Vomiting and Malabsorption Flashcards
What types of vomiting are there?
- Vomiting with Retching
- Projectile vomiting
- Bilious vomiting
- Effortless vomiting
What are the phases of vomiting with retching?
Pre-ejection phase
- Pallor
- Nausea
- Tachycardia
Ejection phase
- Retch
- Vomit
Post-ejection phase
How can the vomiting centre be stimulated?
- Enteric pathogens
- Intestinal inflammation
- Metabolic derangement
- Infection
- Head injury
- Visual stimuli
- Middle ear stimuli
Who does pyloric stenosis occur in?
- Babies 4-12 weeks
- M>F
How does pyloric stenosis present?
- Projectile non-bilious vomiting
- Weight loss
- Dehydration +/- shock
What electrolyte disturbance is associated with pyloric stenosis?
- Metabolic alkalosis
- Hypochloraemia
- Hypokalaemia
What type of vomiting rings alarm bells?
Bilious vomiting
What is bilious vomiting due to?
Intestinal obstruction until proven otherwise
What can cause bilious vomiting?
- Intestinal atresia (in newborn babies only)
- Malrotation +/- volvulus
- Intussusception
- Ileus
- Crohn’s disease with strictures
How is bilious vomiting investigated?
- Abdominal x-ray
- Consider contrast meal
- Surgical opinion re exploratory laparotomy
What is effortless vomiting usually due to?
Gastro-oesophageal reflux
What is the usual outcome of GOR in infants?
Self limiting and resolves spontaneously in the vast majority of cases
Who may GOR not resolve in?
- Cerebral palsy
- Progressive neurological problems
- Oesophageal atresia +/- TOF operated
- Generalised GI motility problem
How can GOR present?
Gastrointestinal
- Vomiting
- Haematemesis
Nutritional
- Feeding problems
- Failure to thrive
Respiratory
- Apnoea
- Cough
- Wheeze
- Chest infections
Neurological
-Sandifer’s syndrome
How is GOR assessed?
- History & examination often sufficient
- Radiological investigations (Video fluoroscopy, Barium swallow)
- pH study
- Oesophageal impedance monitoring
- Endoscopy
What are the aims of barium swallow?
To identify
- Dysmotility
- Hiatus hernia
- Reflux
- Gastric emptying
- Strictures
What are the problems with barium swallow?
- Aspiration
- Inadequate contrast taken by NG
What are the advantages of video fluoroscopy and barium meal?
- May detect aspiration
- Defines anatomy well
What are the advantages of pH study?
-Detects acid reflux missed by barium
What are the advantages of endoscopy?
- Best test for oesophagitis
- Can be combined with pH impedance study
What are the advantages of trial of feeding?
- Most physiological test
- May be best discriminator if child needs surgery
What are the disadvantages of video fluoroscopy and barium meal?
- May miss reflux
- Radiation
What are the disadvantages of pH study?
- Only detects acid reflux
- May be unpleasant for child