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Paediatrics > Vomiting > Flashcards

Vomiting Flashcards

1
Q

What are the types of vomiting

A

Retching
Projectile
Bilious
Effortless

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2
Q

What are the symptoms of retching

A

Pallor, nausea, tachy pre ejection
Retch and vomiting
Weakness / shivery / lethargy after

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3
Q

What does billious vomiting suggest

A

Obstruction until proven otherwise

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4
Q

What causes obstruction

A 
Intestinal atresia
Duodenal atresia 
Imperforate anus 
Malrotation + volvulus
Intussception
Chron's stricture
Ileus 2 to sepsis
Hirschprung's 
Meconium ileus
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5
Q

What stimulates vomit

A 
Infection
- Gastroenteritis = most common
- Consider sepsis / UTI / meningitis / pneumonia 
Intestinal inflammation 
Metabolic derangement 
- DKA 
- Hypoglycaemia 
Enteric pathogens releasing toxins 
Head injury 
Intracranial 
- Tumour or infection 
Visual stimuli 
Middle ear stimuli
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6
Q

What is in your differential for a young baby projectile vomiting after every feed and irritable

A 
Gastro reflux
Over feeding
CMPI 
Pyloric stenosis 
Bilious causes / surgical / obstruction 
Appendicits 
Unlikely infection as protected by mother Ab
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7
Q

What are other causes of vomitng

A

Cyclical vomitng
Infection - gastroenteritis
Sepsis

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8
Q

Vomit in newborn

A

Intestinal atresia

Wont survive if don’t treat

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9
Q

What do you tell parents with infants with reflux

A

Resolve as sphincter tone improves

Reassure if goof weight

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10
Q

Reflux that persists

A

Cerebral palsy
GI motility disorder
Oesophageal atresia

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11
Q

How do you Ix vomit esp billous

A 
Bloods 
AXR
Upper GI USS
Contrast meal
Surgical laparotomy
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12
Q

How do you Rx billous

A

IV fluid
NG
Surgery

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13
Q

What are you at risk of if persistent vomiting

A

Ketoacidosis
Electrolyte
Dehydration

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14
Q

What is important in the hX

A 
Is child well or sick
Growth
Development
Duration
After food
Projectile
Retching or effortless
Colour - billous?
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15
Q

What is the most common cause of vomiting in babies

A

Gastro reflux

Can be physiological due to sphincter not established yet

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16
Q

What are the symptoms of gastro reflux

A 
Effortless vomit 
Painful - discomfort / unsettled
Poor feed
Excessive swallow
Strange position
Haeamtemesis
Resp 
- Apnoea 
- Chronic cough
- Infection
- Wheeze
FTT
If >1 will experience same symptoms as adults
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17
Q

When is reflux more common

A

Pre-term

Neurological

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18
Q

How do you Dx reflux

A 
Clinical
Don't rush to change milk 
Videofluroscopy
Barium swallow
pH and manometry
Endoscopy
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19
Q

What when do you do video

A

Aspiration

Swallowing issue

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20
Q

When do you do barium swallow

A

If think
Dysmotility
Hernia
Strictue

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21
Q

When do you do barium swallow

A

Aspiration

Inadequate contrast

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22
Q

When do you do endoscopy

A

If >2 years

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23
Q

How do you treat reflux

A 
Feeding advise 
Milk thickener- Gavsiscon / Coropril 
Supplements 
Trial of PPI / H2  
NG tube / gastrostomy 
Surgery
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24
Q

When do you give PPI / H2 and what do they do

A

PPI = decrease acid
H2 = stop acid
If feeding difficult / faltering growth or distress or failed to improve with Gaviscon

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25
Q

When do you conisder fundolipication

A

Persistent FTT
Oesophagitis
Aspiration

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26
Q

Complications of reflux

A 
Distress
FTT
Aspiration
Otitis media
Dental erosion
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27
Q

What is Sandifer

A

Reflux
Dystonia
Torticollis
Refer as Dx could be West syndrome

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28
Q

Ddx reflux

A

CMPI

Think if poor response or atopy

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29
Q

Feeding advice in reflux?

A

150ml/kg/day
Position
Routine

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30
Q

What are complications of surgery

A

Bloating
Dumping
Retching

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31
Q

What is CMPI / lactose intolerance

A

Delayed non-Ige reaction to milk (intolerance)
Usually present first 3 months in formula fed (can occur in breast)
If IgE would be immediate (known as allergy)
Can get anaphylaxis / angiooedema but rare

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32
Q

How does CMPI present

A 
Reflux symptoms don't improve
- Regurgitation + vomit
- Wheeze
- Chronic cough 
Skin involvement
Gut involvement
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33
Q

Signs of skin involvement

A

Rash
Ectopic eczema
Urticaria
FH atopy

34
Q

Signs of gut involvement

A 
D+V - osmotic 
Blood / mucous
Frequent runny stools
Abdo pain
Distension
Poor feed
FTT
35
Q

Who is at risk of CMPI

A

Formula fed babies

FH atopy

36
Q

How do you Dx CMPI

A

Clinical
Eliminate diet
Skin prick can be done

37
Q

When do you investigate further

A

Bile

FTT despite change in milk

38
Q

What should you do before leave hospital

A

Milk challenge as anaphylaxis can rarely occur

39
Q

How do you treat

A

4 week milk avoidance
Continue breast but eliminate cow from diet
Calcium supplement

