Vomiting and children Flashcards
How do you define apnea in an infant?
greater than 20 seconds
What are the 5 warning signs of vomiting that require medical investigation?
- HSM
- Diarrhea
- Constipation
- Emesis after 6 mo
- Difficulty eating
What is GER?
Passage of gastric contents into the esophagus
What is regurgitation?
Spitting up is an effortless passage of gastric contents into the pharynx and mouth
What is rumination?
Voluntary, habitual, and effortless regurgitation of recently ingested food
How common is GER in infants?
very–about 50% in infants
By what age do most infants stop spitting up?
12 mo
Pea soup emesis = ?
Bilious emesis–worrisome for pyloric stenosis
What are the ssx of pyloric stenosis?
Projective vomiting
Emesis beginning after what age is concerning?
6 mo
Bulging fontanelle is concerning or not?
Is
What happens developmentally around 12 months that is relevant to children GI symptoms?
More vertical time
Where is the emetic center?
reticular formation the medulla
Where is the chemoreceptor trigger zone?
Floor of the 4th ventricle
What are the ssx of gastroenteritis?
Fever Abdo pain diarrhea n/v h/o ill contacts
What are the viral causes of gastroenteritis?
Rotavirus Adenovirus Norwalk AStrovirus Caliciviridae
What is the treatment for viral gastroenteritis?
Hydration
Fever control
What is the 5HT receptor antagonist that is used for nausea?
Ondansetron
What are the ssx of meningitis?
Fever Irritability Lethargy HA emesis Petechia
What is the viral cause of meningitis? When is this most common?
Enterovirus
Summer
What is the usual cause of meningitis
GBS
What is the usual cause of meningitis 1-23 mo?
S. Pneumo
What is the usual cause of meningitis 2-18 yrs?
N. Mening
What is the usual cause of meningitis 19-59 yrs
S. pneumonia
What is the usual cause of meningitis >60 yo?
S. Pneumonia
Why does meningitis cause vomiting?
meningeal inflammation and ICP
What is gastroesophageal reflux cause disease?
Passage of gastric contents into the esophagus
What are the ssx of GERD in infants?
Persistent cough
Stridor
Wheezing
Apnea`
What is the cause of stridor in emesis in children?
Protection of vocal cords
What is sandifer syndrome?
Reflux in the esophagus causing szs like symptoms d/t pain (not actual szs)
What should always be looked at when investigating GERD?
Growth charts
When should work up be initiated for GERD?
If significant complications or ALTE
What is the initial diagnostic study with GERD?
Ba swallow (upper GI series)
What is the purpose of doing a Ba swallow?
Anatomic abnormalities
Bird’s beak = ?
Achalasia
What is an esophageal pH probe?
Measures the frequency of acidic esophageal reflux episode over a period of time
What is the test for muscle/nerves problems in the GI tract?
Manometry
What is a scintigraphy?
Nuclear med scan and watch it digest
What is combined multiple intraluminal impedance and pH monitoring?
Measure fluids, air an solids in the esophagus along with pH changes
What is the treatment for GERD in infants?
- Increased caloric density
- Thicken feedings with rice cereal
- Use formula with rice starch
What is the MOA of similac?
Thickening when hitting stomach acid
What is the treatment for GERD in adolescence?
Avoid fatty/spicy/caffeine
Maintain healthy weight
What are the meds that are useful for GERD?
Antacids
Is a PPI indicated for GERD in children?
If neurologically intact, yes for 4 weeks
What is the suffix that denotes a PPI?
-prazole
How are PPIs administered?
Qd PO before meals
What is the MOA of cimetidine, famotidine, ranitidine, and nizatidine?
H2 receptor blockers
What is the MOA of metoclopramide?
opioid agonist
What is a nissen fundoplication?
Cardia of the stomach is wrapped around the esophagus, to increase the tone of the esophageal sphincter
What are the complications of untreated GERD in kiddos?
Asthma (?)
Dental caries
Aspiration pneumonia