Vomiting and malabsorption

Question 1

What can stimulate the vomiting centre?

Answer 1

Enteric pathogens
Intestinal inflammation
Metabolic derangement
Infection
Head injury
Visual stimuli
Middle ear stimuli

Question 2

What ae the common causes of vomiting in children?

Answer 2

Gastro-oesopgaeal reflux
Overfeeding
Pyloric stenosis

Question 3

What are the features of pyloric stenosis?

Answer 3

Projectile, non bilious vomiting
Weight loss
visibel gastric peristalsis
Dehydration +/- shock
Characteristic metabolic disturbance

Question 4

What is the characteristic metabolic disturbance in pyloric stenosis?

Answer 4

Metabolic alkalosis
Hypochloraemia
Hypokalaemia

Question 5

When does pyloric stenosis usually present?

Answer 5

4-12 weeka

Question 6

What is the investigation of pyloric stenosis?

Answer 6

US

Question 7

What is the management of pyloric stenosis?

Answer 7

Surgical referral

Question 8

What are the types of vomiting?

Answer 8

Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting

Question 9

What are the phases of vomiting with retching?

Answer 9

Pre-ejection phase
Ejection phase
Pot ejection

Question 10

What are the causes of bilious vomiting?

Answer 10

Intestinal atresia- 4-12 weeks
Malrotation +/- volvulus- <1 year
Intussusception - 6-18 months
Ileus
Crohns disease with strictures

Question 11

What investigations are done for bilious vomiting?

Answer 11

AXR
Consider contrast meal
Surgical referral re exploratory laparotomy

Question 12

What are the causes of effortless vomiting?

Answer 12

Almost always garth-oesophageal reflux
Cerebral palsy
Progressive neuro problems
Oesophageal atresia +/- TOF operated
General GI motility problem

Question 13

How is effortless vomiting assessed?

Answer 13

History and exam- normally all required
Radiological- video fluoroscopy, barium swallow
pH study
Oesophageal impedance monitoring
Endoscopy- if persists beyond 2 years

Question 14

What is the treatment of gastro-oesophageal reflux?

Answer 14

Feeding advice
Nutritional support
Medical treatment
Surgery

Question 15

What feeding advice can be given with gastro-oesophageal reflux?

Answer 15

Thickeners for liquids
Behavioural programme
Feeding position

Question 16

What nutritional support can be given with gastro-oesophageal reflux?

Answer 16

Calorie supplements
Food exclusion
NG tube
Gastrotomy

Question 17

What medical treatment can be given in gastro-oesophageal reflux?

Answer 17

Gaviscon
Prokinetic drugs
Acid suppressing- H2 receptor blockers, PPIs

Question 18

What are the indications for surgery in gastro-oesophageal reflux?

Answer 18

Failure of medical treatment
Failure to thrive
Aspiration
Oesophagitis

Question 19

What is chronic diarrhoea?

Answer 19

4 or more stools a day for > 4 weeks

Question 20

What are the causes of chronic diarrhoea?

Answer 20

Motility disturbance
Active secretion
Malabsorption

Question 21

What are the types of diarrhoea?

Answer 21

Osmotic
Secretory
Motility
Inflammatory

Question 22

What causes osmotic diarrhoea?

Answer 22

Malabsorption- food allergy, coeliac, CF

Question 23

What is the process of osmotic diarrhoea?

Answer 23

Movement of water into bowel lumen to equilibrate osmotic gradient
Usually accompanied by macroscopic and microscopic intestinal injury

Question 24

What are the causes of secretory diarrhoea?

Answer 24

Acute infective

IBD

Question 25

What is the process of secretory diarrhoea?

Answer 25

Associated with toxin production | Intestinal fluid secretion predominantly driven by active Cl- secretion via CFTR

Question 26

What are the features if secretory diarrhoea?

Answer 26

High volume of stool and large amount of electrolytes in stool

Question 27

What are the causes of motility diarrhoea?

Answer 27

Classically toddler's diarrhoea IBS COngenital hyperthyroid Chronic intestinal pseudo obstruction

Question 28

What is done on history and exam with chronic diarrhoea?

Answer 28

Onset FH Nocturnal defaecation- usually indicates organic pathology Growth and weight gain Faeces analysis- appearance, culture, secretory vs osmotic

Question 29

What are the causes of fat malabsorption?

Answer 29

Pancreatic disease- classically CF | Hepatobiliary- chronic liver disease, cholestasis

Question 30

What are the symptoms of coeliac?

Answer 30

``` Abdo bloating and pain Diarrhoea/constipation Failure to thrive Short stature Tiredness Dermatitis herpetiformis ```

Question 31

How is coeliac diagnosed in children?

Answer 31

Serology- anti tissue transglutaminase, anti endomysial, anti gladin IgA HLA DQ2 DQ8 Duodenal biopsy- not required if all other tests strong +