44. Differential diagnosis of vomiting in different stages of childhood physical development Flashcards
When is the oral incidence of cyclic vomiting syndrome?
3-7 years of age
What is the clinical presentation
Recurrent severe vomiting which can be bilious or non - billous
Attacks can be associated with headaches and photophobia
How to diagnose cyclic vomiting syndrome
Rome 3 criteria
three or more episodes of acute vomiting in the past year
Each episode lasting less than one week
Asymptomatic intervals between episodes
Treatment for cyclic vomiting syndrome
Avoid triggers such as cheese chocolates or stress
Prophylaxis
Cyproheptadine in patients < 5 years old and amitriptyline in patients > 5 years old.
Iv hydration
What are all the ddFor vomiting ?
Hypertrophic pyloric stenosis
GERD
Cyclic vomiting syndrome
Gastroenteritis
Congenital adrenal hyperplasia.
Midgut volvulus and intestinal malrotation
Etiology Of hypertrophic pyloric stenosis
Nicotine during pregnancy
Bottle feeding- drink more milk in less time leading to hypertrophic of pyloric
Marie antibiotics
Azithromycin and erythromycin
When do the symptoms appear in hypertrophic pyloric stenosis
2nd -7th week of life!
What are the clinical manifestations of hypertrophic pyloric stenosis
Projectile non bilious vomiting immediately after feeding
enlarged, thickened, “olive-shaped”, non-tender pylorus (diameter of 1–2 cm) should be palpable in the epigastrium
A peristaltic wave, moving from left to right, may be evident in the epigastrium
re-feeding after vomiting, demonstrates a strong rooting and sucking reflex, irritable
dehydration, weight loss, failure to thrive
Diagnosis of hypertrophic
Pyloric stenosis
abdominal ultrasound elongated and thickened pylorus
Barium studies
Narrow pyloric orifice
String sign: elongated, thickened pylorus
Beak sign: The pylorus is only partially open to the stomach because of hypertrophy, resulting in two muscular layers adjacent to one another in an “open beak.”
Endoscopy
Laboratory tests
Hypochloremic, hypokalemic metabolic alkalosis, a classic result, is now uncommon because infants are typically diagnosed and treated early.
loss of gastric hydrochloric acid from emesis results in increased bicarbonate and decreased chloride concentrations in the blood.
Hypokalemia usually occurs in infants that have been vomiting for many days or even weeks.
Hyponatremia or hypernatremia may be present.
Treatment of hypertrophic pyloric stenosis
IV hydration
Correct electrolyte balance
Frequent administration of small maj with head propped up
Surgery always- ramstedt PYLOROMYOTOMY
What is the etiology Of GERD
Lower esophageal sphincter is relaxed or when the intragastric pressure is higher than the lower esophageal sphincter
LES time decreases by caffeine and NG Scleroderma Obesity Iatrogenic after gastroectomy Gastric outlet obstruction Sliding hiatal hernia Asthma Obesity Angle of His enlargement
Clinical features of GERD
Retrosternal burning pain
Regurgitation
Disphagia
Dyspepsia
Epigastric pain
Chronic non productive cough
Hoarsness
Dental erosion
Weight loss
Iron def due to erosion - bleeding
Diagnosis of GERD
Esophageal PH monitoring over 24-48h
Esophageal barium swallow - smith tapering
Esophageal rings or webs
Achalasia
Esophageal manometry
Treatment of GERD
PPI for 8 weeks
H2 receptor antagonist - second line of first does not work
L
Lowest dose of acid suppression therapy
Dietary - small portions avoid eating before bed time
Surgical therapy- refractory to medical therapy
Laparoscopic and open fundoplication
Complication ofGERD
Barrett esophagus
Aspiration pneumonia
Asthma exacerbation. strictures
Esophageal ring