40
Q

What is 1st line and what do you do if doesn’t work

A

Highly hydrolysed cow milk protein - protein broken down

AA if severe colitis

41
Q

What should you do regularly

A

Rechallenge

Milk ladder approach - cooked milk in biscuit then yoghurt then milk

42
Q

What should you suspect if dehydrated

A

Obstruction as CMPI doesn’t cause

43
Q

DDX

A 
Reflux
Coeliac - not if baby
Cows milk allergy - no allergic / skin symptoms (will still grow if have milk will just feel sick)
Pyloric stenosis
NEC
Surgical
Infection - culture?
44
Q

What is NEC and what are RF

A 
Inflammatory bowel necrosis common in pre-term
Necrosis can lead to bowel perforation, peritonitis and death 
- Pre-term
- LBW
- Enteral feeding 
- Formula feed 
- Resp distress
- Sepsis
45
Q

How does NEC present

A 
Poor feed
Abdo distension
Bloody / mucous stool
Lethargy
Vomiting bile
Sepsis
Vital signs instability 
Absent bowel sounds
Rapid progression ot shock requiring mechanical ventilation
46
Q

How do you Dx NEC

A 
FBC, CRP
Blood gas
Stool and blood culture
X-match blood
AXR
47
Q

What does AXR show

A 
Asymmetrical dilated bowel
Bowel oedema
Pneumatosis intestinalis - gas in gut wall
Free air
Pneumoperitoneum
48
Q

What is Rx

A 
Stop feed + NBM 
NG
IV fluids 
TPN if long term
Ax as risk of perforation
Surgical laparotomy if perforate / to remove necrotic bowel
May need resection + stoma
49
Q

What Ax

A

Amoxicillin
Metronidazole
Gentamicin

50
Q

If pre-term what do you do prophylaxis

A

Careful introduction of food

Breast milk protective

51
Q

What are complications

A 
Shock
DIC
Perforation
Peritonitis
Stricutres
Abscess
Long term stoma 
Short bowel syndrome
52
Q

DDX

A

CMPI
Hirschprung
Volvulus

53
Q

What is pyloric stenosis

A

Pylorus muscle hypertrophies at 6 weeks

54
Q

How does it present

A 
Projectile non bile vomit
30 mins after feed
No bowel Sx
Palpable mass
Visible peristalsis 
Constipation
Dehydration
Weight loss
FTT
55
Q

RF

A

6 weeks
Male
FH

56
Q

How do you Dx

A

USS - olive shape mass
U+E = hypochlorameia / hypokalaemia alkalosis
Test feed

57
Q

How do you treat

A

IV fluid to correct electroylte
NBM and NG to remove acid
Pyloromytomy when biochemistry improves

58
Q

Why alkalosis

A

Lose HCL in vomit
Lose K to keep H
Increased bicarb

59
Q

Complications

A

Dehydration

60
Q

What is intussusception

A

Invagination of one portion of bowel into adjacent

Commonly ileo-caecal

61
Q

How does it present

A 
Hx viral illness
Intermittent colic or crying
Drying spell due to vagal - floppy / apnoea
Abdo distension
Loose frequent stool
Billious vomit 
Toxic / irritable
Blood / mucous PR
Mass RIF
Long cap refil
Not always bilious / blood
62
Q

Who is at risk

A

Toddler
6-18 months
Older tha DIC

63
Q

How do you Dx

A

USS = target mass 1st line
AXR rule out obstruction
CT / bowel enema

64
Q

How do you treat

A

Pneumostatic reduction urgent under radiological guidance = 1st line
Barium enema

65
Q

What do you do if fails

A

Laparotomy if fails or peritonitis

66
Q

What are complications

A

Dehydration
Obstruction
Necrosis of bowel

67
Q

DDX

A

Gastroenteritis

Sepsis

68
Q

What gives you clue to Dx

A

Lack of fever

Immense frequent stools

69
Q

Where does malroation occur and what does it present with

A

High caecum
Bile vomit
Volvulus = scaphoid

70
Q

RF

A

Newborn but any age
Diaphragmatic hernia
Duodenal atresia
Exomphalos

71
Q

How do you Dx

A

Upper GI contrast study and USS

72
Q

How do you Rx

A

Laparotomy

Ladds if volvulus

73
Q

Complications

A

Obstruction
Peritoneal signs
Instability

74
Q

What is another cause of vomiting

A

Cyclical
N+V lasting hours to days
Well in between
May be associated with weight loss, poor appetite, diarrhoea, abdominal pain, headache, dizzy, photophobia

75
Q

How do you Dx and Rx

A 
Clinical 
Blood tests to rule out 
Pregnancy in young women 
Avoid triggers
Fluid 
Medication
76
Q

How does duodenal present

A

Few hours after birth
Billious vomitnig
Down = increased risk
AXR = double bubble sign

77
Q

If child comes in vomiting

A

ABCDE
Don’t forget glucose
Vitals
Signs of dehydration

78
Q

What should you always consider and document even if suspect gastroenteritis

A 
Intracranial 
Surgical
Serious bacterial
- Dip urine for UTI  
DKA / hypo
79
Q

DDX child FTT, vomiting and poor appetite

A 
Coeliac disease 
Iron deficiency anaemia 
CMPI / lactose intolerance 
Cow's milk anaemia 
IBD but quite young 
Metabolic
80
Q

What should you do

A

FBC to look for anaemia

Coeliac screen + IgA

81
Q

What should you always think of in iron deficiency anaemia

A

Coeliac disease

82
Q

How do they present

A 
Tend to not have GI Sx
Low energy levels
Iron anaemia
Rash / joint pain / chronic cough 
Also neuro Sx adults

Paediatrics (35 decks)

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