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par Patrick Teloken Il y a 16 années

509

Vomiting in Children

Vomiting in children can occur due to various causes, with different conditions presenting distinct symptoms and requiring specific treatments. Intussusception, common in children aged 3 months to 3 years, often presents with sudden colicky pain, early vomiting, and constipation, progressing to currant jelly stool and a palpable '

Vomiting in Children

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

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
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%