Vomiting and Malabsorption in Childhood Flashcards
types of vomitting
- vomiting and retching
- projectile vomiting
- bilious vomiting
- effortless vomiting
describe vomiting with retching
pre-ejection phase: - pallor - nausea - tachycardia ejection phase: - retch - vomit post-ejection phase
stimulation of vomiting centre
- enteric pathogens
- intestinal inflammation
- metabolic derangement
- infection
- head injury
- visual stimulation
- middle ear stimuli
presentation pyloric stenosis
babies 4-12 weeks boys>girls projectile non-bilious vomiting weight loss dehydration +/- shock characteristic electrolyte disturbance (metabolic alkalosis, hypochloraemia, hypokalaemia)
causes of bilious vomiting
- intestinal atresia
- malrotation +/- volvulus
- intussusception
- ileus
- Crohns with strictures
bilious vomiting investigations
- abdo x-ray
- consider contrast meal
- surgical opinion re exploratory laparotomy
initial response to bilious vomitting
- should always ring alarm bells
- due to intestinal obstruction until proven otherwise
most common cause of effortless vomitting
- gastro-oesophageal reflux
less common causes of effortless vomitting
- cerebral palsy
- progressive neurological disorders
- oesophageal atresia
- generalised GI motility problem
presenting symptoms of gastro-oesophageal reflux
- vomitting
- haematemesis
- feeding problems
- failure to thrive
- apnoea
- cough
- wheeze
- chest infections
- Sandifers syndrome
suspicion of what conditions indicates barium swallow investigation
- dysmotility
- hiatus hernia
- reflux
- gastric emptying
- strictures
benefits of a pH studied compared to barium swallow
detects acid reflux
potential feeding advice
- thickeners for liquids
- texture
- amount
- oral stimulation
- removal of adverse stimuli
- feeding position
medical treatment of gastro-oesophageal reflux
- feed thickener
- gaviscon
- pro kinetic drugs
- acid suppressing drugs (H2 receptor blockers, PPIs)
describe essential secretory component of small intestine
- water for fluid/ enzyme transport/ absorption
- ions e.g. duodenal HCO3-
- defence mechanism against pathogens/ harmful substances/ antigens (flushes them out)
define chronic diarrhoea
- 4+ stools per day
- 4+ weeks
define persistent diarrhoea
- 2-4 weeks
define acute diarrhoea
- <1week
motility disturbance causes of diarrhoea
- toddlers diarrhoea
- IBS
active secretion causes of diarrhoea
- acute infective diarrhoea
- IBD
malabsorption of nutrients
- food allergy
- coeliac
- cystic fibrosis
describe osmotic diarrhoea
- 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
describe secretory diarrhoea
- classically associated with cholera and e.coli
describe inflammatory diarrhoea
- malabsorption due to intestinal damage
- secretory effect of cytokines
- accelerated transit time in response to inflammation
- protein exudate across inflamed epithelium
clinical approach to chronic diarrhoea
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
describe fat malabsorption due to pancreatic disease
- diarrhoea due to lack of lipase
- steatorrhoea
- CF
describe fat malabsorption due to hepatobiliary disease
- chronic liver disease
- cholestasis
childhood presentation of coeliac disease
- abdo bloat
- diarrhoea
- failure to thrive
- short stature
- constipation
- tiredness
- dermatitis herpatiformis
histological appearance of coeliac disease
- lymphocytic infiltration of surface epithelium
- partial/ total(yay me) villous atrophy
- crypt hyperplasia
