Approach To Vomiting
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Denise CastroApproach To Vomiting
Uploaded by
Denise CastroAPPROACH TO VOMITING IN
PEDIATRICS
VOMITING
Vomiting involves the forceful expulsion of the
contents of the stomach and is a highly
coordinated, reflexive process.
Can be classified according to its nature and
cause
As well as character of vomitus
AAP: Vomiting in children
NATURE
Projectile vs NonProjectile
CHARACTER
Bloody vs NonBloody
Projectlie vs NonProjectiles
History
Age of the patient
Duration /Frequency
Onset
Associated with food intake
instantly : esophageal obstruction
After a while : stomach or duodenal obstruction
Nature (projectile / non projectile)
Color and contents
Non digested food :proximal obstruction
Semi digested food : distal obstruction
Billous content
: distal to 2nd part of duodenum
Fecal material
: obstruction at the large intestine
Associated symptoms
Fever / Abdominal Pain /Diarrhea /constipation/
dysphagia.
History
Respiratory cough, chest discomfort
Urinary dysuria,hematuria
CNS irritability, altered sensorium,drowsy, neck stiffness,
headache, visual disturbance
Past medical history
Any known medical illness such as metabolic inborn error,
cerebral palsy, down syndrome, neurological deficit
Drug and allergy history
Birth history
Nutritional history
Recently change into cow milk/ food allergy/ type of food
Other relevant history
Recent eating outside, recent travelling, family member or
friends in school have similar illness
Physical Examination
Look for any evidence of any specific disorder/
disease based on history
Abdominal Examination
Distension/ Visible peristalsis
Tenderness/ hepatospelnomegaly
abdominal masses
Bowel sounds
CNS Examination
Power, Tone, reflexes
Changes in vision
Vomiting in infancy Beyond the Neonatal Perind
The differential diagnosis of vomiting in inihnts
beyond dre neonatal period is more extensive.
Common causes are aclrte gastroenteritis, GE\
and nutrient intolcrances such as rnilk or soy
protein allergies. Metabolic diseases ar,d inborn
errors of metabolism also shouicl be consid- ered
for infants lvho have persistent progressive
vomit- ing.
FOOD INTOLERANCE VS FOOD ALLERGIES
Both adverse reactions to food
adverse physiologic responses vs adverse
immunologic responses and can be
immunoglobulin (Ig) E-mediated or nonIgEmediated
GASTROESOPHAGEAL REFLUX
most common cause of recurrent nonbilious
emesis in infancy
It involves the retrograde movement of gastric
contents into the esophagus as a result of an
abnormally functioning lower esophageal
sphincter (LES)
recurrent postprandial regurgitation of ingested
food or milk
most often within 30 minutes of a feeding
DIETARY PROTEIN INTOLERANCE
non-immunoglobulin E-mediated type of food
hypersensitivity
typically presents in infants in the first postnatal year,
shortly after exposure to the offending allergen
Commonly implicated proteins include cow milk
protein, soy protein, and egg protein.
Among the clinical symptoms are irritability, feeding
intolerance, recurrent vomiting and diarrhea, and in
severe cases, failure to thrive.
