Vomiting

Annotations:

• -common chronic causes= GORD, feeding probs (force-feeding or overfeeding) -if transient, w/ other sx e.g. fever, diarrhoea, runny nose and cough- most likely gastroenteritis or RTI, but consider UTI and meningitis -if projectile at 2-7 weeks old, exclude pyloric stenosis -if bile stained vomit, exclude intestinal obstruction, esp intussusception, malrotation and strangulated hernia. Assess for dehydration & shock.

1. forceful ejection of gastric contents
2. differs from
   1. non-forceful return of milk
      1. regurgitation
         1. larger, more frequent losses
      2. posseting
         1. small amounts of milk w/ return of swallowed air ('wind')
3. red flag clinical features in vomiting child
   1. bile stained vomit (dark green)
      1. intestinal obstruction
         1. if more proximal
            1. vomiting is more prominent
            2. vomit becomes bile-stained sooner (unless obstruction prox to ampulla of Vater)
   2. haematemesis
      1. oesophagitis
      2. peptic ulceration
      3. oral/nasal bleeding
   3. projectile vomiting in 1st few weeks of life
      1. pyloric stenosis
   4. vomiting @ end of paroxysmal coughing
      1. pertussis
   5. abdo tenderness/abdo pain on movement
      1. surgical abdomen
   6. abdo distension
      1. intestinal obstruction, e.g. strangulated inguinal hernia
      2. more marked in distal obstruction
   7. hepatosplenomegaly
      1. chronic liver disease
   8. blood in the stool
      1. intussusception
      2. gastroenteritis
         1. Salmonella
         2. Campylobacter
   9. severe dehydration, shock
      1. diabetic ketoacidosis
      2. severe gastroenteritis
      3. systemic infection, e.g.
         1. UTI
         2. meningitis
   10. failure to thrive
       1. gastro-oesophageal reflux
       2. coeliac disease
       3. other chronic gastrointestinal conditions
   11. bulging fontanelle or seizures
       1. raised intracranial Pa
4. usually benign
5. often caused by feeding disorders or mild GORD or gastroenteritis
6. Causes in different age groups
   1. infants
      1. GORD
      2. feeding problems
      3. infection
         1. gastroenteritis
         2. respiratory tract/otitis media
         3. pertussis
         4. urinary tract
         5. meningitis
      4. dietary protein intolerances
      5. intestinal obstruction
         1. pyloric stenosis
         2. atresia
            1. duodenal
            2. other sites
         3. intussusception
         4. malrotation
         5. volvulus
         6. duplication cysts
         7. strangulated inguinal hernia
         8. Hirschprung disease
      6. renal failure
      7. inborn errors of metabolism
      8. congenital adrenal hyperplasia
   2. preschool kids
      1. gastroenteritis
      2. infection
         1. respiratory tract/otitis media
         2. urinary tract
         3. meningitis
         4. whooping cough (pertussis)
      3. appendicitis
      4. intestinal obstruction
         1. intussusception
         2. malrotation
         3. volvulus
         4. adhesions
         5. foreign body- bezoar
      5. raised ICP
      6. coeliac disease
      7. renal failure
      8. inborn errors of metabolism
      9. torsion of the testis
   3. school age and adolescents
      1. gastroenteritis
      2. infection e.g.
         1. pyelonephritis
         2. septicaemia
         3. meningitis
      3. peptic ulceration & H. pylori infection
      4. appendicitis
      5. migraine
      6. raised ICP
      7. coeliac disease
      8. renal failure
      9. diabetic ketoacidosis
      10. alcohol/drug ingestion or medications
      11. bulimia/anorexia nervosa
      12. pregnancy
      13. torsion of the testis