Vomiting Flashcards
Infnat vomiting can be split into 4 types?
- With retching
- Projectile
- Bilious
- Effortless
What do you expect to see in vomiting with retching?
A prodrome of pallor, nauseas and tachycardua
Retching and vomiting
Often a follow on of weakness, shivering and lethargy
What can cause vomiting with retching in a child?
Anything really:
- Enteric pathogen
- Other inf e.g. uti
- Intestinal inflammation
- Metabolic
- Head injury
- Visual or middle ear stimuli
What could cause a child to projectile vomit?
GORD
Overfeeding
Pyloric Stenosis
Who gets pyloric stenosis?
Expect to see it 4-12wks and more often in boys
6wk old boy comes in with projectile vomiting, weight loss and dehydration? How do you test for pyloric stenosis?
Test feed in hospital and look for:
- Palpable “olive” tumour
- Visible gastric peristalsis
- Non-bilious vomit
From there you can do an ABG & US
What would you expect to see on a pyloric stenosis ABG? and can you explain it?
Metabolic Alkalosis (vomiting HCl)
Hypokalaemia (Secondary Hyperaldosteronism due to dehydration)
Hypochloraemia (Vomiting HCl)
How do you treat Pyloric Stenosis?
Dehydrated from all the vomiting so Fluid Resus
Followed by Ramstedt’s Pyloromyotomy
Bilious vomiting is an intestinal obstruction until proven otherwise, due to?
- Intestinal Atresia (newborn)
- Malrotation +/- volvulus
- Intussusception
- Crohn’s + strictures
How would you approach a child with bilous vomiting?
Abdo X-ray
Contrast meal
~Exploratory Laparotomy
What causes effortless vomiting?
Mostly GORD
How would GORD look in a child?
Effortless vomiting +/- haematemesis
Feeding Aversionm & FTT
~Resp symptoms e.g. apnoea, cough, wheeze or inf
~Sandifer’s syndrome
Sandifer’s syndrome?
Spastic Torticollis & dystonia due to GORD, resolved by treating GORD
How do we test kids for GORD?
In most cases you can just ressure them that it’s self-limiting, if necessary do:
- Video fluoroscopy or Barium Swallow
- Oesophageal Impedance Monitoring
- UGIE (if >2yrs old, looking for oesophagitis)
There are 4 stages to treating childhood GORD, what feeding advice would you give?
- Thickener’s
- Appropriate texture/amount of food
- Feeding position
- Oral stimulation & removal of aversive stimuli
