vomiting Flashcards
what symptoms do you see in the pre-ejection phase
Pallor
Nausea
Tachycardia
triggers of vomitting?
visual /olfactory stimuli fear Head- injury/ raised ICP Inner ear stimuli Metabolic dereangement/ chemo enteric pathogens infection
5 types of vomitting?
vomitting with retching projectile vomitting bilious vomiting effortless vomiting haemetemsis
causes of vomiting in infants
GOR
cows milk allergy
infection
intestinal obstruction
causes of vomitting in children?
gastroenteritis infection appendicitis intestinal obstruction raised ICP coeliac disease
young adult causes of vomiting
gastroenteritis infection H.pylori infection appendecitis raised ICP DKA cyclical vomiting syndrome bulimia
what are the ddx for…..
6 week old baby boy
3 week history of vomiting after every feed
Bottle fed 6 ounces 3 hourly
Vomitus- large volume, milky or curdy, mostly projectile
Irritable and crying
Not gaining weight adequately
o/e looks slightly dehydrated
Gastroesophageal reflux
Overfeeding
Pyloric stenosis
Cow’s milk protein allergy
what is the electrolyte disturbance in a patient with pyloric stenosis?
Metabolic alkalosis (↑pH)
Hypochloraemia (↓Cl)
Hypokalaemia (↓K)
management of a patient with pyloric stenosis?
Fluid resuscitation
Refer to surgeons-
Ramstedt’s pyloromyotomy
what is the typical presentation of pyloric stenosis?
Babies 4-12 weeks
Boys > Girls
Projectile non-bilious vomiting!!!!
Weight loss
Dehydration +/- shock
what is effortless vomiting usually due to?
GORD
disease pathway for effortless vomiting
Self limiting and resolves spontaneously in the vast majority of cases
when is effortless vomiting not have good prognosis?
Cerebral palsy
Progressive neurological problems
Oesophageal atresia +/- TOF operated
Generalised GI motility problem
what is Sandifer’s syndrome?
the association of gastro-oesophageal reflux disease with spastic torticollis and dystonic body movements
how to assess a child presenting with GORD?
history and exam usually enough
oesophageal pH study
upper GI endoscopy
radiological investigations- video fluoroscopy, barium swallow
is growth faltering common in GORD?
no- if it is presenting do further studies
treatment of GORD?
Feeding advice
Nutritional support
Medical treatment
Surgery
what feeding advice can be given?
-Thickeners for liquids
-Appropriateness of foods:
Texture
Amount
-Behavioural programme:
Oral stimulation
Removal of aversive stimuli
Feeding position
-Check feed volumes:
Neonates- 150mls/kg.day
Infants – 100mls/kg/day
how can you provide nutritional support in a child with GORD?
Calorie supplements
Exclusion diet (cow’s milk protein free trial for 4 weeks)
Nasogastric tube
Gastrostomy
what medical treatment can be given in GORD?
-Feed thickener:
Gaviscon
Thick & Easy
Prokinetic drugs
Acid suppressing drugs:
- H2 receptor blockers!!!!
- Proton pump inhibitors!!!
indications for surgery in GORD?
Failure of medical treatment
Persistent:
Failure to thrive
Aspiration
Oesophagitis
Vomiting without complications may not be an indication
surgery that can be done in gORD?
Nissen Fundoplication
what is very important to ask about vomit?
ask what colour the vomit is;better so if can actually look at the vomitus
what is green vomnmit mean?
BILE
bilious vomtting good or bad
ALWAYS ring alarm bells
what assume with bilious vomiting?
Due to intestinal obstruction until proved otherwise
causes of bilious vomitting?
Intestinal atresia (in newborn babies only)
Malrotation +/- volvulus
Intussusception
Ileus
Crohn’s disease with strictures
————————-
Intestinal atresia (in newborn babies only!)
Malrotation (a few weeks old)
Intussusception (Usually older infants (11-12 months + toddlers)
Ileus (?sepsis)- any age
Crohn’s disease (unusual in infants)
investigation to do with bilious vomiting:
Abdominal x-ray
Consider contrast meal
Surgical opinion re exploratory laparotomy
definition of chronic diarrhoea?
4 or more stools per day For more than 4 weeks
what is acute diarrhoea?
<1 week
persistant diarrhoea?
2 to 4 weeks
what is chronic diarrhoea?
> 4 weeks
