Vomiting and malabsorption 1 (PS & GOR) Flashcards
What are the physiological phases of vomiting?
What symptoms/signs define each stage
Pre-ejection phase:
- Pallor
- Nausea
- Tachycardia
Ejection phase:
- Retch
- Vomit
Post-ejection phase:
- may feel better
- Shivering
- Lethargy
What are the potential triggers of vomiting?
GI triggers - enteric pathogens, allergies, obstructions
Infections
Head injuries / raised ICP
Inner ear stimuli (motion sickness, vertigo etc)
Visual / olfactory stimuli or fear
Metabolic derangements, chemotherapy
What are the different types of vomiting?
Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting (regurgitation)
Haemetemesis
How does retching work?
Deep inspiration against closed glottis
Abdominal contraction
Together^ pressure difference displaces gastric contents up
What are the main causes of vomiting in infants?
GOR
cows milk allergies
infection
intestinal obstruction
What are the main causes of vomiting in children?
gastroenteritis
appendicitis
infection
intestinal obstruction
raised ICP
coeliac disease
What are causes of vomitng in young adults?
Gastroenteritis
Infection
H.Pylori infection
Appendicitis
Raised ICP
DKA
Cyclical vomiting syndrome
Bulimia
What is pyloric stenosis?
When does it tend to present in a baby’s life?
What sex is more likely to get it?
Thickened narrowing of the pyloric sphincter
Babies 4-12 weeks
Boys > girls
Give the typical presentation for pyloric stenosis
Baby boy, 4-12 weeks old
Projectile, non-billious vomiting - after every feed
Weight loss
Dehydration +/- shock
Electrolyte disturbance
What is the characteristic electrolyte disturbance seen in pyloric stenosis?
Hypokalaemic, hypocholeremic metabolic alkalosis
Decreased potassium
Decreased chloride
Increased pH
What feature on examination of a beby is characteristic of pyloric stenosis
Olive mass - on palpation of epigastrum
Describe the clinical significance of effortless vomiting
What usually causes it?
What are the rarer causes?
Happens to near enough all babies - most commonly caused by GOR
Usually self limiting and will resolve - with the exception of:
Cerebral palsy
Progessive neurological problems
Oesophageal atresia +/- Tracheosophageal fistula operation
Generalised GI motility problem
Why does GOR happen in babies?
Relaxed LOS
Babies are supine a lot
Liquid feed
How might neonatal GORD present?
Vomiting - rarely haemetemesis
Feeding problems & failure to thrive
Respiratory symptoms - apnoea, cough, wheeze, chest infections
Sandifer’s syndrome - spastic torticollis (neck bending) and dystonic body movements
What age range is GOR expected in infants?
From what age would investigation be needed?
Why might investigation be warrented earlier?
Starts at 2 weeks
Worst 4-6 months
Stops after a year
If it does not improve after a year of age then investigation is indicated
Can be indicated <1 year if growth faltering
What surgical procedure is done for GOR in kids?
Nissen fundoplication (same as for hiatus hernia in adults)
