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Paediatrics > Vomiting (malabsorption) > Flashcards

Vomiting (malabsorption) Flashcards

1
Q

Pre-ejection phase features

A

pallor
nausea
tachycardia

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2
Q

Ejection Phase

A

Retch

Vomit

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3
Q

When the vomiting centre is stimulated what is triggered?

A

the chemoreceptors trigger zone dopamine and serotonin receptors

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4
Q

chemotherapy receptors trigger?

A

muscarinic receptors in the vomiting centre

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5
Q

where is the CTZ?

A

outside the blood brain barrier.

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6
Q

Where does the labrynth send signals?

A

vestibular nuclei in the pons which contains histamine and muscarinic receptors during motion sicknesss, these send signals to CTZ which inturn sends message to vomiting centre in medulla oblongata

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7
Q

triggers for vomiting (6)

A

= Enteric pathogens - GI triggers - impulses to vom centre through the vagus nerve

  • infection
  • Visual/olfactory stimuli
    fear
  • Head injury/raised ICP/ - encephalitis, brain tumours
  • Inner ear stimuli
  • Metabolic derangements/
    chemotherapy
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8
Q

Retching involves?

A

deep inspiration against a closed glottis - contraction of the abdomen - pressure difference between abdo and thoracic cavities

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9
Q

easy morning retching associated with?

A

intracranial pathology

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10
Q

Causes of Haemetemesis

A

peptic ulcers

portal hypertension

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11
Q

infants - common causes of vomiting (4)

A

GOR
cow’s milk allergy
infection
intestinal obstruction

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12
Q

Children - common causes of vomiting (6)

A 
Gastroenteritis
Infection
Appendicitis
Intestinal obstruction
Raised ICP
Coeliac disease
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13
Q

young adults - common causes of vomiting (7)

A 
Gastroenteritis
Infection
H.Pylori infection
Appendicitis
Raised ICP
DKA
Cyclical vomiting syndrome
Bulimia
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14
Q

150ml per kilo a day

A

neonates

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15
Q

1 month - 12 months - 100mls per kilo per day

A

infants

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16
Q

cows protein milk allergy can present with

A

irritability and vomiting

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17
Q

Lots of vomiting tends to lead to a?

A

metabolic alkalosis

Hypokalemic, hypochloremic

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18
Q

pyloric stenosis management?

A

fluid resuscitation

  • feeds are stopped and nasogastric tube put in for free fluid
  • Ramstedt’s pyloromyotomy
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19
Q

Pyloric stenosis presenting features

A

Babies 4-12 weeks
Boys > Girls

project non-bilious vomiting
- weight loss

20
Q

Features a baby will have with pyloric stenosis

A

Weight loss

Dehydration +/- shock

21
Q

Characteristic electrolyte disturbance

A

Metabolic alkalosis (↑pH)
Hypochloraemia (↓Cl)
Hypokalaemia (↓K)

22
Q

Effortless vomiting is always due to?

common in?

A

gastro-oesophageal reflux

- infants

23
Q

Exceptions of effortless vomiting (4)

A
  • Cerebral palsy
  • Progressive neurological problems
  • Oesophageal atresia +/- TOF operated
  • Generalised GI motility problem
24
Q

when are solid foods introduced?

A

6 months

25
Q

Presenting symptoms of GOR

A

Vomiting
Haematemesis

Feeding problems
Failure to thrive

Apnoea
Cough
Wheeze
Chest infections

Sandifer’s syndrome

26
Q

What is Sandifer’s syndrome?

A

GOR associated - spastic torticollis and dystonic body movements

27
Q

What physical symptoms are noted with Sandifer’s syndrome?

A

Nodding and rotation of the head, neck extension, gurgling sounds, writhing movements of the limbs, and severe hypotonia

28
Q

Diagnosis GOR?

A

History & examination often sufficient
Oesophageal pH study/impedance monitoring
-Endoscopy

Radiological investigations

  • Video fluoroscopy
  • Barium swallow - rules out hiatus hernia and rotation
29
Q

What age does reflux often start and end?

A

2 weeks

gets worse 4-6 months

gets better after 1 year

30
Q

If reflux doesn’t get better..

A

look for oesophagitis

rule out anatomical problems such as hiatus hernia

31
Q

Barium swallow in GORD looks for?

A
  • Dysmotility
  • Hiatus hernia
  • Reflux
  • Gastric emptying
  • strictures
32
Q

Problems of barium swallow?

A
  • Aspiration

- Inadequate contrast taken (NG tube) - might not be able to drink the barium

33
Q

pH meter is placed

A

5 cm above the LOS

34
Q

pH in the oesophagus should remain above?

A

4

35
Q

Treatment of reflux

A
  • Feeding advice
  • Nutritional support
  • Medical treatment
  • Surgery
36
Q

Feeding advice may include (for reflux)?

A

Thickeners for liquids
Appropriateness of foods- texture, amount

Behavioural programme
Oral stimulation
Removal of aversive stimuli

Feeding position
Check feed volumes

37
Q

Nutritional support advice for reflux?

A
  • Calorie supplements
  • Exclusion diet (cow’s milk protein free trial for 4 weeks)
  • Nasogastric tube
  • Gastrostomy
38
Q

medical treatment for reflux

A

Feed thickeners - gaviscon, thick and easy

  • pro kinetic drugs
  • acid suppressing drugs
  • h2 receptor blockers
  • PPI
39
Q

indications for surgery with reflux?

A

Failure to thrive
Aspiration
Oesophagitis

40
Q

what is the procedure done for reflux?

A

Nissen Fundoplication

41
Q

Nissen Fundoplication complications?

A

bloating dumping and retching of patients with cerebral surgery

42
Q

what is dumping syndrome?

A

early jejunal filling due to rapid gastric emptying and can lead to unpleasant symptoms such as intermittent sweating and diarrhoea following meals.

43
Q

What is bilious vomiting caused by?

A

intestinal obstruction until proved otherwise

44
Q

causes of bilious vomiting?

A
  • Intestinal atresia (in newborn babies only)Malrotation +/- volvulus

toddlers
- Intussusception
Ileus

adolescents Crohn’s disease with strictures

45
Q

Investigations for bilious vomiting (3)

A
  • Abdominal x-ray
  • Consider contrast meal
  • Surgical opinion re exploratory laparotomy

Paediatrics (49 decks)

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