Vomiting and malabsorption Flashcards
What can stimulate the vomiting centre?
Enteric pathogens Intestinal inflammation Metabolic derangement Infection Head injury Visual stimuli Middle ear stimuli
What ae the common causes of vomiting in children?
Gastro-oesopgaeal reflux
Overfeeding
Pyloric stenosis
What are the features of pyloric stenosis?
Projectile, non bilious vomiting Weight loss visibel gastric peristalsis Dehydration +/- shock Characteristic metabolic disturbance
What is the characteristic metabolic disturbance in pyloric stenosis?
Metabolic alkalosis
Hypochloraemia
Hypokalaemia
When does pyloric stenosis usually present?
4-12 weeka
What is the investigation of pyloric stenosis?
US
What is the management of pyloric stenosis?
Surgical referral
What are the types of vomiting?
Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting
What are the phases of vomiting with retching?
Pre-ejection phase
Ejection phase
Pot ejection
What are the causes of bilious vomiting?
Intestinal atresia- 4-12 weeks Malrotation +/- volvulus- <1 year Intussusception - 6-18 months Ileus Crohns disease with strictures
What investigations are done for bilious vomiting?
AXR
Consider contrast meal
Surgical referral re exploratory laparotomy
What are the causes of effortless vomiting?
Almost always garth-oesophageal reflux Cerebral palsy Progressive neuro problems Oesophageal atresia +/- TOF operated General GI motility problem
How is effortless vomiting assessed?
History and exam- normally all required Radiological- video fluoroscopy, barium swallow pH study Oesophageal impedance monitoring Endoscopy- if persists beyond 2 years
What is the treatment of gastro-oesophageal reflux?
Feeding advice
Nutritional support
Medical treatment
Surgery
What feeding advice can be given with gastro-oesophageal reflux?
Thickeners for liquids
Behavioural programme
Feeding position
What nutritional support can be given with gastro-oesophageal reflux?
Calorie supplements
Food exclusion
NG tube
Gastrotomy
What medical treatment can be given in gastro-oesophageal reflux?
Gaviscon
Prokinetic drugs
Acid suppressing- H2 receptor blockers, PPIs
What are the indications for surgery in gastro-oesophageal reflux?
Failure of medical treatment
Failure to thrive
Aspiration
Oesophagitis
What is chronic diarrhoea?
4 or more stools a day for > 4 weeks
What are the causes of chronic diarrhoea?
Motility disturbance
Active secretion
Malabsorption
What are the types of diarrhoea?
Osmotic
Secretory
Motility
Inflammatory
What causes osmotic diarrhoea?
Malabsorption- food allergy, coeliac, CF
What is the process of osmotic diarrhoea?
Movement of water into bowel lumen to equilibrate osmotic gradient
Usually accompanied by macroscopic and microscopic intestinal injury
What are the causes of secretory diarrhoea?
Acute infective
IBD
What is the process of secretory diarrhoea?
Associated with toxin production
Intestinal fluid secretion predominantly driven by active Cl- secretion via CFTR
What are the features if secretory diarrhoea?
High volume of stool and large amount of electrolytes in stool
What are the causes of motility diarrhoea?
Classically toddler’s diarrhoea
IBS
COngenital hyperthyroid
Chronic intestinal pseudo obstruction
What is done on history and exam with chronic diarrhoea?
Onset
FH
Nocturnal defaecation- usually indicates organic pathology
Growth and weight gain
Faeces analysis- appearance, culture, secretory vs osmotic
What are the causes of fat malabsorption?
Pancreatic disease- classically CF
Hepatobiliary- chronic liver disease, cholestasis
What are the symptoms of coeliac?
Abdo bloating and pain Diarrhoea/constipation Failure to thrive Short stature Tiredness Dermatitis herpetiformis
How is coeliac diagnosed in children?
Serology- anti tissue transglutaminase, anti endomysial, anti gladin
IgA
HLA DQ2 DQ8
Duodenal biopsy- not required if all other tests strong +
