Growth and gastrointestinal problems

Vomiting Center

Vomiting Center

Primary control center located in the medulla oblongata that initiates the vomiting reflex in response to various signals.

Chemoreceptor Trigger Zone (CTZ)

Area postrema outside the blood-brain barrier that detects blood-borne toxins and chemicals, activating the vomiting center.

Labyrinth of the Inner Ear

Involved in motion sickness by activating receptors that relay signals to the vomiting center.

Mechanoreceptors and Chemoreceptors

Located throughout the gastrointestinal tract, detecting irritation, distension, and chemical stimuli.

Muscarinic M1 Receptors

Involved in the activation of the vomiting reflex.

Dopamine D2 Receptors

Triggered by toxins and drugs in the Chemoreceptor Trigger Zone (CTZ).

Histamine H1 Receptors

Play a role in motion sickness.

5-Hydroxytryptamine (5-HT)3 Receptors

Activated by serotonin in the gastrointestinal tract.

Neurokinin 1 (NK1) Receptors

Substance P acts on these receptors in the vomiting center.

Hirschsprung Enterocolitis

An inflammatory condition of the bowel in patients with Hirschsprung disease, leading to severe complications like sepsis and bowel perforation.

Intussusception

Invagination of a proximal bowel segment into a distal lumen, often at the ileocecal valve, causing ischemia, necrosis, and perforation.

Necrotizing Enterocolitis

Hemorrhagic necrotizing inflammation of the intestinal wall, common in premature infants, with unknown causes and requiring supportive care or surgical intervention.

Meckel's Diverticulum

A true diverticulum near the ileocecal valve, causing lower GI bleeding, obstruction, or diverticulitis, managed by surgical resection if symptomatic.

Mesenteric Lymphadenitis

Enlargement and inflammation of mesenteric lymph nodes, common in children under 15, often due to bacterial infections and managed with supportive care and antibiotics.

Pyloric Stenosis

Hypertrophy of the pyloric sphincter leading to gastric outlet obstruction, characterized by projectile vomiting, managed with pyloromyotomy.

Failure to Thrive

Abnormal growth pattern due to inadequate calorie intake, absorption issues, excessive caloric utilization, psychosocial factors, or other medical conditions.

Short Stature

Abnormal growth pattern caused by familial short stature, systemic diseases, endocrine disorders, genetic diseases, or skeletal dysplasias, requiring investigations like blood tests and imaging.

Tall Stature

Abnormal growth pattern in infancy or childhood/adolescence due to endocrine or non-endocrine disorders, necessitating blood tests, imaging, and karyotype analysis for diagnosis.

Coeliac Disease

An autoimmune disorder triggered by gluten, leading to villous atrophy, crypt hyperplasia, and malabsorption due to immune response to gliadin peptides.

Crohn's Disease

Chronic inflammation with skip lesions, transmural involvement, granuloma formation, leading to fibrosis, strictures, and fistulae in the gastrointestinal tract.

Ulcerative Colitis

Recurrent inflammation confined to mucosa and submucosa, superficial ulceration, pseudopolyps, and increased risk of colorectal cancer.

Coeliac Disease Pathophysiology

Immune response to gluten peptides causing epithelial damage, villous atrophy, crypt hyperplasia, and malabsorption.

Crohn's Disease Pathophysiology

Dysregulation of Th17 signaling, NOD2 mutations, transmural inflammation, skip lesions, granuloma formation, fibrosis, strictures, and fistulae.

Ulcerative Colitis Pathophysiology

Abnormal immune response to commensal bacteria, Th2-mediated inflammation, continuous colonic involvement, superficial ulceration, pseudopolyps, and increased cancer risk.

Bacterial Gastroenteritis

Symptoms include secretory and inflammatory diarrhea, malaise, dysentery, abdominal pain mimicking appendicitis, and tenesmus.

Viral Gastroenteritis

Characterized by watery diarrhea, vomiting, cramping abdominal pain, fever, dehydration, and electrolyte disturbances.

Complications of Gastroenteritis

Include bacteraemia, secondary infections like pneumonia, Reiter’s syndrome, Haemolytic-uraemic syndrome, Guillain-Barré syndrome, and reactive arthropathy.

Toxin-mediated Infections

Present with prominent N/V and abdominal pain, delayed diarrhea, short incubation period, and closely clustered cases.

Investigations for Gastroenteritis

Include assessing dehydration degree, calculating fluid deficit, fecal samples for bacterial culture, C. difficile infection diagnosis based on clinical features, and stool microbiological investigations.

Treatment of Gastroenteritis

Antibiotics are not usually needed for viral diarrhea; empirical antibiotics are considered for severe cases or specific groups; C. difficile infection treatment varies based on episodes; fluid management involves oral rehydration solutions and nasogastric rehydration.

Severe Dehydration Management

Severely dehydrated children require hospital admission for IV rehydration, fluid boluses, electrolyte monitoring, and assessment for underlying conditions.

Electrolyte Management

Use Plasma-Lyte 148 and 5% Glucose or 0.9% sodium chloride and 5% Glucose for rehydration; add KCl if serum K <3mmol/L; monitor electrolytes regularly.

Antiemetics/Antidiarrhoeal Agents

Ondansetron is effective in reducing vomiting; antidiarrheals are not recommended for acute diarrhea in infants and children.

Urinary Tract Infection in Children

Common causes include E. coli, Proteus mirabilis, Staphylococcus saprophyticus, and Staphylococcus aureus; diagnosis involves clinical symptoms, urine culture methods, and initial testing for suspected cases.

UTI Localisation Tests

CRP alone not sufficient to differentiate acute pyelonephritis from cystitis.

Imaging Recommendations

Routine imaging not advised for localising UTI; power Doppler ultrasound for confirming pyelonephritis.

