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MBChB IV Paediatrics > Vomiting > Flashcards

Vomiting Flashcards

1
Q

Vomiting

General

A

Common complaint

Sign of many diseases affecting different organ systems -> determining cause can be difficult

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2
Q

Vomiting

Complications

A

Metabolic derangement
Electrolyte derangement
Mallory Weiss syndrome

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3
Q

Vomiting

Definition

A

Complex reflex behavioural response to a variety of stimuli

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4
Q

Vomiting

Phases

A

3 phases

  1. Prodromal (nausea, autonomic sx)
  2. Retching
  3. Forceful expulsion of stomach contents via mouth
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5
Q

Regurgitation

Definition

A

Effortless, passive reflux of the intragastric contents into the oesophagus

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6
Q

Regurgitation (vs vomiting)

A

No prodromal events
No retching/muscle contraction
No forceful expulsion of gastric contents
DIFFERENT CAUSES + PHYSIOLOGICAL MECHANISMS

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7
Q

Vomiting

Pathophysiology

A

Highly coordinated reflex process
Preceded increased salivation, involuntary retching
Violent descent diaphragm, constriction abdominal muscles with relaxation gastric cardia actively force gastric contents back up the esophagus
Process coordinated by the medullary vomiting center, influenced directly by afferent innervation and indirectly by chemoreceptor trigger zone and higher central nervous system centers

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8
Q

Vomiting history

A 
Symptom durations
Vomitus frequency and quantity. character, contents
Assoc symptoms
Relationship to other events
Additional info
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9
Q

Duration of symptoms

A

Acute (infective)

Recurrent (chronic eg mucosal injury or cyclical eg abdominal migraine)

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10
Q

Age of onset

A

1st week of life
Early infancy
Late infancy
Childhood

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11
Q

First week of life

Common vomiting causes

A 
Gastric irritation (ingestion blood/mucus)
Feeding faults (over/underfeeding)
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12
Q

First week of life

Less common vomiting causes

A

Infections (sepsis, meningitis, NEC, UTI, oral thrush)
Raised ICP (ICH, hydrocephalus)
Intestinal malformation + obstruction (hiatus hernia, intestinal atresia, malrotation, meconium ileus, volvulus)
Toxic and metabolic disorders

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13
Q

Early infancy

Common vomiting causes

A

GORD
Feeding faults
Infection (URTI, oral thrush, gastroenteritis)

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14
Q

Early infancy

Less common vomiting causes

A

Infection (UTI, encephalitis, meningitis, pertussis)
Intestinal malformation + obstruction (HPS, malrotation, volvulus)
Intracranial pathology (hydrocephalus)
Toxic and metabolic disorders (IEM, uremia, drugs)

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15
Q

Late infancy

Common vomiting causes

A

Infections (gastroenteritis, UTI, respiratory tract infection)

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16
Q

Late infancy

Less common vomiting causes

A

Infections (meningitis, hepatitis)
Intestinal malformation + obstruction (intussusception, malrotation)
Food intolerance (celiac, CMPA)
Toxic and metabolic disorders (poisoning, drugs, uremia)

17
Q

Childhood

Common vomiting causes

A

Acute (gastroenteritis, respiratory tract infection, food poisoning)
Acute dietary indiscretion

18
Q

Childhood

Less common vomiting causes

A

Infections (UTI, meningitis, encephalitis, hepatitis)
Digestive tract d/o (peptic ulcers, appendicitis)
Toxic and metabolic disorders (drugs, poison, DM)
Raised ICP (HT, tumour, hydrocephalus)
Psychogenic/other (migraine, buimia, cyclic vomiting syndrome)

19
Q

Vomiting

Frequency and quantity

A

Indicates severity
Frequent small vs 3 large vomits per day
Compare volume to size of feed

20
Q

Vomiting

Character

A

Vomiting
Regurgitation
Projectile vomiting

21
Q

Vomiting

Assoc symptoms

A 
Autonomic (sweating, pallor, nausea, salivating)
Diarrhea 
Constipation
Fever
Headache
Abdominal pain
22
Q

Vomiting

Contents of vomitus

A

Undigested food -> GOO
Bile -> intestinal obstruction
Blood fresh vs coffee ground -> oesophagiti, oesophageal varices, gastritis, peptic ulcer, secondary swallowing of nasopharyngeal blood

23
Q

Vomiting

Relationship to other events

A

Time of day

Mealtimes

24
Q

Vomiting

Additional information

A 
Other medication
Thriving child vs FTT
Dehydration
Jaundice
Thrush, tonsillitis, OM
Distended abdomen
Peristaltic waves
Hernial sites
Palpation abdominal mass
Acute abdomen
Meningeal irritation
Signs raised ICP (hypertension, bradycardia)
Persistent paroxysmal coughing (pertussis)
Congestive cardiac failure
25
Q

Vomiting

Special investigations

A

For uncommon presentations eg projectile vomiting, hyponatremic hypochloremic alkalosis

Electrolytes
UMCS
AXR
U/S
Contrast studies
Endoscopy
CT of brain
26
Q

Vomiting

General management

A 
Hydration status (water + electrolyte balance)
Malnutrition/FTT (nutritional replenishment)
Pharmacological agents (caution, limit in chemo/radiotherapy pt -> extrapydramidal S/E OR masking disease signs)
27
Q

Auscultation of bowel sounds
Increased indicate?
Decreased indicate?

A

Increased -> gastroenteritis, obstruction

Decreased -> ileus

MBChB IV Paediatrics (81 decks)

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