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Exam - M - Paediatrics (Megan) > Vomiting + malabsorption > Flashcards

Vomiting + malabsorption Flashcards

GOR GORD Pyloric stenosis Cows Milk protein allergy Overfeeding Coeliac Intussusception

1
Q

what are signs of chronic constipation?

A 
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.

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2
Q

where is the vomiting centre located?

A

in the medulla oblongata

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3
Q

where do chemoreceptors stimulate vomiting?

A

in the chemoreceptor trigger zone just below the base of the 4th ventricle

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4
Q

what signs precede vomiting?

A

pallor
nausea
tachycardia

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5
Q

what signs follow on from vomiting?

A

lethargy
pale
sweaty

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6
Q

what are the main types of vomiting?

A 
with retching
projectile vomiting
bilious vomiting
effortless vomiting (regurgitation)
haematemesis
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7
Q

what usually causes blood in the vomit?

A

peptic ulcers

portal hypertension

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8
Q

what does vomiting in the morning signify?

A

intracranial pathology

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9
Q

what are the most common causes of vomiting in neonates?

A

COR
cows milk allergy
infection
intestinal obstruction

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10
Q

what is the most common cause of vomiting in children?

A 
gastroenteritis
infection
appendicitis 
coeliac disease
raised ICP
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11
Q

what is the most common cause of vomiting in young adults?

A 
gastroenteritis
infection
H. Pylori
Raised ICP
DKA
cyclical vomiting syndrome
bulimia.
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12
Q

how much should neonates be fed?

A

150ml per kg per day.

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13
Q

how much should babies aged 1-12 months be fed?

A

100mls per kg per day.

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14
Q

what does bilious vomiting ALWAYS signify?

A

Intestinal obstruction - ALWAYS an emergency.

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15
Q

what causes bilious vomiting?

A

Volvulus
intussisception
Ileus
crohns with strictures

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16
Q

what typical mineral abnormality does pyloric stenosis present with?

A

Metabolic alkalosis
Hypochloraemia
Hypokalaemia

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17
Q

Who are most at risk of pyloric stenosis?

A

Babies aged 4-12 weeks
Boys
First born males

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18
Q

What signs suggest pyloric stenosis?

A 
Hungry baby 
thin and pale
failure to thrive
dehydrated
sunken fontanelles 
PROJECTILE NON BILIOUS VOMITING 
Firm round olive mass felt in the upper abdomen
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19
Q

how is pyloric stenosis treated?

A

Fluid resuscitation

Ramsted’s pyloromyotomy.

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20
Q

what investigation is done for lyric stenosis?

A

abdominal ultrasound

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21
Q

What is gastrooesophageal reflux?

A

when the contents from the stomach reflux through the lower oesophageal sphincter, into the oesophagus, the throat then the mouth.

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22
Q

what usually causes gastro oesophageal reflux?

A

Immaturity of the lower oesophageal sphincter.

23
Q

when is GOR normal?

A

If they are still having normal growth

24
Q

When does GOR usually stop?

A

90% stops after 1yr.

25
Q

What are problematic signs of GOR?

A 
cough
cry
reluctant to feed
pneumonia
poor weight gain
26
Q

what signs of GOR are often seen in older children?

A

Children >1yr often have the same symptoms as adults with GORD:
heartburn
epigastric pain
bloating

27
Q

when does GOR begin, get worse then resolve?

A

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.

28
Q

when is GOR investigated?

A

If it doesn’t improve after 1yr.
IF there is growth faltering (child is moving down centiles).
if theres no response to reflux medication

29
Q

what is the investigation done in GOR?

A

video fluroscopy
barium swallow
Upper GI endoscopy

30
Q

which conditions might cause GOR that doesn’t improve?

A

Cerebral palsy + other neurological conditions.

31
Q

What is the treatment for GOR?

A

Gaviscon (to thicken fluids)

Surgery - nissen fundoplication

32
Q

what are red flags considering vomiting?

A 
Not keeping down any feeds 
projectile vomiting
Bilious vomiting
Haematamesis
Abdominal distention
Apnoea
33
Q

what is the common management for vomiting?

A

small frequent meals
burping
not over feeding
keep baby bright

34
Q

what are medications used for vomiting?

A

gaviscon
ranitidine
omeprazole

35
Q

what is sanders syndrome?

A

a rare condition caused by brief episodes of abnormal movements associated with GOR. presents with contraction of the neck muscles or dystonia.

36
Q

when is diarrhoea acute?

A

< 1 week

37
Q

hen is diarrhoea persistent?

A

2-4 weeks

38
Q

when is diarrhoea chronic?

A

> 4 weeks

39
Q

what are the signs of IBS?

A

stomach pains get BETTER after passing stools

40
Q

what type of defecation is always pathological?

A

Nocturnal

41
Q

what are the main differences between osmotic and secretory diarrhoea?

A

Osmotic:
small, stops when fasting, low pH, low sodium, potassium and chloride.

Secretory:
large, continues when fasting, higher pH, high sodium, potassium and chloride.

42
Q

what does coeliac do to the intestines?

A

causes blunting of the villi +. crypt hypertrophy

43
Q

what are the main signs of coeliac disease?

A 
diarrhoea
belatedness 
failure to thrive
short stature
tiredness
44
Q

what is the gold standard investigation for coeliac disease?

A

endoscopy + duodenal biopsy

45
Q

what antibodies are seen in coeliac disease?

A

Anti TTG

Anti EMA

46
Q

what condition often occurs alongside coeliac disease?

A

Type 1 diabetes

47
Q

which genetics are involved in coeliac disease?

A

HLA DQ2

HLA DQ8

48
Q

what is the treatment for coeliac disease?

A

gluten free diet for life

49
Q

what is intussusception?

A

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.

50
Q

what age does intussusception occur at?

A

6 months - 2 yrs.

Most common in boys

51
Q

what are the signs of intussusception?

A 
severe colicky abdominal pain
pale
lethargic
abdominal distention
RED CURRANT JELLY STOOLS
Right UQ mass
Vomiting
Intestinal obstruction 
SAUSAGE SHAPED MASS IN THE ABDOMEN.
52
Q

What is the treatment for intussusception?

A

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.

53
Q

what are the complications of intussusception?

A

Obstruction
Gangrenous bowel
Perforation
Death

Exam - M - Paediatrics (Megan) (57 decks)

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