Vomiting - Pyloric stenosis, Intussusception, Malrotation, Esophageal atresia, Meconium ileus, NEC, Meckels diverticulum, GERD Flashcards
Causes of vomiting
Pyloric stenosis
Intussuception
Malrotation
Esophageal atresia
Meconium ileus
Necrotising enterocolitis
Meckels diverticulum
GERD
Travellers diarrhoea - gastroenteritis
Pyloric stenosis
-what is it
-presentation
-diagnosis
-management
Idiopathic thickening of pyloric sphincter muscles => difficulty in eating
2wk onwards
Projectile non-bilious vomit 30mins after feeding
Palpable mass in upper abdo
Low Cl, K alkalosis
US
Ramstedt pyloromyotomy
Intussusception
-what is it
-presentation
-investigationn
-management
Telescoping bowel
6-18months
Intense crying
Ischemia of affected bowel segment => acute cyclical colicky abdo pain
Late sign - red currant jelly stool and vomiting
US
1st line - radiology-guided reduction by air insufflation
If fails or peritonitic => SURGERY
Intestinal malrotation
-what is it
-presentation
-investigations
-management
Cecum confined to RUQ => increased risk of volvulus and obstruction
FIRST MONTH OF LIFE
Bilious vomiting
Bowel obstruction distal to ampulla of Vater
CONTINUOUS PAIN
Circulatory compromise => peritoneal signs
US - abnormal orientation of SMA, SMV
UGI contrast - DJflexure more medial
BO drip and suck
Surgery - Ladd’s procedure
-dividing peritoneal (Ladd’s) bands, and placing bowel in correct place
Esophageal atresia
-what is it
-presentation
Upper esophagus not continuous with lower esophagus
End blindly instead
Pooling of secretions
Choking, drooling, inability to feed
Non bilious vomit
Meconium ileus
-what is it
-associations
-presentation
-investigations
-management
Meconium is sticker and thicker than usual => obstruction
hrs-days after birth
CF!
Hirsprungs
Abdo distention
Bilious vomit
AXR
Contrast enema
Drip and suck
Enema
Surgery
Necrotising enterocolitis
-what is it
-presentation
-investigations
-management
Neonatal GI immaturity =>
-reduced acid prod
-reduced intestinal barrier
-immature immune function
-immature digestion
-immature motility
Made worse by frequent ABx use
Shiny distended abdo
Periumbilical erythema
Abdo tender
Bloody stool
Abdo discolouration, perforation and peritonitis
AXR
-Dilated bowel loops
-Bowel wall edema
-Pneumatosis intestinalis
-Portal venous gas
-Pneumoperitoneum
-Rigler’s sign
Blood cultures, gas, CRP, routine biochem
Drip and suck
Broad spec IV ABx - pen, gent, met
Surgery - peritoneal drain, laparotomy and stoma creation
Meckels diverticulum
-what is it
-presentation
-investigations
-management
Congenital diverticulum of small intestine containing
-ectopic ileal, gastric, pancreatic mucosa => secretes acid which can cause ulceration and bleeding
2 feet from ICV
2 inches long
CAN PRESENT AS INTUSSUSCEPTION, VALVULUS
Abdo pain - appendicitis mimic
Rectal bleeding - most common cause of painless massive GI bleeding needing transfusion in children
GI obstruction
Vomiting, constipation - if obstructed
Hemodynamically stable, less severe - Meckel’s scan (Tc99 has affinity for gastric mucosa)
Severe - mesenteric arteriography
Remove if narrow neck/symptomatic
GERD
-prevalence
-risk factors
-presentation
-diagnosis
-management
MOST COMMON CAUSE OF VOMITING IN INFANCY - some overlap with normal physiological processes
-lower esophageal sphincter has not fully developed
Preterm delivery
Neurological disorders
Develops before 8wks
Vomiting/regurgitation
-milky vomit after feed
-often after laying flat
Excessive crying, especially while feeding
Clinical diagnosis
Supportive
-30deg head up during feed
-infant sleeps on back
-don’t overfeed, have smaller and frequent feeds
1st line - gaviscon if breastfed
1st line - feed thickener if bottlefed
Can trial 4wk PPI if
-unexplained feeding difficulties
-distressing behaviour
-faltering growth
