Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics > Vomiting Child > Flashcards

Vomiting Child Flashcards

1
Q

How might you divide neonatal vomiting according the characteristic of the vomit?

A

Bilious or non-bilious

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

If vomiting is bilious where does the locate the obstruction to?

A

The obstruction must be distal to the ampulla of vater in order for bile to be present in the vomit. The ampulla of vater opens into the second part of the duodenum at the major duodenal papilla, it is formed by the union of the pancreatic duct and the common bile duct.

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

What features might indicate that vomiting is normal?

A

Low volumes
Shortly after eating
Non-projectile
Milky/formula coloured

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

What features indicate that vomiting may be pathological?

A 
Projectile
Bilious/Green
Large volumes
Distended abdomen
Any other signs of illness- fever, lethargy, diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some causes of bilious vomiting for children under three months?

A

Bilious= obstruction after ampulla of vater (2nd part of duodenum)

Intestinal Atresia
Intestinal Malrotation + Volvulus
Intestinal Stenosis
Hirschsprung’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some causes of non-bilious vomiting in a child under 3 months?

A

Non-bilious= Proximal to the ampulla of vater

Pyloric Stenosis
Annular Pancreas

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

What can parents do to reduce normal reflux after eating?

A

Feeding in upright position
Winding/burping the baby after and during feeding
Avoid active play after feeds

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

What is intestinal malrotation?

A

A congenital abnormality of the small intestine where there is absent attachment which can lead to rotation and volvulus. The caacum and apendix are located in the upper right quadrant rather than the lower left.

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

What are three important complications of intestinal malrotation?

A

Volvulus/Obstruction
Bowel Ischaemia
Sepsis (following bowel ischaemia)

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

How can intestinal malrotation be investigated for?

A

Abdominal X-Ray in upright Position
Abdominal USS
Upper GI Contrast Series/ Barium Follow Through

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

What is seen on an AXR for intestinal malrotation with volvulus?

A

Distended bowel with air fluid level

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

What is the broad initial management for bowel obstruction?

A

NBM
Fluid Resus if dehydrated
NG Decompression
ABx if at risk of intestinal ischaemia and sepsis

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

What is volvulus?

A

An obstruction caused by a loop of bowel becoming twisted

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

What are the core symptoms of bowel obstruction?

A

Vomiting
Abdominal distension
Nausea
Abdo pain

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

Why is bowel infarction an important complication?

A

Death of the bowel can allow for the bacteria found within the bowel to enter the bloodstream and ultimately lead to sepsis.

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

How must a midgut volvulus due to intestinal malrotation ultimately be managed?

A

Surgically

Any necrotic bowel must also be removed during surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What symptoms might indicate bowel ischaemia with volvulus?

A

Bloody stool/diarrhoea
Abdominal pain
Abdominal distension
Vomiting

Note- also get a raised lactate due to ischaemic process

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

What unique feature may be seen with contrast series in intestinal malrotation with volvulus?

A

Corkscrew appearance of the duodenum and jejunum.

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

What is atresia?

A

Atresia is a lack of patency leading to obstructive symptoms

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

What condition is duodenal atresia associated with?

A

Down’s Syndrome- Trisomy 21

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

What sign might be present meaning atresia is picked up before birth? Why?

A

Polyhydramnios- due to obstruction the fetus is less able to swallow amniotic fluid meaning there is a build up of it. Bilious vomiting is then seen soon after birth.

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

What investigations would you do if suspecting duodenal atresia?

A

Abdominal X-ray
Contrast Series
Abdominal USS

Karyotyping may be done to investigate for trisomy 21.

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

What feature may be seen for duodenal atresia on an AXR?

A

Double bubble

Obstruction causes air-fluid levels to be visible proximal to the obstruction. Double as bubble separated by the pyloric valve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What would the initial management for duodenal atresia be?

A

NBM
NG Tube Decompression
Fluid Resus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the definitive management for intestinal atresia?

A

Surgical correction- duodenoduodenostomy removing the problematic section.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the difference between stenosis and atresia?

A 
Stenosis= Narrowed
Atresia= Closed or Absent
27
Q

What process failure leads to duodenal atresia?

A

There is failure of recanalisation/vacuolation of the duodenum

28
Q

Why does polyhydramnios occur with duodenal atresia?

A

Obstruction means there is difficulty swallowing amniotic fluid which leads to increasing levels in the amniotic sac. This can be detected prenatally.

29
Q

What are the sx of duodenal atresia?

A

Bilious vomiting in the first few days of life

Abdominal distension

30
Q

What is Hirschsprung’s disease?

A

Congenital aganglionic megacolon- absence of ganglia in a portion of the small intestine. Leads to failure of peristalsis in that area and so intestinal obstruction.

31
Q

Where does Hirschsprung’s disease commonly affect?

A

Distal/Sigmoid colon and rectum

32
Q

What condition is associated with Hirschsprung’s disease?

A

Down’s Syndrome- Trisomy 21

33
Q

What are the symptoms of Hirschsprung’s disease?

A

Failure to pass meconium within first 48 hrs of life
Abdominal distension
Vomiting

34
Q

Why should a chest X-ray be done in cases of intestinal obstruction?

