Vomiting Flashcards

1
Q

Infnat vomiting can be split into 4 types?

A
  • With retching
  • Projectile
  • Bilious
  • Effortless
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2
Q

What do you expect to see in vomiting with retching?

A

A prodrome of pallor, nauseas and tachycardua

Retching and vomiting

Often a follow on of weakness, shivering and lethargy

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3
Q

What can cause vomiting with retching in a child?

A

Anything really:

  • Enteric pathogen
  • Other inf e.g. uti
  • Intestinal inflammation
  • Metabolic
  • Head injury
  • Visual or middle ear stimuli
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4
Q

What could cause a child to projectile vomit?

A

GORD
Overfeeding
Pyloric Stenosis

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5
Q

Who gets pyloric stenosis?

A

Expect to see it 4-12wks and more often in boys

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6
Q

6wk old boy comes in with projectile vomiting, weight loss and dehydration? How do you test for pyloric stenosis?

A

Test feed in hospital and look for:

  • Palpable “olive” tumour
  • Visible gastric peristalsis
  • Non-bilious vomit

From there you can do an ABG & US

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7
Q

What would you expect to see on a pyloric stenosis ABG? and can you explain it?

A
Metabolic Alkalosis (vomiting HCl)
Hypokalaemia (Secondary Hyperaldosteronism due to dehydration)
Hypochloraemia (Vomiting HCl)
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8
Q

How do you treat Pyloric Stenosis?

A

Dehydrated from all the vomiting so Fluid Resus

Followed by Ramstedt’s Pyloromyotomy

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9
Q

Bilious vomiting is an intestinal obstruction until proven otherwise, due to?

A
  • Intestinal Atresia (newborn)
  • Malrotation +/- volvulus
  • Intussusception
  • Crohn’s + strictures
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10
Q

How would you approach a child with bilous vomiting?

A

Abdo X-ray
Contrast meal
~Exploratory Laparotomy

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11
Q

What causes effortless vomiting?

A

Mostly GORD

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12
Q

How would GORD look in a child?

A

Effortless vomiting +/- haematemesis

Feeding Aversionm & FTT

~Resp symptoms e.g. apnoea, cough, wheeze or inf
~Sandifer’s syndrome

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13
Q

Sandifer’s syndrome?

A

Spastic Torticollis & dystonia due to GORD, resolved by treating GORD

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14
Q

How do we test kids for GORD?

A

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)
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15
Q

There are 4 stages to treating childhood GORD, what feeding advice would you give?

A
  • Thickener’s
  • Appropriate texture/amount of food
  • Feeding position
  • Oral stimulation & removal of aversive stimuli
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16
Q

What nutritional support can you offer in GORD?

A

Calorie supplements
Exclusion diet (mostly Milk)
Ng tube
Gastrostomy

17
Q

What medical interventions can help with GORD?

A

Thickener’s e.g. Gaviscon
Prokinetic Drugs
Acid Suppressants (H2 receptor blockers & PPIs)

18
Q

What surgical interventions are there for GORD?

A

Nissen Fundoplication

beware of bloating, dumping and retching. Esp in cerebral palsy

19
Q

How could you image for intussusception?

A

US for target sign

20
Q

How can you treat intussusception?

A

Air enema

Surgical