Vomiting Child

Question 1

How to approach a case of vomiting?

Answer 1

1. Finding a cause
   
   1. Taking detailed history: type: forceful?, colour: ?bile? Blood, frequency, duration,
   2. Examination:
   3. Investigations
2. Treat dehydration
3. Treat underlying condition if treatable

Question 2

Causes of vomiting in infants?

Answer 2

• Gastroenteritis
• Gastroesophageal reflux
• GIT Obstruction: PS, Intestinal Obstruction
• Over feeding
• Systemic infection: sepsis, UTI, meningitis
• Otitis media, URTI
• Cough induced vomiting
• Metabolic illness

Question 3

Symptoms of pyloric stenosis? (less than 3 months old)

Answer 3

• Forceful/ projectile
• Milky
• Feeds well but vomits while or immdiately after feed
• Looks for feed again after vomiting
• Looks well initially
• May have poor growth/ wt loss if going on for days
• May have a family history

Question 4

What will investigations of PS show?

Answer 4

• Capp blood gas: metabolic alkalosis
• Low K
• Low Na
• Low Cl
• pH high
• Other for differential diagnosis: Urine check, U&E, infection screen?

Question 5

PS diagnosis and treatment?

Answer 5

Diagnosis

• History
• Blood gas
• Test Feed
• Ultra sound

Treatment

• Fluid management
• Stop feeds if diagnosis likely
• Surgeon: pyloromyotomy

Question 6

What is bilious vomiting and what are the differential diagnosis?

Answer 6

Intestinal obstruction (until proven otherwise)

Differential Diagnosis

• Intussusception (like a telescope)
• Volvulus (like twisting of bowel)
• Appendicitis
• Hirschsprung disease
• Duodenal atresia
• Migraine

Question 7

Causes of vomiting in older children?

Answer 7

• Gastroenteritis
• Gastroesophageal reflux
• GIT Obstruction: Intestinal Obstruction
• Gastritis
• Systemic infection: sepsis, UTI, meningitis,
• Otitis media, URTI,
• Cough induced vomiting
• Metabolic problems
• Toxins/ poisoning
• Raised ICP
• Migraine
• Pregnancy