EXAM #2: VOMITING IN INFANTS & CHILDREN Flashcards
What is the definition of apnea in infants?
Apnea lasting longer than 20 seconds
What is GER?
Gastroesophageal Reflux–passage of gastric contents into the esophagus
*Normal process
What is regurgitation?
Effortless spitting up of gastric contents
Is pea-soup emesis worrisome? Why?
Yes–bilious emesis
Is projectile vomiting worriesome? Why?
Yes–pyloric stenosis
What are the red flags of emesis in the pediatric population?
- Bilious emesis
- GI Bleeding
- Failure to thrive
- Forceful projectile emesis
- Emesis after 6 months (should be getting better)
- Lethargy
- Bulging fontanelle
Where is the emetic center located?
Reticular formation of the medulla
Where is the chemoreceptor trigger zone?
Floor of the 4th ventricle
What are the signs of Gastroenteritis?
- History of ill contacts
- Fever
- Abdominal pain i.e. irritability in kids
- Diarrhea
- Nausea vomiting
- Acute onset
What are the common viral causes of Gastroenteritis in the pediatric population?
Rotavirus
- Adenovirus
- Norwalk virus
- Astrovirus
- Calcivirus
What viral cause of gastroenteritis has a vaccine?
Rotavirus
How is Gastroenteritis treated?
1) Hydration
2) Fever control
3) Tincture of Time
What are the signs of meningitis?
- Fever (high)
- Irritability
- Lethargy
- Headache
- Vomiting
- Petechia
What is the common viral cause of meningitis in kids?
Enterovirus
How does meningitis cause vomiting?
- Meningeal inflammation
- Increased ICP
What is the definition of GERD?
- Passage of gastric contents into the esophagus
- + symptoms
What are the signs of GERD in infants?
1) Feeding difficulty
2) Hematemesis
3) Failure to thrive
4) Wheezing–aspiration, lower
5) Stridor–aspiration, lower
6) Apnea
Why does GERD cause apnea?
Laryngospasm–airway protection mechanism
What is Sandifer Syndrome?
Reflux resulting in a seizure-like presentation
- Pain
- Rhythmic tensing/ alternating head movements
This puts GERD in the differential for infantile seizures
How should you begin to work-up of GERD for a child?
1) History and physical
2) Review growth chart
What is the initial diagnostic study for GERD?
Upper GI Series to rule out anatomic anomaly
What is a secondary study to perform in the initial work-up GERD?
Esophageal pH probe
What lifestyle modifications can be made to treat GERD in infants?
1) Increase caloric density and decrease volume
2) Thicken feeding with rice cereal
3) Use formula with rice starch or carob bean that THICKENS IN THE STOMACH
What medications can be used to treat GERD?
1) Antacids
2) PPI
3) H2 blockers
4) Prokinetic agents
What is the utility of a PPI in the diagnosis and treatment of GERD?
4 week trial can be used for diagnosis and treatment
What is the surgical intervention for GERD?
Nissen Fundoplication
What is a Nissen Fundoplication?
- Upper stomach sutured around the esophagus
- Increases the tone of the LES
What are the complications can occur with a Nissen Fundoplication?
1) 10% have issues with procedure
2) 10% require revision
