Vomiting Flashcards
Vomiting
General
Common complaint
Sign of many diseases affecting different organ systems -> determining cause can be difficult
Vomiting
Complications
Metabolic derangement
Electrolyte derangement
Mallory Weiss syndrome
Vomiting
Definition
Complex reflex behavioural response to a variety of stimuli
Vomiting
Phases
3 phases
- Prodromal (nausea, autonomic sx)
- Retching
- Forceful expulsion of stomach contents via mouth
Regurgitation
Definition
Effortless, passive reflux of the intragastric contents into the oesophagus
Regurgitation (vs vomiting)
No prodromal events
No retching/muscle contraction
No forceful expulsion of gastric contents
DIFFERENT CAUSES + PHYSIOLOGICAL MECHANISMS
Vomiting
Pathophysiology
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
Vomiting history
Symptom durations Vomitus frequency and quantity. character, contents Assoc symptoms Relationship to other events Additional info
Duration of symptoms
Acute (infective)
Recurrent (chronic eg mucosal injury or cyclical eg abdominal migraine)
Age of onset
1st week of life
Early infancy
Late infancy
Childhood
First week of life
Common vomiting causes
Gastric irritation (ingestion blood/mucus) Feeding faults (over/underfeeding)
First week of life
Less common vomiting causes
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
Early infancy
Common vomiting causes
GORD
Feeding faults
Infection (URTI, oral thrush, gastroenteritis)
Early infancy
Less common vomiting causes
Infection (UTI, encephalitis, meningitis, pertussis)
Intestinal malformation + obstruction (HPS, malrotation, volvulus)
Intracranial pathology (hydrocephalus)
Toxic and metabolic disorders (IEM, uremia, drugs)
Late infancy
Common vomiting causes
Infections (gastroenteritis, UTI, respiratory tract infection)
Late infancy
Less common vomiting causes
Infections (meningitis, hepatitis)
Intestinal malformation + obstruction (intussusception, malrotation)
Food intolerance (celiac, CMPA)
Toxic and metabolic disorders (poisoning, drugs, uremia)
Childhood
Common vomiting causes
Acute (gastroenteritis, respiratory tract infection, food poisoning)
Acute dietary indiscretion
Childhood
Less common vomiting causes
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)
Vomiting
Frequency and quantity
Indicates severity
Frequent small vs 3 large vomits per day
Compare volume to size of feed
Vomiting
Character
Vomiting
Regurgitation
Projectile vomiting
Vomiting
Assoc symptoms
Autonomic (sweating, pallor, nausea, salivating) Diarrhea Constipation Fever Headache Abdominal pain
Vomiting
Contents of vomitus
Undigested food -> GOO
Bile -> intestinal obstruction
Blood fresh vs coffee ground -> oesophagiti, oesophageal varices, gastritis, peptic ulcer, secondary swallowing of nasopharyngeal blood
Vomiting
Relationship to other events
Time of day
Mealtimes
Vomiting
Additional information
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
Vomiting
Special investigations
For uncommon presentations eg projectile vomiting, hyponatremic hypochloremic alkalosis
Electrolytes UMCS AXR U/S Contrast studies Endoscopy CT of brain
Vomiting
General management
Hydration status (water + electrolyte balance) Malnutrition/FTT (nutritional replenishment) Pharmacological agents (caution, limit in chemo/radiotherapy pt -> extrapydramidal S/E OR masking disease signs)
Auscultation of bowel sounds
Increased indicate?
Decreased indicate?
Increased -> gastroenteritis, obstruction
Decreased -> ileus
