Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Paeds > Vomiting and Malabsorption in Childhood > Flashcards

Vomiting and Malabsorption in Childhood Flashcards

1
Q

Types of vomiting

A

Vomiting with retching
Projective vomiting
Bilious vomiting
Effortless vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does bilious vomiting generally indicate?

A

Malabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does effortless vomiting generally indicate?

A

Gastro oesophageal reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Phases of vomiting with retching and their presentations

A 
Pre ejection phase
- pallor
- nausea 
- tachycardia 
Ejection phase
- retch 
- vomit 
Post ejection phase
- floppy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of vomiting

A 
Enteric pathogens - release toxins
Intestinal inflammation 
Metabolic derangement 
Infection 
- e.g. UTI/ meningitis, sepsis 
Head injury 
Visual stimuli 
- migraines, headaches
Middle ear stimuli (infections)
Gastro oesophageal reflux
Overfeeding 
Pyloric stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is vomiting triggered?

A

By stimulation of the vomiting centre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the commonest cause of vomiting?

A

Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Investigations for vomiting

A

Test feed
Blood gas
- metabolic alkalosis = hyperchloric acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Any slight tinge of yellow / green indicates that the cause is NOT…

A

Pyloric stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment of vomiting

A

Fluid resuscitation

Refer to surgeons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What surgical procedure can relieve obstruction causing vomiting?

A

Ramstedts Pyloromyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Who gets pyloric stenosis?

A

Babies aged 4 - 12 weeks

B > G

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Presentation of pyloric stenosis

A

Projective non-bilous vomiting
Weight loss
Dehydration / shock
Characteristic electrolyte disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the characteristic electrolyte disturbance of pyloric stenosis?

A

Metabolic alkalosis - increase pH
Hypochloraemia (decreased Cl)
Hypokalaemia (decreased K)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of vomiting should always ring alarm bells?

A

Bilious vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of bilious vomiting

A 
Intestinal atresia (newborns only)
Malrotation + / - volvulus
Intussusception 
Ileus 
Crohn's disease with strictures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is intussusception?

A

A process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is ileus?

A

Painful obstruction of the ileum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Investigations of bilious vomiting

A

Abdo X ray
Contrast meal
Surgical opinion re exploratory laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is effortless vomiting almost always due to?

A

Gastro oesophageal reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What type of vomiting is a very common problem in infants?

A

Effortless vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Effortless vomiting often resolves spontaneously except in….

A

CP
Progressive neurological problems
Oesophageal atresia +/- TOF operated
Generalised GI motility problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Presentation of effortless vomiting

A 
Vomiting 
Haematemesis 
Feeding problems (due to acid coming up)
Failure to thrive 
Apnoea
Cough 
Wheeze
Chest infections 
Sandifer's syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Investigations of effortless vomiting

