Vomiting Flashcards
Common causes of vomiting in infant or child
Over feeding
Physiological gastro-oesophageal reflux or spitting
Gastroenteritis (vomiting may precede diarrhoea)
Surgical causes of vomiting in children and infants
Pyloric stenosis Bowel obstruction (bile stained)
Infections causes of vomiting in children or infant
UTI
Meningitis
Intracranial causes of Vomiting in children or infant
Raised intracranial pressure
Complications of gastro oesophageal reflux
Aspiration
Oesophagitis
Failure to thrive
Apnea so
Causes of vomiting in new born and infants
Over feeding greater that 200ml/kg/day Gastro oesophageal reflux Pyloric stenosis - 4-6 wk - projectile vomiting - red flag Whooping cough Small bowel obstruction - congenital atresia or mal rotation - red flag Malrotation Intussusception Constipation Systemic infection eg UTI or meningitis Gastroenteritis Allergies, intolerance eg cow's milk protein intolerance Rare metabolic disorder.
Causes of vomiting in older children and adolescents
Gastroenteritis Migraine Raised intracranial pressure Bulimia Toxic ingestion or medication Pregnancy.
Gastro-oesophageal reflux in infants
Common in preterm
Due to lax gastrooesophageal sphincter: positional vomiting
Symptoms - range from possessing or significant Oesophagitis, worse after feeds and on lying down.
May lead to Oesophagitis or aspiration pneumonia
May cause apnoea and failure to thrive
Abnormal posturing may occur in severe acid reflux - known as Sandifer’s syndrome and can be mistaken with seizure.
Dx clinical on Hx
Ix - only if significant. Barium swallow and pH of oesophagus. Endoscopy to confirm Oesophagitis
Mx - Feed sitting up. Thickening feeds with thickening formula. Or Gaviscon prior to BF. Winding after feeds. Meds to affect gastric emptying, PPIs and gut motility. If getting recurrent aspiration then surgical fundoplication.
Most resolve over time as infant starts to sit up and when weaned on a more solid diet.
Pyloric stenosis
Cause - hyper trophy of pylorus muscle
2-8wk of life
Most common in first born males
1/300 to 1/500
Commonest indication for surgery in infancy
Symptoms - vomiting increasing in intensity and is characteristically projectile, immediately after a feed. Non bile stained and infant is usually hungry. May have hx of constipation.
Signs - wt loss and dehydration, and irritable child due to hunger. Jaundice. Palpated after a test feed for hard mobile mass from left to right epigastric area. Prominent peristaltic waves over stomach.
IX - USS thickened and elongated pyloric muscle.
Blood test - low plasma chloride, potassium and sodium and metabolic alkalosis secondary to protracted vomiting of stomach acid.
They get Hypocholraemic and Hypokalaemic. Group and hold, Glucose, LFT.
Mx - Hydration, with correction of electrolyte imbalance prior to surgery. Surgery - splitting pylorus muscle without cutting through the mucosa - Ramstedt’s pyloromyotomy. Laparoscopic pyloromyotomy
Oral feeds can normal be commenced after surgery
Gastroenteritis in paediatric
Commonest cause of vomiting in childhood
Usually with diarrhoea sometime viral cause may be vomiting without diarrhoea
Viral causes most common - rota and norovirus, Adenovirus, astrovirus,
Bacterial - less common. - Salmonellaspp, campylobacter jejuni, Yersinia enterocolitica, E.coli
Parasite - Cryptosporidium- immunosuppressed.
Symptoms - fever, poor feeding and vomiting followed by diarrhoea. Stools frequent and watery. Bacteria - hx of frequent small volume stools with blood and mucus and abdo pain.
Need to exclude - appendicitis, UTI, meningitis, sepsis, surgical cause eg intussusception,Haemolytic uraemia syndrome.
Ix - only if prolonged severe diarrhoea, ALOC, Convulsions, comorbidity or less then 6months of age who are dehydrated.
Mx need frequent reevaluated to confirm Dx of Gastroenteritis and adequacy rehydration therapy.
Rehydrate
ABx for salmonella or campylobacter and Shigella
Bowel obstruction
Surgical emergency
Underlying causes - congenital duodenal or ileal atresia (Down’s) or mal rotation of small bowel. Hirshprung’s disease and meconium ileus (CF). Also intussusception.
In order children bowel obstruction may be secondary to adhesion from previous abdominal surgery eg appedicectomy.
Symptoms - bile stained
Mx - NGT to aspirated stomach. Nil by mouth until Ix causes.
- Find underlying causes:
- congenital mal rotation - USS - small bowel is rotated on its mesentery and a Doppler USS scan may show mal alignment of mesenteric vessels.
- Hydration
- surgery
-
Bulimia nervosa
Dx criteria
- Recurrent episodes of binge eating characterised by lack of control during the episode
- Recurrent inappropriate compensatory behaviour in order to prevent wt gain
- The binge eating and inappropriate compensatory behaviours both occur, on average, at least once per week for 3 months and
- self evaluation is unduly influenced by body shape and wt.
Bulimia nervosa complications
Comorbidity and cx - Depression and anxiety and difficulties with impulse control Potential Cx - Dental erosion - Oesophagitis - Electrolyte abnormalities
Mx of Bulimia
Out pt
Psychotherapy - CBT
Antidepressants eg SSRI when depression is present.
