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Paediatrics Jenna To Sort > Vomiting and Malabsorption in Children 1 > Flashcards

Vomiting and Malabsorption in Children 1 Flashcards

1
Q

What are the different phases of vomiting

A
  • Pre-ejection phase
    • Pallor
    • Nausea
    • Tachycardia
  • Ejection phase
    • Retch
    • Vomit
  • Post-ejection phase
    • Lethargy
    • Pain
    • Sweaty
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2
Q

What are the clinical features of each vomiting phase:

  • pre-ejection phase
  • ejection phase
  • post-ejection phase
A
  • Pre-ejection phase
    • Pallor
    • Nausea
    • Tachycardia
  • Ejection phase
    • Retch
    • Vomit
  • Post-ejection phase
    • Lethargy
    • Pain
    • Sweaty
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3
Q

Physiologically, what causes vomiting?

A

Happens due to stimulation of vomiting centre, located medulla:

  • Triggered by chemicals and toxins, such as chemotherapy
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4
Q

Where is the vomiting centre located?

A

Medulla

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5
Q

What is stimulationof the vomiting centre triggered by?

A

Chemicals adn toxins, such as chemotherpy

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6
Q

What are some triggers of vomiting?

A
  • Vomiting with renching
  • Projectile vomiting
  • Bilious vomiting
  • Effortless vomiting
  • Haemetemesis
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7
Q

What are the different kinds of vomiting?

A
  • Vomiting with renching
  • Projectile vomiting
  • Bilious vomiting
  • Effortless vomiting
  • Haemetemesis
    • Usually seen in peptic ulcers or portal hypertension
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8
Q

What is haemetemesis usually seen in?

A

Peptic ulcers or portal hypertension

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9
Q

What are causes of vomiting in:

  • infants
  • children
  • young adults
A
  • Infants
    • GOR
    • Cow’s milk allergy
    • Infection
    • Intestinal obstruction
  • Children
    • Gastroenteritis
    • Infection
    • Appendicitis
    • Intestinal obstruction
    • Raised ICP
    • Coeliac disease
  • Young adults
    • Gastroenteritis
    • Infection
    • H. Pylori infection
    • Appendicitis
    • Raised ICP
    • DKA
    • Cyclical vomiting syndrome
    • Bulimia
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10
Q

Pyloric stenosis - epidemiology

(age group, sex)

A
  • Babies 4-12 weeks
  • Boys > girls
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11
Q

Pyloric stenosis - presentation

A
  • Projectile non-bilious vomiting
  • Weight loss
  • Dehydration +/- shock
  • Characteristic electroylyte disturbance
    • Metabolic alkalosis (increased pH)
    • Hypocholeraemia (decreased chlorine)
    • Hypokalaemia (decreased potassium)
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12
Q

What kind of vomiting does pyloric stenosis cause?

A

Projectile non-bilous vomiting

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13
Q

What are the characteristic electroylyte disturbances of vomiting due to pyloric stenosis?

A
  • Characteristic electroylyte disturbance
    • Metabolic alkalosis (increased pH)
    • Hypocholeraemia (decreased chlorine)
    • Hypokalaemia (decreased potassium)
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14
Q

Pyloric stenosis - investigations

A
  • Test feed
  • Blood gases
    • Often see hypokalemic, hypocholermic metabolic alkalosis after prolonged vomiting
  • USS
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15
Q

What is seen in blood gases after prolonged vomiting?

A
  • Often see hypokalemic, hypocholermic metabolic alkalosis after prolonged vomiting
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16
Q

Pyloric stenosis - management

A
  • Fluid resuscitation
    • To correct from vomiting
  • Refer to surgeons if obstruction
17
Q

What is effortless vomiting also called?

A

Also called regurgitation, reflux

18
Q

Effortless vomiting- aetiology

A
  • Almost always due to gastro-oesophageal reflux
19
Q

Efforless vomiting - epidemiology

A
  • Very common in infants
20
Q

Effortless vomiting - presentation

A
  • GI
    • Vomiting
    • Haematemesis
  • Nutritional
    • Feeding problems
    • Failure to thrive
  • Reparatory
    • Apnoea
    • Cough
    • Wheeze
    • Chest infections
  • Neurological
    • Sandifer’s syndrome
21
Q

Effortless vomiting - investigations

A
  • History and examination often sufficient
  • Oesophageal pH study/impedance monitoring
    • pH in oesophagus dropping below 4 indicates reflux
  • Endoscopy
  • Imaging
    • Video fluoroscopy
    • Barium swallow
      • Shows hiatus hernia, reflux, gastric emptying, stricturing
22
Q

Effortless vomiting - management

A
  • Self-limiting and resolves spontaneously with age
  • Few exceptions
    • Cerebral palsy
    • Progressive neurological problems
    • Oesophageal atresia
    • Generalised GI motility problem
  • Feeding advice
    • Thickeners for liquid
    • Appropriateness of food
    • Behavioural programme
    • Feeding position
    • Check feed volumes – 150mls/kg/day for neonates, 100ml/kg/day for infants
  • Nutritional support
    • Calories supplements
      • Exclusion diet (cows milk protein free trial for 4 weeks)
      • Nasogastric tube
      • Gastrostomy
  • Medical treatment rarely
    • Acid suppressing drugs
    • H2 receptor blockers
    • Proton pump inhibitors
  • Surgery rarely
    • Indications – failure of medical treatment, persistent failure to thrive or aspiration or oesophagitis, vomiting without complications is not indication
    • Procedure is Nissen fundoplication
23
Q

What are indications for surgery for effortless vomiting?

A
  • Indications – failure of medical treatment, persistent failure to thrive or aspiration or oesophagitis, vomiting without complications is not indication
24
Q

What medical treatment can be used for effortless vomiting?

A
  • Acid suppressing drugs
  • H2 receptor blockers
  • Proton pump inhibitors
25
Q

What should bilous vomiting always be presumed to be due to?

A

Due to intestinal obstruction until proved otherwise

  • ALWAYS ring alarm bells
26
Q

Bilous vomiting - aetiology

A
  • Intestinal atresia (in newborn babies only)
  • Malrotation
  • Intussusception
  • Ileus
  • Crohn’s disease with strictures
27
Q

Bilous vomiting - investigations

A
  • Abdominal x-rays
  • Consider contrast meal
  • Surgical opinion regarding laparotom

Paediatrics Jenna To Sort (37 decks)

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