Vomiting

Question 1

Regurgitation

Answer 1

effortless passive reflux of intragastric contents into oesophagus
no prodromal events
no retching or muscle contraction
no forceful expulsion of gastric contents

Question 2

Double bubble

Answer 2

Duodenal atresia

Question 3

Bile stained

Answer 3

Obstruction distal to 2nd part of duodenum

Question 4

Undigested food

Answer 4

Gastric outlet obstruction, achalasia, oesophageal strictures - single bubble on X-ray

Question 5

Blood

Answer 5

oesophagitis, oesophageal varices, gastritis, peptic ulcer, secondary swallowing nasopharyngeal blood

Question 6

Morning vomiting

Answer 6

increased ICP - brain tumour

Question 7

Danger signs in vomiting child

Answer 7

bile-stained/feculent vomiting 
blood in the vomit 
projectile vomiting 
dehydration 
acid base and electrolyte abnormalities 
weight loss 
signs of intestinal obstruction 
fever, other signs systemic infections 
CNS symptoms - drowsiness, headache, signs raised ICP

Question 8

HPS

Answer 8

Nonbilious vomiting in first weeks life
hungry feeds eagerly
projectile vomiting
rhythmic and retrograde peristalsis visible abdomen
olive shaped mass
ultrasound - sensitive and specific
hypochloraemic hyokalaemic metabolic alkalosis

Question 9

7 year old - clusters severe vomiting
once a month - more frequently
associated severe dehydration
father migraine

Answer 9

EEG: temporal lobe epilepsy