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Paediatrics > Vomiting and Malabsorption in Childhood > Flashcards

Vomiting and Malabsorption in Childhood Flashcards

1
Q

types of vomitting

A
  • vomiting and retching
  • projectile vomiting
  • bilious vomiting
  • effortless vomiting
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2
Q

describe vomiting with retching

A 
pre-ejection phase:
- pallor
- nausea
- tachycardia
ejection phase:
- retch 
- vomit
post-ejection phase
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3
Q

stimulation of vomiting centre

A
  • enteric pathogens
  • intestinal inflammation
  • metabolic derangement
  • infection
  • head injury
  • visual stimulation
  • middle ear stimuli
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4
Q

presentation pyloric stenosis

A 
babies 4-12 weeks
boys>girls
projectile non-bilious vomiting
weight loss
dehydration +/- shock
characteristic electrolyte disturbance (metabolic alkalosis, hypochloraemia, hypokalaemia)
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5
Q

causes of bilious vomiting

A
  • intestinal atresia
  • malrotation +/- volvulus
  • intussusception
  • ileus
  • Crohns with strictures
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6
Q

bilious vomiting investigations

A
  • abdo x-ray
  • consider contrast meal
  • surgical opinion re exploratory laparotomy
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7
Q

initial response to bilious vomitting

A
  • should always ring alarm bells

- due to intestinal obstruction until proven otherwise

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8
Q

most common cause of effortless vomitting

A
  • gastro-oesophageal reflux
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9
Q

less common causes of effortless vomitting

A
  • cerebral palsy
  • progressive neurological disorders
  • oesophageal atresia
  • generalised GI motility problem
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10
Q

presenting symptoms of gastro-oesophageal reflux

A
  • vomitting
  • haematemesis
  • feeding problems
  • failure to thrive
  • apnoea
  • cough
  • wheeze
  • chest infections
  • Sandifers syndrome
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11
Q

suspicion of what conditions indicates barium swallow investigation

A
  • dysmotility
  • hiatus hernia
  • reflux
  • gastric emptying
  • strictures
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12
Q

benefits of a pH studied compared to barium swallow

A

detects acid reflux

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13
Q

potential feeding advice

A
  • thickeners for liquids
  • texture
  • amount
  • oral stimulation
  • removal of adverse stimuli
  • feeding position
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14
Q

medical treatment of gastro-oesophageal reflux

A
  • feed thickener
  • gaviscon
  • pro kinetic drugs
  • acid suppressing drugs (H2 receptor blockers, PPIs)
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15
Q

describe essential secretory component of small intestine

A
  • water for fluid/ enzyme transport/ absorption
  • ions e.g. duodenal HCO3-
  • defence mechanism against pathogens/ harmful substances/ antigens (flushes them out)
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16
Q

define chronic diarrhoea

A
  • 4+ stools per day

- 4+ weeks

17
Q

define persistent diarrhoea

A
  • 2-4 weeks
18
Q

define acute diarrhoea

A
  • <1week
19
Q

motility disturbance causes of diarrhoea

A
  • toddlers diarrhoea

- IBS

20
Q

active secretion causes of diarrhoea

A
  • acute infective diarrhoea

- IBD

21
Q

malabsorption of nutrients

A
  • food allergy
  • coeliac
  • cystic fibrosis
22
Q

describe osmotic diarrhoea

A
  • movement of water into bowel to equilibrate osmotic gradient
  • usually a feature of malabsorption
  • generally accompanied by macroscopic and microscopic intestinal injury
  • clinical remission with removal of causative agent
23
Q

describe secretory diarrhoea

A
  • classically associated with cholera and e.coli
24
Q

describe inflammatory diarrhoea

A
  • malabsorption due to intestinal damage
  • secretory effect of cytokines
  • accelerated transit time in response to inflammation
  • protein exudate across inflamed epithelium
25
Q

clinical approach to chronic diarrhoea

A

history

  • age of onset
  • abrupt/ gradual
  • FH
  • nocturnal defecation suggests organic pathology

consider growth and weight gain of child

faeces analysis:

  • appearance
  • stool culture
  • determination of secretory vs. osmotic
26
Q

describe fat malabsorption due to pancreatic disease

A
  • diarrhoea due to lack of lipase
  • steatorrhoea
  • CF
27
Q

describe fat malabsorption due to hepatobiliary disease

A
  • chronic liver disease

- cholestasis

28
Q

childhood presentation of coeliac disease

A
  • abdo bloat
  • diarrhoea
  • failure to thrive
  • short stature
  • constipation
  • tiredness
  • dermatitis herpatiformis
29
Q

histological appearance of coeliac disease

A
  • lymphocytic infiltration of surface epithelium
  • partial/ total(yay me) villous atrophy
  • crypt hyperplasia

Paediatrics (23 decks)

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