Vomiting and Malabsorption in Childhood Flashcards
what are the different types of vomiting?
- vomiting with retching
- projectile vomiting
- bilious vomiting
- effortless vomiting
- haemetemesis
what are some triggers for stimulation of vomiting centre in brain?
- enteric pathogens
- intestinal inflammation
- metabolic derangement
- infection
- head injury
- visual stimuli
- middle ear stimuli
where is the vomiting centre in the brain?
- medulla oblongata of brainstem
6 week old baby boy
3 week history of vomiting after every feed
Bottle fed 6 ounces 3 hourly
Vomitus- large volume, milky or curdy, mostly projectile
Irritable and crying
Not gaining weight adequately
o/e looks slightly dehydrated
What are the differential diagnoses?
- GORD
- overfeeding
- pyloric stenosis
what is the management of pyloric stenosis?
- fluid resuscitation
- refer to surgeons > Ramstedt’s pyloromyotomy
Pyloric stenosis clinical presentation
- Babies 4-12 weeks
- Boys > girls
- Projectile non-bilous vomiting
- weight loss
- dehydration +/- shock
- characteristic electrolyte disturbance: metabolic alkalosis, hypochloraemia, hypokalaemia
why should bilious vomiting always ring alarm bells?
- due to intestinal obstruction until proven otherwise
what are some causes of bilious vomiting?
- intestinal atresia (in newborn babies only)
- malrotation +/- volvulus
- intussusception
- ileus
- Crohn’s disease with strictures
Bilious vomiting investigations
- abdominal x-ray
- consider contrast meal
- surgical opinion re exploratory laparotomy
effortless vomiting is almost always due to? what are the exceptions?
Gastro-oesophageal reflux (very common)
Exceptions:
- cerebral palsy
- progressive neurological problems
- oesophageal atresia +/- TOF operated
- generalised GI motility problem
Gastro-oesophageal reflux presenting symptoms
- GI: vomiting, haematemesis
- Nutritional: FTT, feeding problems
- Respiratory: apnoea, cough, wheeze, chest infections
- Neurological: Sandifer’s syndrome
Gastro-oesophageal reflux investigations
- history and exam often sufficient
- radiology: video fluoroscopy, barium swallow
- pH study
- oesophageal impedance monitoring
- endoscopy
what are the indications for gastro-oesophageal reflux surgery?
- failure of medical treatment: feed thickener, gaviscon, prokinetic drugs, PPIs
- persistent: FTT, aspiration, oesophagitis
what is considered chronic diarrhoea?
4 or more stools per day for more than 4 weeks
what are some causes of diarrhoea?
Motility disturbance:
- toddler diarrhoea
- IBS
Active secretion:
- acute infective diarrhoea
- IBD
Malabsorption of nutrients:
- food allergy
- coeliac disease
- cystic fibrosis
features osmotic diarrhoea
- movement of water into the bowel to equilibrate osmotic gradient
- usually a feature of malabsoription: enzymatic defect (e.g. lactose intolerance) or transport defect (glucose-galactose malabsorption)
- clinical remission with removal of causative agent
what conditions can cause fat malabsoprtion?
- pancreatic disease: diarrhoea due to lack of lipase and resultant steatorrhoea > cystic fibrosis
- hepatobiliary disease > chronic liver disease, cholestasis
coeliac disease clinical features
- abdominal bloatedness
- diarrhoea
- FTT
- short stature
- constipation
- tiredness
- dermatitis herpatiformis