Treatment Guidelines

Conservative measures for asymptomatic bacteriuria; oral antibiotics like Trimethoprim for non-severe UTI.

Antibiotic Choices

Gentamicin with amoxicillin for severe UTI; Cephalexin for non-severe UTI in infants >3 months.

Follow-Up Procedures

Repeat urine culture post-antibiotics; imaging if <6 months, atypical UTI, or recurrent UTIs.

Prophylaxis Considerations

Oral antibiotic prophylaxis for VUR or recurrent UTIs; Trimethoprim or Nitrofurantoin options.

Urine Culture Collection

Methods like clean catch, catheterisation, or suprapubic aspiration for accurate diagnosis.

Weight Measurement (Children <2)

Use levelled pan scale, remove nappy, record weight to nearest 5g, plot on WHO growth chart.

Weight Measurement (Children 2+)

Use beam balance or electronic scale, remove heavy clothing, record weight to nearest 100g.

Length Measurement (Children <2)

Use infantometer, record length to nearest 1mm, plot on WHO length-for-age chart.

Height Measurement (Children 2+)

Use stadiometer, record height to nearest 1mm, plot on height-for-age growth chart.

Hydration Assessment

Clinical features for mild, moderate, and severe dehydration in children.

Skin Color

Describes the color of the skin, which can indicate normal, pale, mottled, warm, or cold conditions.

Peripheral Pulses

Refers to the pulsations felt in the extremities, which can be normal, weak, or absent.

Central Capillary Refill Time

The time taken for capillaries to refill after pressure, indicating normal, prolonged, or markedly prolonged circulation.

Mental State

Describes the level of alertness and consciousness, ranging from alert to apathetic or lethargic.

Oral Rehydration Guidelines

Recommendations for managing dehydration through appropriate fluids, feeding methods, and returning to a regular diet.

IV Fluid Content for Children

Details the types of fluids used for resuscitation, replacement, and maintenance in pediatric patients, including specific compositions and indications.

Criteria for Oral Rehydration Management

Outlines conditions suitable for oral rehydration, exclusion criteria, and guidelines for appropriate fluids and feeding methods.

History Taking

Involves gathering information about the child's age, pain characteristics, medical history, and developmental milestones to assess acute abdominal pain.

GI-Specific History

Focuses on stool color, vomiting, hematemesis, jaundice, abdominal pain, colic, and appetite in children.

GU-Specific History

Involves urinary symptoms, abdominal pain related to urination, quality of urinary stream, polyuria, previous infections, facial edema.

Pediatric Assessment Triangle (PAT)

Includes appearance, work of breathing, circulation to skin, hands, face, and neurological signs for quick pediatric assessment.

Abdominal Examination Techniques

Covering inspection, palpation, percussion, and auscultation, including special techniques like play techniques for children.

General Management of Abdominal Pain

Involves fluid resuscitation, analgesia, NPO status, NG tube consideration, and early referral for surgical or gynecological management.

Assessment and Monitoring

Emphasizes repeated examinations, pain assessment tools like Wong-Baker FACES, FLACC Scale, and Neonatal Infant Pain Scale.

Common and Time-Critical Causes of Abdominal Pain by Age

Lists causes in neonates, infants/children, and adolescents, along with important non-abdominal causes to consider.

Recognizing Diabetic Ketoacidosis (DKA) in Children

Discusses pathophysiology, clinical features, complications, precipitants, diagnostic criteria, and severity assessment of DKA.

Diabetic Ketoacidosis (DKA) Severity Levels:

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Venous pH < 7.3, Bicarbonate < 15 mmol/L

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Venous pH < 7.2, Bicarbonate < 10 mmol/L

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Venous pH < 7.1, Bicarbonate < 5 mmol/L

Investigations for DKA Management:

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To check for ketonuria and glucose.

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Including serum glucose, electrolytes, liver function tests, venous blood gas, blood ketones, full blood count, HbA1c, and septic workup if needed.

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May involve chest X-ray, abdominal X-ray, or ultrasound based on suspicion.

Management Goals for DKA:

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Cerebral edema, hypoglycemia, hypo/hyperkalemia

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Supportive Measures and Monitoring in DKA:

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Fluid Resuscitation in DKA:

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10 mL/kg 0.9% sodium chloride for children with tachycardia

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Add if serum potassium < 5.5 mmol/L and child is passing urine

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Switch to 0.9% sodium chloride with 5% glucose and potassium chloride

Insulin Therapy in DKA:

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Start with 0.1 units/kg/hour

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Media Campaigns

Utilize paid and non-paid media to change attitudes towards diet and physical activity, targeting nutrition and physical activity behaviors.

Health Star Rating System

Front-of-pack labeling system rating nutritional profile from ½ to 5 stars, aiding consumers in making healthier food choices.

Healthy Food Partnership

Collaboration between government, public health sector, and food industry to promote healthy eating and combat obesity.

Australian Dietary Guidelines

Offer advice on types and amounts of foods for health, based on scientific evidence.

Girls Make Your Move Campaign

Aims to inspire young women to be more active through physical activities and sports.

Socio-Economic Factors

Income and disadvantage impact food insecurity and access to nutritious food for Indigenous Australians.

Geographical and Environmental Factors

Issues like food security, geographical isolation, and housing affect nutrition and growth in Aboriginal and Torres Strait Islander children.

Cultural and Social Factors

Traditional food values, education, and social norms influence nutritional status in Indigenous populations.

Health Disparities

High rates of low birthweight and chronic diseases are linked to poor nutrition among Aboriginal and Torres Strait Islander populations.

National and Community-Based Programs

Government initiatives and community programs address factors affecting growth and nutrition in Indigenous children.