Vomiting in Children

Tracheoesophageal Fistula

1:3000-4500 ; Proximal atresial with distal fistula ==> 75%

Polyhydramnios; associated abn. in 50% (eg. VACTERL)

1st feeding

Coughing, cyanosis; excessive frothy salivation

Abd x-ray: distented abdomen; curled NG tube

Mx:

investigate abnormalities

early surgical correction

Duodenal Atresia

1:10.000; 50% are premature

Polyhydramnios; associated with Down´s; 30% life-threatening abn

1st day

Bilious vomiting; dehydration

Abd x-ray: "double-bubble" sign; air fluid levels

Mx:

decompression + correction metabolic abn

surgery

Pyloric Stenosis

1:500; positive family history

2-4 weeks

projectile vomiting after feeding; visible peristalsis; "olive"

metabolic alkalosis (normal AG)

U/S: > pyloric thickness/lenght

Abd x-ray: shoulder/"double track" sign

Mx: pylorotomy

Intestinal Malrotation

80% present within 2 months

Acute/Chronic obstruction Sx (vomiting + distension)

Sudden pain + Shock + Bilious vomiting = volvulus

Subtopic

U/S

Mx: NG tube + surgery

Intussusception

3 mos - 3 yrs

associated with adenovirus; ileocolic is most common

Sudden colicky pain; early vomiting; constipation ==> currant jelly stool; "sausage" mass

U/S: target/donut

Abd x-ray: obstruction

Mx:

Early :Contrast/Air Enema

Late/Peritonitis: surgery

Gastroesophageal Reflux

extremely common ==> physiologic

FTT

Atypical: coughing; bronchospasm; respiratory infections; apnea

24h pH probe; upper GI series; endoscopy

Mx: domperidone; ranitidine/omeprazole

Other

CNS (increased ICP)

Drugs

Migraine

Metabolic

Overfeeding