Viral Gastroenteritis and Pyloric Stenosis

Question 1

Transmission of viral gastroenteritis

Answer 1

fecal to oral
best prevention: GOOD HANDWASHING
Young infants at greater risk of dehydration –> bring to medical attention promptly

Question 2

Fluid therapy for dehydration?

Answer 2

IV Boluses with normal saline (isotonic)

- 20 mL/kg, up to 3 boluses before considering other therapies

Question 3

Electrolyte abnormalities with pyloric stenosis

Answer 3

hypochloremic, hypokalemic metabolic alkalosis is the HALLMARK

• vomitting up all your chloride
• kidney tries to compensate for loss of H+ and sacrifices the K+ instead

Question 4

Asses illness by telephone

Answer 4

Anyone else sick?
Significant abdominal pain?
What does emesis/diarrhea look like?
Fever?
Eating and drinking? How much?

Question 5

Assess hydration status of kid by phone

Answer 5

Activity level?

Desire to intake fluids?

Question 6

Determining degree of dehydration

Answer 6

weight loss in kg = water loss in L
weight loss in g = weight loss in mL
- also look at % loss

Question 7

DDx for recurrent emesis in infant

Answer 7

GERD
Viral gastroenteritis
Malrotation +/- volvulus
Inborn Error of metabolism
Pyloric Stenosis
Intussusception
CNS disease
UTI

Question 8

GERD

Answer 8

Regurg/spitting up may be the vomit
pain from reflux can lead to food aversion
FTT

Question 9

Viral gastroenteritis

Answer 9

starts with isolated vomiting and progresses to watery stools
dehydration from fluid loss
bilious emesis not seen because above ligament of Treitz

Question 10

Malrotation +/- volvulus

Answer 10

can lead to bowel obstruction
bilious emesis common and blood may be in stool
bowel ischemia can occur and cause significant abdominal pain
- can lead to shock and significant dehydration

Question 11

Inborn error in metabolism

Answer 11

uncommon, can and should be considered

- can present with shock which may be seen as significant dehydration

Question 12

Pyloric Stenosis

Answer 12

escalating pattern of projectile vomit (non-bilious)

• develop rapid dehydration due to inadequate fluid absorption (still have vigorous appetite)
• hypochloremic, hypokalemic metabolic alkalosis
• can lead to bloody emesis from Mallory-Weis tear
• visible peristaltic wave (palpable olive)

Question 13

Intussusception

Answer 13

bilious emesis and crampy, severe abdominal pain

• currant jelly stools and pulling legs up to chest
• sausage mass due to telescoped bowel

Question 14

CNS disease

Answer 14

hydrocephalus, intracranial neoplasm, and trauma should be considered but less common

Question 15

UTI

Answer 15

important cuase of non-GI vomiting

- poor feeding, vomiting, fever –> dehydration

Question 16

Work-up for Pyloric Stenosis

Answer 16

US - study of choice to confirm
upper GI study - demonstrate string sign in pyloric channel
- could also reveal malrotation/volvulus
Check electrolytes

Question 17

Management of dehydration

Answer 17

ORT -> as effective if not safer than IV and less costly

• solutions (pedialyte, etc) typically have 45-50 mmol/L of sodium
• don’t use gatorade, not enough sodium and too much glucose

Question 18

Solid foods with vomiting and diarrhea

Answer 18

ok to eat if not dehydrated

- if dehydrated, wait to eat until rehydrated