Vomiting Flashcards
what are the differentials of non-billious vomiting in children?
infection gastroeosophageal reflux overfeeding pyloric stenosis metabolic derangement head injury middle ear stimuli visual stimuli cerebellar tumour / medulloblastoma
what are the differentials of billious vomiting in children?
biliary atresia interusccession intestinal atresia ileus crohns with strictures malrotation +/- volvolus
what is the presentation of pyloric stenosis?
vomiting after every feed milk or curdy, non billious irritable not gaining weight dehydration +/- shock
how would you investigate suspected pyloric stenosis?
test feed
- palpation of olive tumour
- visible gastric peristalsis
- projection of non-billions vomiting
blood gas
- alkalosis
- hypocalcaemia, hypokalaemia
ultrasound
how would you manage pyloric stenosis?
fluid resuscitation
refer to surgery
- ramstedts pyloromyotomy
what is the most common cause of effortless vomiting in children?
gastro-oesophageal reflux
how would you manage gastro-oesophageal reflux in children?
majority resolve on their own spontaneously
feeding advice nutritional support medical; - PPI - H2 receptor antagonist - feed thickener (gaviscon, thick and easy) - prokinetics
surgery - fundoplication
a child presents with billious vomiting. how would you investigate?
contrast meal
abdominal x-ray
exploratory laparotomy
what electrolyte disturbance would you worry with if a child has been vomiting?
hypocalcaemia
hypokalaemia
metabolic alkalosis
what is the presentation of gastro-oesophageal reflux in children?
vomiting haematemesis feeding problems failure to thrive apnoea cough wheeze chest infections sandifer's syndrome
wha sort of feeding advice would you give a parent if the child has been diagnosed with gastro-oesophageal reflux?
thickeners for liquid - start on solids, feed thickeners
appropriateness of texture and volume
behavioural programme - oral stimulation, remove averse stimuli
feeding position
what nutritional support would you give a child with gastro-oesophageal reflux?
calorie support
NG tube
exclusion of milk
gastrostomy
what are the complications of fundoplication?
bloating
retching
dumping syndrome
what is the normal feed volume for an infant per day?
150ml/kg per day
