Vomiting Child Flashcards
1
Q
Describe gastroenteritis and key points
A
- GE is a very common cause of vomiting in children but vomiting is a non-specific symptom, so ask yourself - what else could it be?
- The mother is always right – if she is worried you should be too
- Initial management is always ABC DEFG
- Choose IV fluid & rate carefully, use 0.9% saline with 5% glucose and KCL 20mmol/l for rehydration
- If your diagnosis & management are right, the child should improve
2
Q
Definition for gastroenteritis?
A
A common acute communicable intestinal infection causing vomiting, fever and diarrhoea
3
Q
Definition of acute diarrhoea?
A
3 or more loose stools / 24 hours for < 14 days
4
Q
Describe epidemiology of rotavirus gastroenteritis?
A
- Each year, in children < 5 yrs in Australia
- 115,000 visit GP
- 22,000 go to ED
- 10,000 admitted (3,700 in NSW)
- 1 death (may be underestimate)
- Rotavirus was responsible for 50% of gastro admissions
- First infection age 3-36 months likely most severe
- Peak in mid to late winter
- Indigenous kids x 3-5 admission, ALOS 5 v 2 days
5
Q
Causes of gastroenteritis?
A
- Viruses (70%)
- Rotavirus
- Adenovirus
- Epidemics, rash maybe prominent
- Norovirus (Calicivirus)
- Epidemics - camps, schools, child care Game of Thrones (Khaleesi-virus, get it?)
- Others
- Enteroviruses
- Parechovirus
- Astrovirus
- Bacteria (15%)
- Campylobacter
- Salmonella
- E.coli
- enteropathogenic, enterotoxigenic
- Others
- Shigella
- S Typhi
- Cholera
- Yersinia (reputation for mimicking appendicitis)
- Parasites
- Giardia
- Cryptosporidium
- Others: entamoeba
6
Q
Describe rotavirus (pathophys, transmission, complications).
A
- RNA virus (family Reoviridae)
- many serotypes/genotypes
- immunity not life-long
- vaccine available free since July 2007
- 80-100% of > 3 yo have antibodies
- incubation 1-3 days → vomiting
- temp > 39C in 1/3
- Faecal – oral transmission
- minor resp spread (?important in hospital)
- • Small bowel damage
- virus penetrates cells of small bowel
- villus destruction
- takes 5-7 days to reform
- loose watery stools, full of rotavirus
- nosocomial infection very common – profuse early vomiting
- virus penetrates cells of small bowel
7
Q
Describe human parechovirus (presentation, complications, investigation, management)
A
- Can cause acute sepsis-like syndrome with fever >38C in infants <3months, followed by erythematous rash
- Presentation + acute sepsis-like syndrome + fever
- Irritability and appearing to be in pain
- Maculopapular or erythematous rash
- Distended abdomen, diarrhoea
- Tachycardia
- Tachypnoea
- Encephalitis
- Myoclonic jerks
- Hepatitis
- Complications
- Volvulus
- Intussusception
- Bowel ischaemia
- Investigation: stool culture
- Management: supportive care
8
Q
Describe campylobacter (source, clinical presentation)
A
- wide variety animal hosts, incl chicken
- abdo pain maybe prominent
- maybe difficult to find in outside labs
- findings on laparotomy
- ileum inflamed, oedematous
- mesenteric adenitis
9
Q
Describe salmonella (source, pathophys)
A
- contaminated food, summer epidemics
- mucosal invasion, colitis prominent
- white cells in stool
- prolonged excretion of salmonella
- age 3 months: 27% at 8/52, 8% at 6/12
- older kids: 7% at 8/52, 2% at 6/12
10
Q
Describe diagnosis of gastroenteritis?
A
- Diagnosis of GE in children usually made on basis of history, examination and awareness of epidemiological information
- Investigations (blood, stool, urine, other) may be needed to rule out conditions other than GE, or to inform management decisions (degree of dehydration etc)
11
Q
Factors supporting cause of gastroenteritis: viral vs bacterial?
A
- Viral / Rotavirus
- Presents in autumn/winter
- Watery diarrhoea without blood
- +/- vomiting
- Low grade fever
- Anorexia
- 90% under 5 years
- Bacteria
- Blood and mucus in stool
- +/- vomiting
- High fever
- May have history of recent travel
- May be food borne
- Haemolytic uraemic syndrome - ARF, thrombocytopaenia, microangiopathic haemolytic anaemia
12
Q
Important aspects on history for the vomiting child?
A
- Vomiting - how frequent, bile, blood
- Stool output - number of stools, blood, mucous, watery
- Intake (compare to usual – is it at least 50%)
- how much, type of fluid (e.g. water, juice, ORS)
- Urine output (compare to usual – is it at least 50%)
- number of wet nappies
- Lethargy, drowsy, colour, abdo pain, rash, bruise
- Other changes
- Duration of illness
- Loss of weight (Blue Book – Personal Health Record)
- Other family members ill
- Previous illness (e.g. short gut)
- Family history (e.g. inflammatory bowel disease)
- NB: Age of child:highest risk in young infants
13
Q
Important aspects on examination for the vomiting child?
A
- Initial impression – “gestalt”
- Stop. Take some time to look, listen, smell…
- Centiles
- Is there a pre-existing growth problem? Use charts.
- Assess hydration
- System exam – Head to toe starting with GIT…
14
Q
Differentials for the vomiting child/gastroenteritis?
A
- Gastroenteritis: triad of fever, vomiting, diarrhoea
- Acute appendicitis
- Strangulated hernia
- Intussusception of other causes of bowel obstruction
- Urinary tract infection
- Meningitis and other types of sepsis
- Any cause of raised intracranial pressure
- Diabetic ketoacidosis
- Inborn errors of metabolism
- Inflammatory bowel disease
- Haemolytic uraemic syndrome
15
Q
What red flags are there with vomiting/when to consider another differential other than gastroenteritis?
A
- Blood in the stool or vomit
- bloody stool: intussesception
- bloody vomit: mallory weiss tear, sepsis
- Bile in vomit - bowel obstruction, intussusception, malrotation
- Vomiting but no diarrhoea - bowel obstruction, intussusception, malrotation
- Diarrhoea first, then vomiting - unusual, appendicitis, bowel obstruction
- Headache - raised ICP, meningitis, significant ear infection
- Very high fever (>39C) - other infectious causes
- Young child (esp < 3m) - other infectious causes
- Severe abdominal pain / distension - acute abdomen
18
Q
Describe the management algorithm for acute gastroenteritis in children
A
20
Q
Describe the composition of different oral rehydration solutions
A
