Vomiting + malabsorption Flashcards
GOR GORD Pyloric stenosis Cows Milk protein allergy Overfeeding Coeliac Intussusception
what are signs of chronic constipation?
poor appetite irritable lack of energy abdominal pain distention witholding/straining diarrhoea loss of the sensation to move the bowels
Usually gets better after passing bowel movement then gradually gets worse again.
where is the vomiting centre located?
in the medulla oblongata
where do chemoreceptors stimulate vomiting?
in the chemoreceptor trigger zone just below the base of the 4th ventricle
what signs precede vomiting?
pallor
nausea
tachycardia
what signs follow on from vomiting?
lethargy
pale
sweaty
what are the main types of vomiting?
with retching projectile vomiting bilious vomiting effortless vomiting (regurgitation) haematemesis
what usually causes blood in the vomit?
peptic ulcers
portal hypertension
what does vomiting in the morning signify?
intracranial pathology
what are the most common causes of vomiting in neonates?
COR
cows milk allergy
infection
intestinal obstruction
what is the most common cause of vomiting in children?
gastroenteritis infection appendicitis coeliac disease raised ICP
what is the most common cause of vomiting in young adults?
gastroenteritis infection H. Pylori Raised ICP DKA cyclical vomiting syndrome bulimia.
how much should neonates be fed?
150ml per kg per day.
how much should babies aged 1-12 months be fed?
100mls per kg per day.
what does bilious vomiting ALWAYS signify?
Intestinal obstruction - ALWAYS an emergency.
what causes bilious vomiting?
Volvulus
intussisception
Ileus
crohns with strictures
what typical mineral abnormality does pyloric stenosis present with?
Metabolic alkalosis
Hypochloraemia
Hypokalaemia
Who are most at risk of pyloric stenosis?
Babies aged 4-12 weeks
Boys
First born males
What signs suggest pyloric stenosis?
Hungry baby thin and pale failure to thrive dehydrated sunken fontanelles PROJECTILE NON BILIOUS VOMITING Firm round olive mass felt in the upper abdomen
how is pyloric stenosis treated?
Fluid resuscitation
Ramsted’s pyloromyotomy.
what investigation is done for lyric stenosis?
abdominal ultrasound
What is gastrooesophageal reflux?
when the contents from the stomach reflux through the lower oesophageal sphincter, into the oesophagus, the throat then the mouth.
what usually causes gastro oesophageal reflux?
Immaturity of the lower oesophageal sphincter.
when is GOR normal?
If they are still having normal growth
When does GOR usually stop?
90% stops after 1yr.
What are problematic signs of GOR?
cough cry reluctant to feed pneumonia poor weight gain
what signs of GOR are often seen in older children?
Children >1yr often have the same symptoms as adults with GORD:
heartburn
epigastric pain
bloating
when does GOR begin, get worse then resolve?
begins at 2 weeks
gets worse at months 4-6
begins to get better after 1 year, as the child begins to eat solid food, and sits up instead of lying down.
when is GOR investigated?
If it doesn’t improve after 1yr.
IF there is growth faltering (child is moving down centiles).
if theres no response to reflux medication
what is the investigation done in GOR?
video fluroscopy
barium swallow
Upper GI endoscopy
which conditions might cause GOR that doesn’t improve?
Cerebral palsy + other neurological conditions.
What is the treatment for GOR?
Gaviscon (to thicken fluids)
Surgery - nissen fundoplication
what are red flags considering vomiting?
Not keeping down any feeds projectile vomiting Bilious vomiting Haematamesis Abdominal distention Apnoea
what is the common management for vomiting?
small frequent meals
burping
not over feeding
keep baby bright
what are medications used for vomiting?
gaviscon
ranitidine
omeprazole
what is sanders syndrome?
a rare condition caused by brief episodes of abnormal movements associated with GOR. presents with contraction of the neck muscles or dystonia.
when is diarrhoea acute?
< 1 week
hen is diarrhoea persistent?
2-4 weeks
when is diarrhoea chronic?
> 4 weeks
what are the signs of IBS?
stomach pains get BETTER after passing stools
what type of defecation is always pathological?
Nocturnal
what are the main differences between osmotic and secretory diarrhoea?
Osmotic:
small, stops when fasting, low pH, low sodium, potassium and chloride.
Secretory:
large, continues when fasting, higher pH, high sodium, potassium and chloride.
what does coeliac do to the intestines?
causes blunting of the villi +. crypt hypertrophy
what are the main signs of coeliac disease?
diarrhoea belatedness failure to thrive short stature tiredness
what is the gold standard investigation for coeliac disease?
endoscopy + duodenal biopsy
what antibodies are seen in coeliac disease?
Anti TTG
Anti EMA
what condition often occurs alongside coeliac disease?
Type 1 diabetes
which genetics are involved in coeliac disease?
HLA DQ2
HLA DQ8
what is the treatment for coeliac disease?
gluten free diet for life
what is intussusception?
when the bowel invaginate into itself. Leads to a thickening of the overall size of the bowel but narrowing of the lumen of the part that’s narrowed.
what age does intussusception occur at?
6 months - 2 yrs.
Most common in boys
what are the signs of intussusception?
severe colicky abdominal pain pale lethargic abdominal distention RED CURRANT JELLY STOOLS Right UQ mass Vomiting Intestinal obstruction SAUSAGE SHAPED MASS IN THE ABDOMEN.
What is the treatment for intussusception?
Enema - contrast, water and air are pumped into the colon to force the bowel out.
Surgery - if the above doesn’t work.
surgical resection - if theres necrosis.
what are the complications of intussusception?
Obstruction
Gangrenous bowel
Perforation
Death
