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Paeds AM > Vomiting and malabsorption > Flashcards

Vomiting and malabsorption Flashcards

1
Q

What can stimulate the vomiting centre?

A 
Enteric pathogens
Intestinal inflammation
Metabolic derangement
Infection
Head injury
Visual stimuli
Middle ear stimuli
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2
Q

What ae the common causes of vomiting in children?

A

Gastro-oesopgaeal reflux
Overfeeding
Pyloric stenosis

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3
Q

What are the features of pyloric stenosis?

A 
Projectile, non bilious vomiting
Weight loss
visibel gastric peristalsis
Dehydration +/- shock
Characteristic metabolic disturbance
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4
Q

What is the characteristic metabolic disturbance in pyloric stenosis?

A

Metabolic alkalosis
Hypochloraemia
Hypokalaemia

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5
Q

When does pyloric stenosis usually present?

A

4-12 weeka

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6
Q

What is the investigation of pyloric stenosis?

A

US

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7
Q

What is the management of pyloric stenosis?

A

Surgical referral

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8
Q

What are the types of vomiting?

A

Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting

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9
Q

What are the phases of vomiting with retching?

A

Pre-ejection phase
Ejection phase
Pot ejection

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10
Q

What are the causes of bilious vomiting?

A 
Intestinal atresia- 4-12 weeks
Malrotation +/- volvulus- <1 year
Intussusception - 6-18 months
Ileus
Crohns disease with strictures
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11
Q

What investigations are done for bilious vomiting?

A

AXR
Consider contrast meal
Surgical referral re exploratory laparotomy

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12
Q

What are the causes of effortless vomiting?

A 
Almost always garth-oesophageal reflux
Cerebral palsy
Progressive neuro problems
Oesophageal atresia +/- TOF operated
General GI motility problem
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13
Q

How is effortless vomiting assessed?

A 
History and exam- normally all required
Radiological- video fluoroscopy, barium swallow
pH study
Oesophageal impedance monitoring
Endoscopy- if persists beyond 2 years
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14
Q

What is the treatment of gastro-oesophageal reflux?

A

Feeding advice
Nutritional support
Medical treatment
Surgery

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15
Q

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

A

Thickeners for liquids
Behavioural programme
Feeding position

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16
Q

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

A

Calorie supplements
Food exclusion
NG tube
Gastrotomy

17
Q

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

A

Gaviscon
Prokinetic drugs
Acid suppressing- H2 receptor blockers, PPIs

18
Q

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

A

Failure of medical treatment
Failure to thrive
Aspiration
Oesophagitis

19
Q

What is chronic diarrhoea?

A

4 or more stools a day for > 4 weeks

20
Q

What are the causes of chronic diarrhoea?

A

Motility disturbance
Active secretion
Malabsorption

21
Q

What are the types of diarrhoea?

A

Osmotic
Secretory
Motility
Inflammatory

22
Q

What causes osmotic diarrhoea?

A

Malabsorption- food allergy, coeliac, CF

23
Q

What is the process of osmotic diarrhoea?

A

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

24
Q

What are the causes of secretory diarrhoea?

A

Acute infective

IBD

25
Q

What is the process of secretory diarrhoea?

A

Associated with toxin production

Intestinal fluid secretion predominantly driven by active Cl- secretion via CFTR

26
Q

What are the features if secretory diarrhoea?

A

High volume of stool and large amount of electrolytes in stool

27
Q

What are the causes of motility diarrhoea?

A

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

28
Q

What is done on history and exam with chronic diarrhoea?

A

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

29
Q

What are the causes of fat malabsorption?

A

Pancreatic disease- classically CF

Hepatobiliary- chronic liver disease, cholestasis

30
Q

What are the symptoms of coeliac?

A 
Abdo bloating and pain
Diarrhoea/constipation
Failure to thrive
Short stature
Tiredness
Dermatitis herpetiformis
31
Q

How is coeliac diagnosed in children?

A

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

Paeds AM (19 decks)

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