Pediatrics - Vomiting

Question 1

why do infants have such a high incidence of GERD?

Answer 1

• Weak upper gastrointestinal sphincter

Question 2

What is pyloric stenosis?

Answer 2

hypertrophy of the pylorus causing stenosis which does not allow stomach contents to pass through to the intestinal tract

Question 3

Presentation of pyloric stenosis?

Answer 3

• Weight loss
• Non-bile stained projectile vomiting (Block is before CBD)
• Failure to thrive

Question 4

What is the treatment of pyloric stenosis (Be specific)

Answer 4

• Pyloromyotomy

Question 5

What is esophageal atresia

Answer 5

atresia of the esophagus. Most often with a fistula connecting it to the trachea.

Question 6

How does esophageal atresia and TE fistula tend to present?

Answer 6

• cough with feeding

- vomiting

Question 7

Two common conditions caused by NON bile stained vomiting?

Answer 7

1) GERD

2) Pyloric stenosis

Question 8

What are causes of BILIOUS vomiting?

Answer 8

• duodenial atresia

Question 9

What would you suspect with projectile bile stained vomiting?

Answer 9

• Duodenial atresia

- Hirschsprung Disease

Question 10

What will you find on abdominal Xray of a patient with duodenial atresia?

Answer 10

Double Bubble sign

• first original gastric bubble
• second is in the between the pylorus and the atresia in the duodenum.

Question 11

In a patient with hypochloremic metabolic acidosis which condition do you suspect?

Answer 11

• Pyloric stenosis
• First management plan is to correct he electrolyte disturbance
• done before pyelomyotomy

Question 12

On physical examination how will you differentiate duodenial atresia from malrotation with volvulus?

Answer 12

• Duodenal atresia: no food can pass through and will have scaphoid abdomen
• Malrotation w volvulous: Will have bowel obstruction and abdo will be distended

Question 13

A patient with a distended abdomen, delayed passage of the meconium is most likely to have what?

Answer 13

• Hirschprung disease

Question 14

How do you diagnose hirschsprung disease?

Answer 14

• Bowel biopsy to demonstrate lack of ganglionic cells

Question 15

A previously healthy 7 weeks-old boy is brought to the physician because of a 3-day history of vomiting. His mother says that he has been taking his cow milk-based formula well but vomits after every feeding. The vomiting has been increasing in amount and force; the vomitus appears to be nonbloody, nonbilious undigested formula. He appears mildly dehydrated. He is at the 25th percentile for length and 10th percentile for weight. Vital signs are within normal limits. The remainder of the examination shows no abnormalities.
Serum studies show:
Na+		130 mEq/L
K+		                3.0 mEq/L (low)
Cl-		85 mEq/L  (low)
HCO3- 		34 mEq/L  (high)

What is your diagnosis?

Answer 15

• Pyloric stenosis

- weight loss, hypochoremic metabolic alkyalosis

Question 16

A 1-day-old 2460-g (5-Ib 7-oz) boy has progressive abdominal distention. He was born at 38 weeks’ gestation following an uncomplicated pregnancy and delivery Since birth, he has had two episodes of bilious vomiting after feedings and has not yet passed meconium. The abdomen is distended and firm with visible loops of bowel. There are no external hernias, and the anus is patent. X-rays of the abdomen show several dilated loops of bowel with air-fluid levels A barium enema shows an abrupt change in caliber at the midsigmoid colon from normal-sized bowel to dilated bowel proximally. Immediately after the barium enema, he has a large, explosive bowel movement.
Which of the following in utero events is the most likely cause of these findings?

Abnormal caudal migration of ganglion cells
Abnormal pancreatic and intestinal gland secretions
Failure of normal bowel rotation
Persistent patency of the processus vaginalis
Vascular accident involving a segment of bowel

Answer 16

Abnormal caudal migration of ganglion cells

Question 17

A nurse calls the attending physician to examine an infant born at 28 weeks in the NICU now one day of life . She mentions that the baby had been
voiding and stooling appropriately but today has been having bilious residuals
and
began experiencing some short episodes of apnea. On exam, the baby has increased abdominal girth and a distended abdomen with hypoactive bowel sounds.
Bloody stools are present in the diaper. Pulses are slightly diminished peripherally.
An abdominal film reveals dilated loops of bowel, thickening around the right colon, and pneumatosis.

Answer 17

Necrotizing enterocolitis

Pneumatosis is the give away