upper GI paediatrics Flashcards
What is used to diagnose pyloric stenosis and what result shows pyloric stenosis
Blood gas - hypokalaemic hypochloremic metabolic alkalosis
What is the management of pyloric stenosis
- Fluid resuscitation
- Surgery - ramstedt’s pyloromyotomy
What is the presentation of pyloric stenosis
- 4-12 weeks
- Projectile non-bilious vomiting
- Weight loss
- Dehydration with or without shock
- Metabolic alkalosis
- hypochloraemia
- Hypokalaemia
What is the cause of bilious vomiting until proven otherwise
Intestinal obstruction
What is the investigation for bilious vomiting
- Abdominal x-ray
- Contrast meal
- explorative laparotomy
What is the usual cause of effortless vomiting
GORD - common
What is the presentation of GORD in infants
- Vomiting
- Haematemesis
- Feeding problems
- Failure to thrive
- Apnoea
- Cough
- Wheeze
- Chest infections
- Sandifers syndrome (associated spactic torticolis and dystonic body movements)
What is the best investigation for oesophagitis
Endoscopy - done under general anaesthetic
What is the treatment for GORD in infants
- feeding advice - thickeners given - gaviscon
- Exclusion diet such as milk free
- prokinetic drugs
- Acid suppressors - H2 receptor blockers or PPI
What is the indication for surgery in GORD
Persistent:
- Failure to thrive
- aspiration
- oesophagitis
What is the definition of chronic diarrhoea in infants
- 4 or more stools a day for more than 4 weeks
Describe what is seen on investigations in secretory diarrhoea
- Large stool volume >200ml/24 hours
- Diarrhoea continues during fasting
- Higher electrolytes in the stool
Describe the investigation findings in osmotic diarrhoea
- Small stool volume <200ml/24 hours
- Diarrhoea stops after fasting
- Low electrolytes in the stool
What is the presentation of coeliac disease
- Abdominal bloatedness
- DConstipation
- Tiredness
- Diarrhoea
- Failure to thrive
- Short stature
- Dermatitis herpatiformis
What predisposes someone to coeliac disease
HLA DQ2
HLA DQ8
What is seen on serology scans in coeliac disease
- Positive anti-TTG
- anti-endomysial
- Check serum IgA - if low can have a false negative
What is used to diagnose coeliac disease
Duodenal biopsy
or
all of the following:
- Symptomatic children
- Anti-TTG 10x upper normal limit
- Positive anti-endomysial
- HLADQ2 or HLADQ8 positive
What is seen in duodenal biopsy of coeliac disease
- Lymphocytic infiltration of surface epithelium
- Partial/total villous atrophy
- Crypt hyperplasia
What is the treatment for coeliac disease in infants
- Gluten-free diet for life
