What are the different types of vomiting?
- vomiting with retching
- projectile vomiting
- bilious vomiting
- effortless vomiting
What can stimulate the vomiting centre?
- enteric pathogens
- intestinal inflammation
- metabolic derangement
- infection
- head injury
- visual stimuli
- middle ear stimuli
What are features of vomiting with retching?
- pre-ejection phase
- pallor
- nausea
- tachycardia
- ejection phase
- retch
- vomit
- post-ejection phase
What are indications for a test feed?
- palpation of ‘olive’ tumour
- visible gastric peristalsis
- projectile non-bilious vomiting
What is the management?
- fluid resuscitations
- Ramstedts pyloromyotomy
What are features of pyloric stenosis?
- 4-12 weeks age
- boys > girls
- projectile non-bilious vomiting
- weight loss
- dehydration +/- shock
- electrolyte disturbance
- metabolic alkalosis
- hypochloraemia
- hypokalaemia
What are features of bilious vomiting?
- always draw serious attention
- usually due to intestinal obstruction
- intestinal atresia
- malrotation +/- volvulus
- intussusception
- ileus
- Crohn’s disease
- XR
- contrast meal
- laparotomy
What are features of effortless vomiting?
- usually due to GORD
- very common
- self limiting + usually resolves
- except; cerebral palsy, progressive neurological problems, oesophageal atrasia, generalised GI motility problem
What are the symptoms of reflux?
- GI
- vomiting
- haematemesis
- nutritional problems
- failure to thrive
- feeding problems
- respiratory
- apnoea
- cough
- wheeze
- chest infections
- neurological
- Sandifer’s syndrome
What are the investigations for reflux?
- exam
- video fluoroscopy
- barium swallow
- pH study
- oesophageal impedance monitioring
- endoscopy
What is the treatment for reflux?
- feeding advice
- thickeners for liquid
- appropriate amount, thickness of food
- behavioural programme
- feeding position
- nutritional support
- calorie supplements
- exclusion diet (milk free
- NG tube
- gastrostomy
- medical treatment
- feed thickener- Gaviscon, Thick + Easy
- prokinetic drugs
- acid suppressing drugs
- surgery
- failure of medical treatment
- Nissen fundoplication
What is the definition of chronic diarrhoea?
- ≥ 4 stools per day
- > 4 weeks
- > 1 week: acute diarrhoea
- 2-4 weeks: persistant diarrhoea
- > 4 weeks: chronic diarrhoea
What are causes of diarrhoea?
- motiltity disturbance
- toddler diarrhoea
- IBS
- active secretions (secretory)
- acute infective diarrhoea
- IBD
- malabsorbtion of nutrients
- food allergy
- coeliac disease
- cystic fibrosis
What is osmotic diarrhoea?
- movement of water into bowel to equal osmotic gradient
- usually a feature of malabsorbtion
- enzymatic defect
- transport defect
- mechanism of action of lactulose/movicol
- usually with macro/microscopic intestinal injury
- clinical remission with removal of causative agents
What is secretory diarrhoea?
- usually toxin production
- vibrio cholerae
- e. coli
- intestinal fluid secretion
- active Cl- secretion via CFTR
What is motility diarrhoea?
- toddler’s diarrhoea
- IBS
- congenital hyperthyroidism
- chronic intestinal pseudo-obstruction
What is inflammatory diarrhoea?
- mixed
- malabsorbtiondue to intestinal damage
- secretory effects of cytokines
- acceerated transit time in response to inflammation
- protein exudate across inflamed epithelium
What are the investigations for diarrhoea?
- history
- growth + weight gain
- faecal analysis
- appearance
- stool culture
- determination of secretory vs osmotic
What are causes of fat malabsorbtion?
- pancreatic disease
- diarrhoea due to lack of lipase + resultant steatorrhoea
- classically cystic fibrosis
- hepatobillary disease
- chronic liver disease
- cholestasis
What is coeliac disease?
- gluten-sensitive enteropathy
- wheat, rye, barley
- 1% of western population
What are signs of coeliac disease?
- abdominal bloatedness
- diarrhoea
- failure to thrive
- short stature
- constipation
- tiredness
- dermatitis herpatiformis
What are the screening test for coeliac disease?
- serological screens
- anti-tissue transglutaminase
- anti-endomysial
- anti-gliadin
- concurrent IgA deficiency
- duodenal biopsy
- genetic testing
- HLA DQ2, DQ8
What is seen on histology of duodenal biopsy in coeliac disease?
- lymphocytic infiltration of surface epithelium
- partial/total villous atrophy
- crypt hyperplasia
What are the ESPGHAN/BSPGHAN guidelines criteria for diagnosis without biopsy?
- symptomatic children
- anti TTG > 10 X upper limitof normal
- +ve anti-endomysial antibodies
- HLA DQ2, DQ8 +ve
