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🍉paeds > vomiting > Flashcards

vomiting Flashcards

1
Q

what symptoms do you see in the pre-ejection phase

A

Pallor
Nausea
Tachycardia

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2
Q

triggers of vomitting?

A 
visual /olfactory stimuli
fear
Head- injury/ raised ICP
Inner ear stimuli
Metabolic dereangement/ chemo
enteric pathogens
infection
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3
Q

5 types of vomitting?

A 
vomitting with retching
projectile vomitting
bilious vomiting
effortless vomiting
haemetemsis
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4
Q

causes of vomiting in infants

A

GOR
cows milk allergy
infection
intestinal obstruction

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5
Q

causes of vomitting in children?

A 
gastroenteritis
infection
appendicitis
intestinal obstruction
raised ICP
coeliac disease
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6
Q

young adult causes of vomiting

A 
gastroenteritis
infection
H.pylori infection
appendecitis
raised ICP
DKA
cyclical vomiting syndrome
bulimia
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7
Q

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

A

Gastroesophageal reflux
Overfeeding
Pyloric stenosis
Cow’s milk protein allergy

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8
Q

what is the electrolyte disturbance in a patient with pyloric stenosis?

A

Metabolic alkalosis (↑pH)

Hypochloraemia (↓Cl)

Hypokalaemia (↓K)

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9
Q

management of a patient with pyloric stenosis?

A

Fluid resuscitation
Refer to surgeons-

Ramstedt’s pyloromyotomy

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10
Q

what is the typical presentation of pyloric stenosis?

A

Babies 4-12 weeks
Boys > Girls

Projectile non-bilious vomiting!!!!

Weight loss

Dehydration +/- shock

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11
Q

what is effortless vomiting usually due to?

A

GORD

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12
Q

disease pathway for effortless vomiting

A

Self limiting and resolves spontaneously in the vast majority of cases

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13
Q

when is effortless vomiting not have good prognosis?

A

Cerebral palsy
Progressive neurological problems
Oesophageal atresia +/- TOF operated
Generalised GI motility problem

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14
Q

what is Sandifer’s syndrome?

A

the association of gastro-oesophageal reflux disease with spastic torticollis and dystonic body movements

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15
Q

how to assess a child presenting with GORD?

A

history and exam usually enough

oesophageal pH study

upper GI endoscopy

radiological investigations- video fluoroscopy, barium swallow

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16
Q

is growth faltering common in GORD?

A

no- if it is presenting do further studies

17
Q

treatment of GORD?

A

Feeding advice
Nutritional support
Medical treatment
Surgery

18
Q

what feeding advice can be given?

A

-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

19
Q

how can you provide nutritional support in a child with GORD?

A

Calorie supplements
Exclusion diet (cow’s milk protein free trial for 4 weeks)
Nasogastric tube
Gastrostomy

20
Q

what medical treatment can be given in GORD?

A

-Feed thickener:
Gaviscon
Thick & Easy

Prokinetic drugs

Acid suppressing drugs:

  • H2 receptor blockers!!!!
  • Proton pump inhibitors!!!
21
Q

indications for surgery in GORD?

A

Failure of medical treatment

Persistent:
Failure to thrive
Aspiration
Oesophagitis

Vomiting without complications may not be an indication

22
Q

surgery that can be done in gORD?

A

Nissen Fundoplication

23
Q

what is very important to ask about vomit?

A

ask what colour the vomit is;better so if can actually look at the vomitus

24
Q

what is green vomnmit mean?

A

BILE

25
Q

bilious vomtting good or bad

A

ALWAYS ring alarm bells

26
Q

what assume with bilious vomiting?

A

Due to intestinal obstruction until proved otherwise

27
Q

causes of bilious vomitting?

A

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)

28
Q

investigation to do with bilious vomiting:

A

Abdominal x-ray

Consider contrast meal

Surgical opinion re exploratory laparotomy

29
Q

definition of chronic diarrhoea?

A

4 or more stools per day For more than 4 weeks

30
Q

what is acute diarrhoea?

A

<1 week

31
Q

persistant diarrhoea?

A

2 to 4 weeks

32
Q

what is chronic diarrhoea?

A

> 4 weeks

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