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Paediatrics > Vomiting and malabsorption in children > Flashcards

Vomiting and malabsorption in children Flashcards

1
Q

What is the pre-ejection phase of vomiting?

A

Pallor
Nausea
Tachycardia

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2
Q

What is the ejection phase of vomiting?

A

Retch

Vomit

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3
Q

What are some different types of vomiting?

A 
Vomiting with retching
Projectile
Bilious
Effortless
Haemetemesis
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4
Q

What is retching?

A

Deep inspiration against a closed glottis
Contraction of the abdomen
Pressure difference between abdominal and thoracic cavities
Stomach and gastric contents displaced upwards toward the thoracic cavity

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5
Q

What are the main causes of vomiting in infants?

A

GOR
Cow’s milk allergy
Infection
Intestinal obstruction

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6
Q

What are the main causes of vomiting in children?

A 
GE
Infection
Appendicitis
Intestinal obstruction
Raised ICP
Coeliac disease
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7
Q

What are the main causes of vomiting in young adults?

A 
Gastroenteritis
Infection
H.Pylori infection
Appendicitis
Raised ICP
DKA
Cyclical vomiting syndrome
Bulimia
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8
Q

How would pyloric stenosis affect a test feed?

A

Palpation of “olive” tumour
Visible gastric peristalsis
Projectile non bilious vomiting

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9
Q

What are some useful tests in suspected pyloric stenosis?

A 
Blood gas (hypokalaemia, hypochloraemia, metabolic alkalosis)
Ultrasound (pyloric stenosis, thickened muscle at pylorus)
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10
Q

How do we manage pyloric stenosis?

A

Fluid resuscitation

Ramstedt’s pyloromyotomy

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11
Q

Is pyloric stenosis more common in boys or girls?

A

Boys

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12
Q

How might pyloric stenosis present?

A

Projectile non-bilious vomiting
Weight loss
Dehydration
Electrolyte disturbance

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13
Q

What is the main cause of effortless vomiting?

A

GOR

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14
Q

When might effortless vomiting not be self limiting?

A

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

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15
Q

What is Sandifer’s syndrome?

A

Association of gastro-oesophageal reflux disease with spastic torticollis and dystonic body movements

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16
Q

How might Sandifer’s syndrome present?

A 
Nodding and rotating of the head
Neck extension
Gurgling
Limbs writhing
Severe hypotonia
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17
Q

How is Sandifer’s syndrome managed?

A

Treat GORD

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18
Q

What are the main assessment aims of a barium swallow?

A 
Dysmotility
Hiatus hernia
Reflux
Gastric emptying
Strictures
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19
Q

What are the main features of reflux treatment?

A

Feeding advice
Nutritional support
Medical treatment
Surgery

20
Q

What are some common pieces of feeding advice?

A 
Thickeners for liquid
Appropriateness of food texture and amount
Oral stimulation
Removal of aversive stimuli
Feeding position
21
Q

What is an appropriate feeding volume for neonates?

A

150mls/kg/day

22
Q

What is an appropriate feeding volume for infants?

A

100mls/kg/day

23
Q

What are some features of nutritional support?

A

Calorie supplements
Exclusion diet
Nasogastric tube
Gastrotomy

24
Q

Give an example of an exclusion diet?

A

Cow’s milk protein free trial for 4 weeks

25
Q

What are some medical treatments for reflux?

A

Gaviscon for feed thickener
Prokinetics
H2 receptor blockers or PPI’s for acid suppression

26
Q

When is surgery indicated for reflux?

A

Failure of medical treatment
Failure to thrive
Aspiration
Oesophagitis

27
Q

What is Nissen fundoplication?

A

Fundus wrapped around oesophagus

28
Q

What is the usual cause of bilious vomiting?

A 
Due to intestinal obstruction until proved otherwise
Intestinal atresia
Malrotation
Ileus
Crohn's with stricture
29
Q

Which investigations are used for bilious vomiting?

A

Abdominal x-ray
Contrast meal
Exploratory laparotomy

30
Q

How is persistence of diarrhoea classified?

A

<1 week: acute diarrhoea
2 to 4 weeks: persistent diarrhoea
>4 weeks: chronic diarrhoea

31
Q

What are the main causes of diarrhoea?

A

Motility disturbance
Active secretion
Malabsorption

32
Q

What may cause motility disturbance?

A

Toddler diarrhoea

IBS

33
Q

What may cause active secretion?

A

Acute infective diarrhoea

IBD

34
Q

What are some causes of malabsorption?

A

Food Allergy
Coeliac Disease
Cystic Fibrosis

35
Q

How is osmotic diarrhoea resolved?

A

Clinical remission with removal of causative agent

36
Q

What are the main pathogens behind secretory diarrhoea?

A

Vibrio cholerae

Escherichia coli

37
Q

What is the moa in secretory diarrhoea?

A

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

38
Q

How might pancreatic disease cause fat malabsorption?

A

Lack of lipase and resultant steatorrhoea

CF

39
Q

How might hepatobiliary disease cause fat malabsorption?

A

Chronic liver disease

Cholestasis

40
Q

How might coeliac’s disease?

A 
Abdominal bloating
Diarrhoea
Failure to thrive
Short stature
Constipation
Tiredness
Dermatitis herpatiformis
Associated with other autoimmune conditions like IDDM
41
Q

What is the gold standard screening test for coeliacs?

A

Duodenal biopsy

42
Q

How might villous histology differ in coeliacs?

A

Lymphocytic infiltration of surface epithelium Partial/total villous atrophy
Crypt hyperplasia

43
Q

How might coeliac diagnosis be made without biopsy?

A

Symptomatic children
Anti TTG >10 times upper limit of normal
Positive anti endomysial antibodies
HLA DQ2, DQ8 positive

44
Q

How is coeliac managed?

A

Gluten-free diet

Re-challenging and re-biopsy maybe in very young

45
Q

What kind of tumour has increased risk in untreated coeliac?

A

Small bowel lymphoma

Paediatrics (25 decks)

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