tailieunhanh - Ebook Easy paediatrics: Part 2

(BQ) Part 2 book “Easy paediatrics” has contents: Gastroenterology, paediatric prescribing and fluid management, emergencies, accidents and non-accidental injury, surgical conditions, behavioural problems and psychiatric disorders, neuromuscular disorders, rheumatological and musculoskeletal disorders, metabolic disorders, and other contents. | 10 Gastroenterology Gastro-oesophageal reflux Malabsorption Gastroenteritis Diarrhoea Peptic ulcer disease (PUD) Inflammatory bowel disease Constipation Faecal soiling Acute pancreatitis Gastrointestinal tract bleeding Gastrointestinal tract tumours Further reading GASTRO-OESOPHAGEAL REFLUX This is the passage of gastric contents involuntarily into the oesophagus. It is the result of an incompetent or inappropriately relaxing lower oesophageal sphincter, usually secondary to immaturity. Associations n Cerebral palsy n Hiatus hernia n Thoracic stomach n Coeliac disease n Raised intracranial pressure n UTIs n Fictitious or induced illness (formerly called Munchausen syndrome by proxy) n CHD n CF Clinical features n Vomiting (± altered blood) NB: Possetting is a normal physiological phenomenon n Crying, food refusal, poor sleeping, irritability n Usually resolves spontaneously by 12–18 months of age Complications (in the presence of which GOR is termed gastro-oesophageal reflux disease [GORD]) n Faltering growth n Oesophagitis ± oesophageal stricture n Apnoea, ALTE, SIDS 172 10-Easy 172 28/04/2011 14:54 n Aspiration, wheezing, hoarseness, recurrent chest infection n Iron-deficiency anaemia n Seizure-like events, torticollis Investigations These are necessary only if there is failure to resolve with simple measures, or the reflux is complicated (GORD). The investigations are complementary to each other. % of time pH 10% = abnormal if 6% = abnormal if > 1 year old Barium swallow and meal Looking for malrotation, hiatus hernia, oesophageal stricture . anatomical abnormalities only Endoscopy Looking for oesophagitis, stricture, enteropathy or in older children other causes of dyspepsia such as gastritis or peptic ulcer disease Other CXR, urine M, C & S, Hb and iron studies, faecal occult blood. Remember raised intracranial pressure may cause reflux Management Position Thicken feeds Change feeds Drugs