Vomiting Flashcards
What is nausea?
Unpleasant painless subjective feeling that one will imminently vomit
Features of nausea?
- Often vague and epigastric/abdominal, but not always
- Associated with autonomic changes:
- Salivation, cold sweating, peripheral vasoconstriction, proximal gastric relaxation, retrograde movement of intestinal contents, changes in respiratory rhythm and quality, mydriasis
What is retching?
Strong, involuntary reverse movements (retroperistalsis) of the stomach and esophagus without vomiting
Features of retching?
- Accompanied by spasmodic contractions of the diaphragm and abdominal wall, closing of the glottis, and relaxation of lower esophageal sphincter
- Gastric material may be moved into the esophagus in preparation of vomiting
What is vomiting?
Retrograde ejection of gastrointestinal (or esophageal) contents from the mouth
Features of vomiting?
- Forceful (unable to keep contents in the mouth) and involuntary
- Associated with relaxation of the diaphragm and upper esophageal sphincter and reversal of intrathoracic pressure from negative to positive
What is regurgitation?
The spitting up of food from the esophagus or stomach, typically without nausea or forceful contractions of the abdominal muscles
Features of regurgitation?
Apparently effortless and typically caused by lower esophageal sphincter dysfunction:
1. High tone of the lower esophageal sphincter may lead to simple esophageal emptying (think achalasia)
2. Low tone of the lower esophageal sphincter may lead to reflux when the gastric musculature contracts
What is rumination?
Regurgitating undigested or partially digested food from the stomach, rechewing it, and then either re-swallowing it or spitting it out
Features of rumination?
- Again effortless
- Psychological or behavioral problems are considered the cause, although considered behavioral or involuntary
- Often occurs in association with dyspepsia and digestive problems
Differential diagnoses of vomiting in a neonate?
- Reflux +/- overfeeding if bottle/cup feeding
- Swallowed amniotic fluid which may cause irritation/discomfort
- Swallowed maternal blood which may cause irritation (swallowed maternal during delivery in first 2d or mother has cracked nipples)
- Obstruction (malrotation, esophageal/intestinal atresia, meconium ileus or plug, Hirschsprung, etc.)
- Necrotizing enterocolitis (10% occur in full term babies)
- Inborn error of metabolism
- Sepsis/meningitis/UTI
- Non-accidental Trauma
Features of esophageal atresia?
- Prenatal history of polyhydramnios and intolerance of initial feeding
- Accompanied distal tracheoesophageal fistula in 85% of cases (see below)
- Associated with other anomalies in 15-50% of patients (especially VACTERL)
Diagnosis of esophageal atresia?
plain films after passage of an opaque rubber catheter, which coils in the upper pouch
Features of pyloric stenosis?
- Non-bilious projectile vomiting
- Beginning at 2-3 weeks of age and increasing during the next month
- Often in a firstborn male child
Clinical manifestation of pyloric stenosis?
- Propulsive gastric waves can be seen on the abdominal wall and a palpable “olive” in the epigastrium (felt best during or after feeding) represents the hypertrophied pyloric muscle
- Dehydration
- poor weight gain
- hypochloremic metabolic alkalosis
Diagnosis of pyloric stenosis?
Contrast study: “string sign” and ultrasound w/ hypertrophied tissue
Treatment of pyloric stenosis?
Surgical pyloromyotomy
Features of duodenal atresia?
- Bilious vomiting
- Associated prematurity (and polyhydramnios)
- Anomalies, including renal, cardiac, and vertebral defects, occur in approximately 75% of infants
- Trisomy 21 is seen in about 50%