Case 15: Two siblings with vomiting

Question 1

What is the best prevention against transmission of viral gastroenteritis

Answer 1

handwashing

Question 2

What is the typical electrolyte abnormality seen in pyloric stenosis?

Answer 2

hypochloremic hypokalemic matabolic alkalosis

Question 3

What should you keep on your differential for a newborn with recurrent emesis?

Answer 3

GERD
viral gastroenteritis
malro with or without volvulus
inborn error of metabolism
pyloric stenosis
intussusception
CNS disease
UTI

Question 4

What are some hallmarks of viral gastroenteritis in an infant?

Answer 4

isolated vomiting at first, followed by large watery stools with dehydration

bilious emesis typically not seem

Question 5

How will a malro present?

Answer 5

bilious emesis
bloody stools (but not typically bloody emesis)
apparent abdominal pain
can present with shock

Question 6

How will a pyloric stenosis present?

Answer 6

escalating forceful non-bilious vomiting with rapid dehydration, but typically a vigorous appetite until late in the clinical course

can be bloody if associated with a mallory-weiss tear

can have a visible peristaltic wave, abdominal mass

Question 7

How will an intussusception present?

Answer 7

bilious emesis, severe abdominal pain, currant jelly stools (diarrhea)

“sausage-like” mass on abdominal exam (telescoping bowel)

Question 8

How should you evaluate for pyloric stenosis?

Answer 8

pyloric ultrasound

if US unavailable, GI contrast study will show a string sign through the pylorus

Question 9

If you do diagnose a pyloric stenosis, what should be your first management step?

Answer 9

fix the electrolyte abnormalities before surgery!!

Question 10

If someone has mild dehydration, how should you rehydrate?

Answer 10

with oral rehydration therapy

Question 11

What is the recommended volume for mild to moderate dehydration?

Answer 11

50-100 ml/kg