Vomiting Flashcards
Neonatal causes of vomiting (6)
any infection-resp, meningitis, gastro, UTI
overfeeding
obstruction
pyloric stenosis
intussusception
GORD-most common
Causes of neonatal bowel obstruction (8)
small bowel:
- duodenal atresia
- malrotation/volvulus
- meconium ileus
- strangulated hernia
colon:
- hirschprung’s
- imperforate anus
- rectal atresia
NEC can affect any part of bowel
RFs for GORD (3)
prematurity
cerebral palsy
congenital abnormalities e.g. post tracheo-oesophageal fistula repair.
(GORD due to immaturity of oesophageal sphincter).
Presentation of GORD (9)
regurg/vomitting after feeds-not projectile
FTT/wt. loss
halitosis
happier sitting upright
recurrent aspiration pneumonia
bronchospasm/nocturnal wheeze/cough
dysphagia/odynophagia
irritability/inconsolable crying
Oesophagitis
Ix for GORD (4)
mainly clinical Dx
can do 24hr oesophageal monitoring/impedance studies in neonates
Ba swallow if for any underlying abnormalities
endoscopy if oesophagitis suspected.
Mx of GORD (6)
avoid overfeeding
thicken feeds
drugs:
- gaviscon: risk of constipation
- ranitidine: comes as syrup so better than omeprazole
- domperidone: good if vomitting
fundoplication in very severe cases
RFs for pyloric stenosis (4)
5 times more common in boys
Turner’s
first born
FHx
Presentation of pyloric stenosis (7)
2-12 wks
projectile, non-billous vomitting straight after feeds
child keen to feed
FTT/wt. loss/dehydration
constipation
peristaltic waves may be visible
hypochloraemia, hypokalaemic metabolic alkalosis
Dx of pyloric stenosis (4)
palpable pyloric mass
USS shows enlarge pylorus
milk test>visible peristalsis
hypochloraemia, hypokalaemia metabolic alkalosis
Mx of pyloric stenosis (2)
correct fluid and electrolyte imbalances
Ramstedt’s pyloromyotomy
Presentation of intussusception (7)
Triad:
- colicky abdominal pain-afebrile
- vomitting-may be bile stained
- abdominal mass (RUQ)
other features:
- redcurrant jelly stool
- drawing knees up during paroxysm
- extreme pain passing stool
- dance sign-emptiness in lower quadrant
RFs for intussusception (4)
CF
Meckel’s
polyps
lymphoma
Ix for intussusception (2)
Dx mainly clinical+USS
XR shows dilated small bowel w. absence of gas in large bowel
Mx of intussusception (3)
IV fluids
Insufflation:
- only if no peritonitis
- air pumped into anus
- can try w. fluids if air fails
if peritonitic/insufflation unsuccessful: surgical reduction
Causes of haematemesis (5)
neonate swallowing maternal blood
oesophagitis
gastritis
Mallory-Weiss tear
swallowing nosebleed
Causes of vomitting in older children (6)
acute appendicitis
abdominal migraine
rarely:
- raised ICP
- malrotation of intestine
- eating disorders
- inborn errors of metabolism