A 
History and exam often sufficient 
Video fluoroscopy 
Barium swallow 
Ph study 
oesophageal impendance monitoring 
endoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Treatment of effortless vomiting
Feeding advice - thickeners for liquids - appropriateness of foods (texture, amount) - behavioural (oral stimulation, removal of aversive stimuli) - Feeding position (head at 45 degrees) Nutritional support - calorie supplements - exclusion diet (milk dree) - NG tube - gastrotomy Medical treatment - feed thickener (Gaviscon, thick and easy) - Prokinetic drugs - Acid Suppressing Drugs (H2 receptor blockers, PPIs) surgery
26
Indications for surgery in effortless vomiting
``` Failure of medical treatment Persistent - FTF - aspiration - oesophagitis ```
27
When would you do a Nissen Fundoplication?
In children who are more likely to have complications of bloat, dumping and retching after surgery e.g. CP
28
How much volume of faeces are lost per day in a child?
< 200 ml
29
How is the surface area of the small intestine increased?
Mucosal folds | Villi
30
Definition of chronic diarrhoea
4 or more stools per day for more than 4 weeks
31
How long is acute diarrhoea?
< 1 week
32
How long is persistent diarrhoea?
2 - 4 weeks
33
How long is chronic diarrhoea?
> 4 weeks
34
Causes of diarrhoea
``` Motility disturbance - toddler diarrhoea - IBS Active secretion - acute infective diarrhoea - IBD Malabsorption of nutrients (osmotic) - food allergy - coeliac disease - Cystic fibrosis (fat malabsorption) ```
35
4 types of diarrhoea
Osmotic Secretory Motility Inflammatory
36
Pathology of osmotic diarrhoea
Movement of water into the bowel to equilibrate osmotic gradient Mechanism of action of lactulose/movicol
37
What is osmotic diarrhoea usually a feature of?
Enzymatic defect | Transport defect
38
What is osmotic diarrhoea usually accompanied by?
Macroscopic and microscopic intestinal injury
39
How do you get clinical remission of osmotic diarrhoea?
Removal of causative agent
40
What is secretory diarrhoea classically associated with?
Toxin production from vibrio cholerae and enterotoxigenic E coli
41
Pathology of secretory diarrhoea
Intestinal fluid secretion predominately driven by active Cl- secretion via CFTR
42
Causes of motility diarrhoea
Toddlers diarrhoea IBS congenital hyperthyroidism Chronic intestinal pseudo-obstruction
43
Most common cause of motility diarrhoea
Toddlers diarrhoea
44
Pathology of inflammatory damage
Malabsorption due to intestinal damage Secretory effect of cytokines Accelerated transit time in response to inflammation Protein exudate across inflamed epithelium
45
What kind of diarrhoea is ALWAYS pathological?
Nocturnal
46
Stool volume in osmotic vs secretory diarrhoea
``` osmotic = small (generally < 200ml / 24 hours) Secretory = large (>200 ml/ 24 hours) ```
47
Response to fasting, osmotic vs secretory diarrhoea
``` Osmotic = diarrhoea stops Secretory = diarrhoea continues ```
48
Features of molecules in stool in osmotic vs secretory diarrhoea
``` Osmotic - low Na - low K - low Cl Secretory - high sodium - high K - high Cl ```
49
Causes of fat malabsorption
``` Pancreatic disease - lack of lipase and resultant steatorrhoea causing diarrhoea - classically in CF Hepatobiliary disease - chronic liver disease - cholestasis ```
50
What is coeliac disease?
Gluten sensitive enteropathy
51
What triggers coeliac disease?
Wheat Rye Barley
52
How many people does coeliac disease affect of the western population?
1%
53
Genetics of coeliac disease
DQ2 | DQ8
54
Symptoms of coeliac disease
``` Abdo bloating Diarrhoea Failure to thrive Short stature Constipation Tiredness Dermatitis herpatiformis (vasicular skin rash) Autoimmune hepatitis ```
55
Screening for coeliac disease
``` Serological screens - anti tissue transglutaminase - anti-endomysial - anti-gliadin - concurrent IgA deficiency in 2% may give false negatives Genetic testing ```
56
Gold standard investigation for coeliac disease
Duodenal biopsy
57
Genetic testing of coeliac disease
HLA DQ2 | DQ8
58
Features required of coeliac disease to diagnose without a biopsy
Symptomatic children Anti TTG > 10x upper limit of normal +ve anti endomysial antibodies HLA, DQ2, DQ8
59
Treatment of coeliac disease
Gluten free diet for life | In very young under 2 years, re challenge and re biopsy
60
Why should gluten not be removed prior to diagnosis of coeliac disease?
As serological and histological features will resolve
61
What is there a increased risk of if coeliac disease is left untreated?
Rare small bowel lymphoma
62
How do you ask the parents if the child has projectile vomiting?
Is the vomit on their clothes or on the floor and miss their clothes?
63
When should a H2RA or PPI be trialled in infants with GORD?
``` Who do not respond to alginates/food thickener And who have 1. feeding difficulties 2. Distressed behaviour or 3. Faltering growth ```
64
What is highly suggestive of intestinal malrotation and volvulus?
Scaphoid abdomen | Bilious vomiting
65
Investigations of intestinal malrotation
Urgent Upper GI contrast study | USS
66
What is suggestive of congenital diaphragmatic hernia?
Displaced apex beat | Decreased air entry

Paeds (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions