Vomiting and malabsorption Flashcards
Describe the pre-ejection phase in vomiting?
□ Pallor
□ Nausea
□ Tachycardia
Describe the ejection phase of vomiting
□ Retch
□ Vomit
Describe the post-ejection phase in vomiting
□ Floppy
□ Lethargic
□ Pale
What stimulates the vomiting centre in children?
□ Enteric pathogens □ Intestinal inflammation □ Metabolic derangement □ Infection ® UTI ® Meningitis ® Encephalitis ® Cellulitis ® Sepsis □ Head injury □ Visual stimuli □ Middle ear stimuli
Describe billous vomiting and its causes?
- Should always ring alarm bells
- Due to intestinal obstruction until proved otherwise
- Causes
□ Intestinal atresia (in new-born babies only)
□ Malrotation +/- volvulus
□ Intussusception (part of the bowel “telescopes” into another part of the bowel)
□ Ileus
□ Crohn’s disease with strictures
What investigations should be done in a child with bilious vomiting?
□ Abdominal x-ray
□ Consider contrast meal
□ Surgical opinion re exploratory laparotomy
Explain effortless vomiting
- This is almost always due to gastro-oesophageal reflux
- Very common problem in infants
- Self-limiting and resolves spontaneously in the vast majority of cases
- A few exceptions:
□ Cerebral palsy
□ Progressive neurological problems
□ Oesophageal atresia +/- TOF operated
□ Generalised GI motility problem
Describe test feeding
○ Palpation of “olive” tumour
○ Visible gastric peristalsis
- Thickened pylori- the stomach is trying to push the food through
○ Projectile non bilious vomiting
What is pyloric stenosis?
○ Babies 4-12 weeks ○ Boy> girls ○ Projectile non-bilious vomiting ○ Weight loss ○ Dehydration +/- shock
What are the charecteristic electrolyte desturbances in pyloric stenosis?
® Metabolic alkalosis (increased pH)
® Hypochloraemia
® Hypokalaemia
What is the management of pyloric stenosis?
® Fluid resuscitation
® Refer to surgeons
□ Ramstedts pyloromyotomy
What are the presenting syndromes of gastric oesophageal reflux?
® Gastrointestinal □ Vomiting □ Haematemesis ® Nutritional □ Feeding problems □ Failure to thrive ® Respiratory □ Apnoea □ Cough □ Wheeze □ Chest infections ® Neurological □ Sandifer’s syndrome ® Spastic and dystonic body movements ® Nodding and rotation of the head ® Neck extension ® Gurgling sounds ® Withering movements of the limbs ® Severe hypotonia
How is gastric oesophageal reflux medicaly assessed?
® History & examination often sufficient ® Radiological investigations □ Video fluoroscopy □ Barium swallow ® pH study ® Oesophageal impedance monitoring ® Endoscopy □ Severe symptoms □ If reflux hasn't resolved after 2 years of life □ Neurodisability
What might barium swallow show you?
◊ Dysmotility ◊ Hiatus hernia ◊ Reflux ◊ Gastric emptying ◊ strictures
What are problems that could happen in a barrium swallow?
◊ Aspiration
◊ Inadequate contrast taken (NG tube)