A

To check for perforation- there would be air beneath the diaphragm

35
Q

How is Hirschsprung’s diagnosed?

A

AXR with contrast dye
Anorectal manometry
Definitive- Rectal suction biopsy obtaining samples from mucosa and submucosa (to check for nerve plexus)

36
Q

What may occur during examination in Hirschsprung’s disease?

A

Tight anal sphincter and explosive release of stool/gas

37
Q

What is the treatment for Hirschsprung’s disease?

A

Surgical removal of the aganglionic section

38
Q

What are the symptoms of pyloric stenosis?

A

Projectile vomiting after eating

Constipation- little passage of stool as little food passes

39
Q

What may be seen on physical examination in children with pyloric stenosis?

A

An olive shaped mass in the epigastrium- this is the hypertrophic pyloric sphincter
Visible peristaltic waves in the epigastrium

40
Q

What electrolyte imbalance can pyloric stenosis lead to? (And other conditions with prolonged vomiting)

A

Metabolic alkalosis due to the loss of H+ in the vomit
Patients may also be hypochloremic due to loss of chloride ions.

Also, low fluid volume activates RAAS which causes raised sodium and reduced potassium.

41
Q

How would you investigate for pyloric stenosis?

A

Abdominal USS
AXR with contrast series
Pyloric manometry

42
Q

How does the vomit differ between obstruction due to duodenal atresia and pyloric stenosis?

A

Duodenal atresia causes bilious vomiting as the obstruction is distal to the ampulla of vater. The pyloric sphincter is proximal and so the vomit does not contain bile.

43
Q

What is the definitive treatment for pyloric stenosis?

A

Pyloromyotomy- splitting of the sphincter to widen it. Also called Ramstedt’s procedure.

Important to correct fluid status and electrolyte abnormalities first!

44
Q

What is annular pancreas?

A

A ring of pancreatic tissue surrounds and compresses the duodenum

45
Q

What condition is annular pancreas associated with?

A

Down’s Syndrome- Trisomy 21

46
Q

What kind of vomiting does annular pancreas cause?

A

An annular pancreas causes an obstruction that is proximal to the ampulla of vater. This therefore causes non-bilious vomiting.

47
Q

What investigations should be done to investigate for annular pancreas?

A

AXR
Upper GI contrast series
Abdominal CT for definitive diagnosis

48
Q

What is the definitive treatment for annular pancreas?

A

Surgical- duodenojejunostomy (duodenum is connected to the jejunum)

49
Q

What is the most common cause of gastroenteritis?

A

Viral- Rota and Norovirus

50
Q

What bacteria cause gastroenteritis?

A 
Shigella
Salmonella
E.Coli
Yersinia
Campylobacter
51
Q

How does the picture differ between viral and bacterial gastroenteritis?

A

Viral gastroenteritis is typically short lived and has a sudden onset

Bacterial gastroenteritis is prolonged and more severe

52
Q

What parasites may cause gastroenteritis?

A

Giardia lamblia

Cryptosporidium

53
Q

What three types of agents can cause gastroenteritis?

A

Viruses
Bacteria
Parasites

54
Q

What factors may point towards a gastroenteritis causing vomiting and diarrhea?

A

Poor sanitation
Recent travel
Contacts with similar symptoms
Eating suspicious foods

55
Q

What investigations may be done to investigate for a cause of gastroenteritis?

A

Stool Cultures- Bacterial
Stool PCR- Viral
Microscopy- Parasites

Important to check hydration status and inflammatory markers. FBC, U+Es, CRP, ESR, Creatinine/eGFR

56
Q

What is the management for gastroenteritis?

A

Generally Supportive

Oral rehydration solution
Monitor fluid status- IV Fluids if needed
ABx guided by MC+S

Note- If vomiting oral route is contraindicated and so IV route may be needed.

57
Q

What is intussusception?

A

Telescoping of the proximal portion of the bowel into the distal one

58
Q

What are the symptoms of intussusception?

A

As with other abdominal obstructions- Nausea, Bilious vomiting (telescoping of small bowel distal to ampulla of vater)
Acute colicky abdominal pain

59
Q

How is the pain of intussusception relieved sometimes?

A

By sitting with the knees brought up to the chest

60
Q

For patients with intussusception what might indicate bowel ischaemia?

A

Intestinal ischaemia may result due to compression of the vessels that supply that area of bowel.

Results in red currant jelly stool, severe abdo pain and a raised lactate.

61
Q

What is a very important complication of ischaemic bowel?

A

Necrosis of the bowel can lead breakdown of barriers allowing for bacteria to enter the bloodstream- leading to sepsis.

62
Q

What investigations should be done to investigate for intussusception?

A

Abdominal USS- Shows target sign
AXR- Shows obstruction
CXR- Check for perforation

63
Q

What is the treatment for intussusception?

A

Barium or water soluble contrast enema

If any necrotic, ischaemic or perforated bowel surgery is needed.

64
Q

What is gastroparesis?

A

Delayed gastric emptying without any mechanical obstruction

Paediatrics (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions