Vomting and malabsoprtion Flashcards
What ar ethe 3 phases of vomiting and what occurs during them?
Pre-ejection phase: pallor, nausea, tachycardia
Ejection phase: retching (deep breaths against closed glottis), vomitting (contraction of abdo muscles and stomach to expel content)
Post-ejection phase: Lethargy, pale, sweaty
What are the main causes of vomiting in infants
gastroeosphageal reflux
Cow’s milk allergy
Infection
Intestinal obstruction
Main causes of vomiting in children?
Gastroenteritis Infection Apppendicitis Intestinal obstruction Raised ICP Coeliac Disease
Commonest causes of vomiting in young adults?
Gasteroenteritis Infection H.pylori Infection Appendictis Raised ICP DKA Cyclical vominting syndrome Bulimia
How would gastroesophageal reflux present?
Vomiting will be effortless. Inadequate weight gain/FFT Cough Wheeze Chest infection Apnoea
How is gastroeosphageal reflux investigated and treated?
Oespohageal pH study
Endoscopy
Barium swallow
Treatment:
Most self resolve except if: child with cerebal palsy, progressive neurological problems, oesophageal atresia or generalised GI motility problem.
Feeding advice: thickeners, feeding position, feed volumes
Nutrional support: calorie supplements, exclusion diet (Cow’s mild free trail for 4 weeks), nasogastric tube
Feed thickener- e.g. Gavison
Prokinetic drugs
Acid suppressing drugs e..g. H2 recptor blockers, Proton pump inhibitors
Surgery- Nissen Fundoplication
What is the correct feed volume for neonates?
150mls/kg/day
What is the correct feed volume for Infants?
100mls/kg/day
What are indicators for surgery?
Faliure of medical treatment
Peristent FFT, Aspiration or oesophagitis
What is bilious vomit and why does it ring alarm bells?
Green vomit is bilious vomit.
It is assumed to be caused by intestinal obstruction until proven otherwise
What inestiagtions are done for bilious vomit?
Abdominal x-ray
Contrast meal
What are the causes for bilious vomit/intestinal obstruction?
Intestinal atresia- in newborns only
Malrotaion/volvulus
Intussusception- (in toddlers)
Crohn’s disease
What is a definition of diarrhoea?
4 or more stools per day for more than 4 weeks
<1 week - acute
2-4 weeks -persistent
>4 weeks chronic
What are the causes of diarrhoea in children?
Can be split in to three categories:
Moltility disturbance: Toddler diarrhoea (increased GI motility), Irritable bowel syndrome (will have abdo pain after eating)
Active secretion: Acute infective diarrhoea, Inflammatory bowel disease
Malabsorption of nutrients (omotic): food allergy, coeliac disease, cystic fibrosis.
What is commonly seen in diarrhoea caused by cystic fibrosis?
Steatorrhoea
How will Coeliac disease present?
Abdo bloatedness Diarrhoea Short stature Faliure to thrive Constipation Tiredness Dermatitis herpatiformis- blistering skin condition
What investigations are done for Coeliac disease?
Anti-tissue transglutaminase (high often >10 times the upper limit of normal) Anti-endomysial- in Coeliac will be positive Serum IgA (would sepect it to be low)
Duodenal biopsy- gold standard
Genetic testing
How is Coeliac disease treated?
Gluten free diet for life
If diagnosed in <2 years then rechallenge and re-biopsy at later date as could be other conditions such as autoimmune enteritis mimicing Coeliac disease
