkalosis
what does pyloric stenosis look like on US?
longer and thickened
what test should be done for pyloric stenosis ?
test feed to see visible gastric peristalsis
what does the pH, Cl and K look like in pyloric stenosis ?
metabolic alkalosis
hypochloraemia
hypokalaemia
what test is done to check pH of blood?
blood gases
what gender are more affected by pyloric stenosis ?
boys (first born)
is there bile present in pyloric stenosis vomit?
no
is gastro-oesophageal reflux common?
yes
state some symptoms of gastro-oesophageal reflux?
effortless vomiting feeding problems FTT haematamesis aspirations can cause chest infections
what investigations should be done for gastro-oesophageal reflux?
barium swallow SALT pH study endoscopy oesophageal impedance monitoring
how is a pH study of the oesophagus conducted?
place the monitor 5cm from the LOS
what is the treatment for gastro-oesophageal reflux?
usually self limiting
- feeding advice
- nutritional support (NG tube, supplements)
- medical treatment (PPI, H2RA, gaviscon)
what surgical option is there for gastro-oesophageal reflux?
nissen fundoplication
- lots of side effects so not done commonly
is coeliac disease an autoimmune disease?
yes
state the presentation of coeliac disease ?
bloated diarrhoea FTT growth retardation tiredness dermatitis herpetiformis
what investigations should be done for coeliac ?
anti-tissue transglutaminase
anti-endomysial
duodenal biopsy
genetic testing - HLA DQ2/8
what should the biopsy of the coeliac duodenum look like?
partial/total villous atrophy
lymphocytic infiltration
crypt hyperplasia
what groups are at risk of coeliac ?
people with other autoimmune disorders
downs syndrome
FHx
