Vomiting
Vomiting is the forceful expulsion of gastric contents through the mouth that involves an integrated and largely somatic motor response. It represents a protective reflex in the body's defense system. Vomiting may be an initial symptom of an underlying condition or a symptom complex preceded by nausea and retching. The differential diagnosis varies with age, although each diagnosis should be entertained when seeing a patient who presents with vomiting.
Differential Diagnosis
- Infections
–Gastroenteritis is the most common cause among all pediatric age groups; may be viral, bacterial, or parasitic
–Urinary tract infection/pyelonephritis
–Sepsis
–Meningitis
–Viral hepatitis: e.g., Hepatitis A
–Helicobacter pylori-related ulcer
- Anatomic
–Esophageal: Tracheoesophageal atresia, esophageal ring/web/stricture, achalasia
–Gastric: Pyloric stenosis, volvulus
–Small intestine: Duodenal atresia, malrotation, meconium ileus, duodenal hematoma, SMA syndrome, duplication, intussusception, hernia
–Colon: Hirschprung, imperforate anus
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Gastrointestinal
–Gastroesophageal reflux disease
–Allergy (e.g., celiac disease, milk protein)
–Peptic ulcer disease
–Appendicitis
–Foreign body
–Pancreatitis
–Cholecystitis
–Eosinophilic enteropathy
–Pseudo-obstruction
-
Neurologic
–Intracranial mass
–Hydrocephalus
–Pseudotumor cerebri
–Migraines
-
Renal
–Obstructive uropathy
–Nephrolithiasis
–Glomerulonephritis
–Renal tubular acidosis
-
Toxins/drugs
–Aspirin, theophylline, digoxin, lead
–Chemotherapeutics
-
Pregnancy
-
Inborn errors of metabolism
-
Endocrine
–Diabetic ketoacidosis
–Adrenal insufficiency
–Congenital adrenal hyperplasia
-
Respiratory
–Pneumonia
–Post-tussive
Workup and Diagnosis
History and physical crucial because of large differential
- History
–Duration, frequency, bilious material, abdominal pain, diarrhea, hematemesis, hematochezia, melena, headache, fever, dysuria, weight loss, urine output
–Sick contacts, cough, rhinorrhea, neck stiffness
-
Birth history: Polyhydramnios, passage of meconium
-
Family history: Genetic disease, early childhood deaths
-
Physical exam
–Vitals, weight, mucous membranes, nasal discharge, breath sounds, rashes, meningismus
–Abdominal pain/distension, hepatosplenomegaly,
abdominal masses, Murphy/obturator/psoas sign
–Skin turgor, capillary refill
–Neuro exam including funduscopy for papilledema
-
Labs: Initial screen based on physical exam
–Consider electrolytes, LFTs, amylase, lipase
–U/A and culture; lactate and pyruvate
–Serum amino acids/urine organic acids, ammonia for metabolic diseases; blood gas for acidosis
–CBC for infections, lumbar puncture
-
KUB or obstruction series as initial X-ray
-
Contrast study with upper GI series with or without small bowel follow-through or BE for anatomic problem
-
Abdominal ultrasound for pyloric stenosis
-
Head imaging including CT/MRI
-
Upper endoscopy and colonoscopy for mucosal inflammation
Treatment
-
Stabilize patient and fluid resuscitation as initial therapy with electrolyte correction
-
Surgical consultation if obstruction suspected
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Oral rehydration with small amounts of liquids if tolerated
-
If signs of obstruction, nasogastric tube decompression and bowel rest
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Treat infections if indicated
-
Remove toxins and allergens
-
Surgical interventions for volvulus, Hirschprung, intracranial masses, pyloric stenosis, other anatomic causes
-
Correct metabolic derangements
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Lifelong gluten-free diet for celiac disease
-
Rare use of antiemetics/promotility agents for chemotherapy, motion sickness, postsurgery, gastroesophageal reflux disease
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Severe vomiting
Read excerpts from these other book chapters related to Severe vomiting:
Medical Books Excerpts
- Vomiting
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- Nausea
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Vomiting
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Hematemesis
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Nausea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Vomiting
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Nausea and Vomiting
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Hematemesis
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Vomiting
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Hematemesis
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Nausea
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Vomiting
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Nausea
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- Vomiting
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- Vomiting
- "Pediatric Complaints and Diagnostic Dilemmas" (2003)
- [ read ]
Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Severe vomiting
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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» Next page: Vomiting – Projectile (In A Page: Pediatric Signs and Symptoms)
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