Vomiting in Children
After newborn period
Other
Overfeeding
Metabolic
Migraine
Drugs
CNS (increased ICP)
Gastroesophageal Reflux
Mx: domperidone; ranitidine/omeprazole
24h pH probe; upper GI series; endoscopy
Atypical: coughing; bronchospasm; respiratory infections; apnea
FTT
extremely common ==> physiologic
Intussusception
Late/Peritonitis: surgery
Early :Contrast/Air Enema
Abd x-ray: obstruction
U/S: target/donut
Sudden colicky pain; early vomiting; constipation ==> currant jelly stool; "sausage" mass
associated with adenovirus; ileocolic is most common
3 mos - 3 yrs
Newborn Period
Intestinal Malrotation
Mx: NG tube + surgery
Subtopic
Upper GI series
U/S
80% present within 2 months
Sudden pain + Shock + Bilious vomiting = volvulus
Acute/Chronic obstruction Sx (vomiting + distension)
1:500; incomplete malrotation (cecum in RUQ) is most common type ==> midgut volvulus
Pyloric Stenosis
Mx: pylorotomy
Abd x-ray: shoulder/"double track" sign
U/S: > pyloric thickness/lenght
metabolic alkalosis (normal AG)
projectile vomiting after feeding; visible peristalsis; "olive"
2-4 weeks
1:500; positive family history
Duodenal Atresia
Mx:
surgery
decompression + correction metabolic abn
Abd x-ray: "double-bubble" sign; air fluid levels
Bilious vomiting; dehydration
1st day
Polyhydramnios; associated with Down´s; 30% life-threatening abn
1:10.000; 50% are premature
Tracheoesophageal Fistula
Mx:
early surgical correction
investigate abnormalities
Abd x-ray: distented abdomen; curled NG tube
Coughing, cyanosis; excessive frothy salivation
1st feeding
Polyhydramnios; associated abn. in 50% (eg. VACTERL)
1:3000-4500 ; Proximal atresial with distal fistula ==> 75%
