EXAM #2: VOMITING IN INFANTS & CHILDREN

Question 1

What is the definition of apnea in infants?

Answer 1

Apnea lasting longer than 20 seconds

Question 2

What is GER?

Answer 2

Gastroesophageal Reflux–passage of gastric contents into the esophagus

*Normal process

Question 3

What is regurgitation?

Answer 3

Effortless spitting up of gastric contents

Question 4

Is pea-soup emesis worrisome? Why?

Answer 4

Yes–bilious emesis

Question 5

Is projectile vomiting worriesome? Why?

Answer 5

Yes–pyloric stenosis

Question 6

What are the red flags of emesis in the pediatric population?

Answer 6

• Bilious emesis
• GI Bleeding
• Failure to thrive
• Forceful projectile emesis
• Emesis after 6 months (should be getting better)
• Lethargy
• Bulging fontanelle

Question 7

Where is the emetic center located?

Answer 7

Reticular formation of the medulla

Question 8

Where is the chemoreceptor trigger zone?

Answer 8

Floor of the 4th ventricle

Question 9

What are the signs of Gastroenteritis?

Answer 9

• History of ill contacts
• Fever
• Abdominal pain i.e. irritability in kids
• Diarrhea
• Nausea vomiting
• Acute onset

Question 10

What are the common viral causes of Gastroenteritis in the pediatric population?

Answer 10

Rotavirus

• Adenovirus
• Norwalk virus
• Astrovirus
• Calcivirus

Question 11

What viral cause of gastroenteritis has a vaccine?

Answer 11

Rotavirus

Question 12

How is Gastroenteritis treated?

Answer 12

1) Hydration
2) Fever control
3) Tincture of Time

Question 13

What are the signs of meningitis?

Answer 13

• Fever (high)
• Irritability
• Lethargy
• Headache
• Vomiting
• Petechia

Question 14

What is the common viral cause of meningitis in kids?

Answer 14

Enterovirus

Question 15

How does meningitis cause vomiting?

Answer 15

• Meningeal inflammation

- Increased ICP

Question 16

What is the definition of GERD?

Answer 16

• Passage of gastric contents into the esophagus

- + symptoms

Question 17

What are the signs of GERD in infants?

Answer 17

1) Feeding difficulty
2) Hematemesis
3) Failure to thrive
4) Wheezing–aspiration, lower
5) Stridor–aspiration, lower
6) Apnea

Question 18

Why does GERD cause apnea?

Answer 18

Laryngospasm–airway protection mechanism

Question 19

What is Sandifer Syndrome?

Answer 19

Reflux resulting in a seizure-like presentation

• Pain
• Rhythmic tensing/ alternating head movements

This puts GERD in the differential for infantile seizures

Question 20

How should you begin to work-up of GERD for a child?

Answer 20

1) History and physical

2) Review growth chart

Question 21

What is the initial diagnostic study for GERD?

Answer 21

Upper GI Series to rule out anatomic anomaly

Question 22

What is a secondary study to perform in the initial work-up GERD?

Answer 22

Esophageal pH probe

Question 23

What lifestyle modifications can be made to treat GERD in infants?

Answer 23

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

Question 24

What medications can be used to treat GERD?

Answer 24

1) Antacids
2) PPI
3) H2 blockers
4) Prokinetic agents

Question 25

What is the utility of a PPI in the diagnosis and treatment of GERD?

Answer 25

4 week trial can be used for diagnosis and treatment

Question 26

What is the surgical intervention for GERD?

Answer 26

Nissen Fundoplication

Question 27

What is a Nissen Fundoplication?

Answer 27

• Upper stomach sutured around the esophagus

- Increases the tone of the LES

Question 28

What are the complications can occur with a Nissen Fundoplication?

Answer 28

1) 10% have issues with procedure

2) 10% require revision