Vomiting Flashcards
What can cause non bilious vomitig in babies?
GORD
Pyloric stenosis
What is the presentation of GORD?
Very common
Effortless non bilious vomiting
When is GORD investigated?
If suspect of underlying cause
What is the first management of GORD?
Feeding advice- thickeners for liquids, feeding position
Nutritional support
What is the medical management of GORD?
Gaviscon
Prokinetic drugs
Acid suppressing- H2 receptor blockers, PPIs
What are the indications for surgery in GORD?
Failure of medical management
Failure to thrive
Aspiration
Oesophagitis
What is the surgery for GORD?
Nissen fundoplication
Who is pyloric stenosis seen in?
M>F
4-12 weeks
What os the presentation of pyloric stenosis?
Projectile non bilious vomiting
Weight loss
Visible gastric peristalsis
Dehydration and characteristic electrolyte imbalance
What is the electrolyte imbalance seen in pyloric stenosis?
Metabolic alkalosis
Hypochloraemia
Hypokalaemia
What investigations are done for pyloric stenosis?
US
Test feed
What is the management of pyloric stenosis?
Periumbilical pyloromyotomy
What can cause bilious vomiting in babies?
Malrotation Intususseption Duodenal atresia Jejunal atresia Meconium ileus
What is malrotation?
Congenital anomaly of hindgut
Who is malrotation seen in?
Babies
What is the presentation of malrotation?
Bilious vomiting
What is the investigation of malrotation?
Upper GI contrast study
US
What is the management of malrotation?
Laparotomy
What is a complication of malrotation?
Volvulus
What is intususseption?
Section of intestine invaginated into joining intestinal lumen
Where is intususseption often seen?
Proximal to or at level of ileocaecal valve
Who is intususseption seen in?
6-18 months
What is the presentation of intususseption?
Intermittent colic
Red currant jelly stool
Bilious vomiting
What investigation os done for intususseption?
US- target sign
What is the management of intususseption?
Pneumostatic air reduction- air enema
Laparotomy if unsuccessful
What are the risk factors for necrotising enterocolitis?
Prematurity
Intercurrent illness
What is the presentation of necrotising enterocolitis?
Usually second week of life
Abdo distension
Bilious vomiting
Bloody stools
What is the investigation necrotising enterocolitis?
AXR- dilated bowel loops, pneumatosis, portal venous gas
What is the management of necrotising enterocolitis?
Non perforated- conservative dn supportive
Perforated- laparotomy and resection
What is a risk factor for duodenal atresia?
Down’s
What is the presentation of duodenal atresia?
Few hours after birth
Bilious vomiting
What is the investigation of duodenal atresia?
AXR- double bubble sign
What is the management of duodenal atresia?
Duodenoduodenostomy
What causes jejunal atresia?
Usually vascular insufficiency in utero
What is the presentation of jujenal atresia?
First 24 hours
Bilious vomiting
What is the investigation of jujenal atresia?
AXR- air fluid levels
What is the management of jejunal atresia?
Laparotomy with primary resection and anastomosis
What is meconium ileus?
Meconium becomes thick and congested in intestines and fails to pass
What is meconium ileus a red flag for?
CF
What is the presentation of meconium ileus?
Within first 48 hours
Bilious vomiting
Abdo distension
What investigations are done for meconium ileus?
AXR- fluid levels
Investigate for CF
What is the management of meconium ileus?
Surgical decompression
