Vomiting & Acute Abdomen Flashcards
ddx for vomiting in a newborn
meconium ileus (CF) necrotising enterocolitis intestinal atresia / webs inborn errors of metabolism malrotation /w midgut volvulus
ddx for vomiting in 0-3mo old
- malrotation + volvulus
- inborn error of metabolism
- milk / soy protein allergy
- GER
- pyloric stenosis
- child abuse
- (DKA)
ddx for vomiting in 3-12 mo
- intussusception
- intracranial mass / lesion
- child abuse
- gastroenteritis
- (DKA)
Gastroesophageal Reflux Description & age
- “happy spitter”
- feeding refusal
- fussy/irritable
- cough, stridor, wheeze
- rare apnea
- peals 3-4mo, resolves by12-18mo
No FTT, weight gain normal
GERD = above /w poor weight gain, and no improvement /w diet modification
initial management for GER
- education / reassurance
- avoid over-feeding
- positioning may not help
- no meds
complicated GER (aka GERD)
- consider CMPA - 2-4 wk trial of hypoallergenic formula or elimination from mom’s diet
- thickening feeds
- may try H2 blocker (eg ranitidine), but can cause tachyphylaxis
- prokinetics (metoclopramide, erythromicin) may help if delayed gastric empyting, but have significant side effects
work-up for GER
- if uncomplicated, no testing
- if persist after 18 mo: GI for EGD + biopsy
- if poor weight gain consider upper GI series / GI referral
- other tests: esophageal pH monitor, scintigraphy (gastric empyting)
pyloric stenosis age & description
- 3-6 weeks age, rare after 12wks
- projectile, non-bilious vomiting 5-60min after eating
- hungry after feeds
- dehydrated
- palpable “olive” at RUQ
diagnosing / tests for pyloric stenosis
- ultrasound
- lytes (low Cl, K)
- VBG - alkalosis
management of pyloric stenosis
- NPO
- NG tube for suction
- rehydrate /w IV fluids
- correct lytes
- surgery - pyloromyotomy
Malrotation Presentation
- 50% have volvulus <1mo
- bilious vomiting (esp infants)
- abdo pain
- distension
- mucous + blood in stool
older kids - can be chronic abdo pain /w recurrent vomiting
investigations for malrotation
upper GI series (preferred)
- misplaced lig of treitz (on right), corkscrew appearance
plain AXR:
- gastric outlet obstruction: gasless abdomen /w large gastric bubble
- duodenal obstruction: double-bubble sign, ++ air fluid levels, dilated bowl loops (late)
contrast enema - determines cecum position in RLQ
abdo US - SMV+SMA relationship reversed
treatment for malrotation /w volvulus
3mo - 6 year olds
NPO, NG for suction, fluids
broad spectrum Abx
urgent surgical referral (ischemia!)
ladd procedure - complications = short bowel
intussusception presentation
sudden intermittente, severe, crampy progressive pain
episodes q15-20min, become more freq
inconsolible, drawing legs to abdo
+/- red current jelly stool, mucous (late sign),
+/- vomiting (non-bilious -> bilious)
+/- palpable sausage shaped mass in RUQ
rare: lethargy + low LOC
ddx for intussusception
constipation gastroenteritis appendicitis volvulus meckels diverticulum UTI
