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7/31/2019 Vomiting in Infant
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Vomi%ng
in
Infant
Pediatrics,May2012
HugoSousaRafaelaParreira
SlviaFarraposo
Ta5anaQueirs
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Pediatrics
Summary
Defini5ons
Clinicalhistory&Physicalexamina5on
Mainpathologies
Conclusion
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Pediatrics
Defini%ons
Encompassesallretrogradeejec5onofgastrointes5nal,oresophageal,contentsfromthemouth
Subdividedaccordingtoitsforcefulness
None Esophagealemptying
Minimal Regurgita5on
Moderate Vomi5ng
Severe Projec5levomi5ngwithretching
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Vomi%nginInfant
ClinicalHistoryPhysical
Examina%onHospitaliza%on
Pediatrics
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Howoldistheinfant?
Howisthegeneralhealth?
Whatisthevomi%nglike? Volume Frequency Content Periodoftheday Temporalassocia5ons Procedurestoreducevomi
5ng
Arethereassociatedsymptoms?
ClinicalHistory
Pediatrics
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Vmitosnolactente
PhysicalExamina%on
Generalexamin
a%on
Fever Cardiacrythm Respira5on Fundi
Abdominalexamina%
on
Pain Tende
rness
Disten5on Signsofdehydr
a%on
Althoughvomi5ngisagastrointes5nalsymptom,itcan
beamanifesta5onofdiseaseinmul5plesystemsofthe
body
Pediatrics
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Vmitosnolactente
CriteriaforHospitalarAdmission
Severedehydra5on
Uncontrollablevom
i5ng
Refusetofeed Intolerancetor
ehydra5on
Vomi5ngethiology
Socialenvironment
Pediatrics
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Pediatrics
Complica%onsofVomi%ng
Metabolic
Aspira5on
Nutri5onal Shock
Esophagi5s
Mallory-Weisstear
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Pediatrics
Differen%alDiagnosisofVomi%ng
MainCauses
Physiologicreflux/GERD
Gastroenteri5s
Malrota5on/Midgutvolvulus/Intussuscep5on
Obstruc5on/Pyloricstenosis
Metabolicdisorders
UTI
Dietaryproteinintolerance
Increasedintracranialpressure
Hepatobiliarydisease
Pancrea55s
Rumina5on
Munchausensyndromebyproxy
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Surgical Gastrointes%nal Infec%ous
Neurologic
Neurosurgery Metabolic
Pathologies
Vomi%nginInfant
Pediatrics
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Surgical Gastrointes%nal Infec%ous
Neurologic
Neurosurgery Metabolic
Pathologies
Vomi%nginInfant
Pediatrics
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SurgicalPathologyHypertrophicpyloricstenosis
Narrowed(stenosed)pyloricsphincter
Junc%onofstomachandduodenum
Pediatrics
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SurgicalPathologyHypertrophicpyloricstenosis
Whites
NorthernEurope
Males
First-borns
Bloodgroup
TypesB,O
FamilyHistory
MotherwhohadHPS
TEFHypoplasia/agenesisILF
Pediatrics
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SurgicalPathologyHypertrophicpyloricstenosis
Usuallynotpresentatbirth
Moreconcordantin
monozygo5ctwinsMuscleinnerva5on
Infanthypergastrinemia
Nitricoxide
Prostaglandins
Pediatrics
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SurgicalPathologyHypertrophicpyloricstenosis
Hypochloremicmetabolicalkalosis
Chronicmalnutri%on
Severedehydra%on
AQer3weeksofage
1stweekthmonth
Mayfolloweachfeeding
Intermient
Progressive
Imediatelyaerfeeding
Nonbiliousvomi5ng
Pediatrics
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SurgicalPathologyHypertrophicpyloricstenosis
Palpatepyloricmass Gastricperistal5cwave Ultrasound Contraststudies
Oliveshaped
2cminlength
Midepigastrum
Sensi5vityof9%
Pyloricthickness>4mm
Pyloriclenght>14mm
Elongatedpyloricchannel
Shouldersign
DoubletractsignThediagnosiscanbeestablishedclinically60-80ofthe%mebyan
experiencedexaminer
Pediatrics
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SurgicalPathologyHypertrophicpyloricstenosis
Intravenousfluidtherapy
Rehidrated
[HCO3-]
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SurgicalPathologyIntes%nalobstruc%on
BiliousemesisNonbiliousvomi5ng
Proximalobstruc%on
Duodenalobstruc5on
Anularpancreas
Distalobstruc%on
Malrota%on/volvulus
Intussuscep5on
Intes5nalatresia
Hirschsprungdisease
Pediatrics
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SurgicalPathologyMalrota%on/volvulus
Midgutvolvulus
Duodenalobstruc%on
Duringfetaldevelopment
Cecum
Pediatrics
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SurgicalPathologyMalrota%on/volvulus
Pa%entsofanyagewitharota%onalanomalycandevelopacutebowel
threateningvolvuluswithoutpre-exis%ngsymptoms
Biliousemesis Abdominalpain1styearoflife
Pediatrics
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SurgicalPathologyMalrota%on/volvulus
Inversionofthesuperior
mesentericarteryandvein
Duodenalobstruc5on
Thickenedbowelloopsto
therightofthespine
Freeperitonealfluid
Ultrasound
Contraststudies
Malrota%onwithvolvulus
Pediatrics
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SurgicalPathologyMalrota%on/volvulus
Regardlessofage
Immediatelyifvolvulus
Surgicaltreatment
PersistentsymptomsPseudo-obstruc%on-like
mo%litydisorder
Pediatrics
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Surgical Gastrointes%nal Infec%ousNeurologic
NeurosurgeryMetabolic
Pathologies
Vomi%nginInfant
Pediatrics
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Gastrointes%nalPathologyGastroesophagealreflux
Recurrentpost-prandialspi\ngandvomi%nginhealthyinfantsthatresolvesspontaneously
Evidentat1stmonthsoflife(peak4mo)
Resolveinmostcasesby12mo
Pediatrics
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Gastrointes%nalPathologyGastroesophagealreflux
ThickenedFeedsUprightposi5oning
aerfeedsHypoallergenicDiet
Pediatrics
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Gastrointes%nalPathologyGastroesophagealrefluxdisease
EsophagealpH
ImpedancemonitoringRadiographicstudies Endoscopicstudies
Pediatrics
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Gastrointes%nalPathologyGastroesophagealrefluxdisease
Pediatrics
Pharmacotherapy
Prokine5cagents
H2receptor
antagonists
Proton-puminhibitor
SurgeryLifestylechanges
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Gastrointes%nalPathologyGastroenteri%s
Parasi5cagents
Isosporabelli
Cryptosporidium
Giardia
Bacterialagents
Campylobacterjejuni
C.upsaliensis
Salmonellastrains
Escherichiacoli
Entericvirus
Rotavirus
Calicivirus
Astrovirus
Entericadenovirus
Somepicornavirus
Pediatrics
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Gastrointes%nalPathologyGastroenteri%s
Pediatrics
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Gastrointes%nalPathologyGastroenteri%s
Pediatrics
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Gastrointes%nalPathologyGastroenteri%s
Pediatrics
VirusAge
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Gastrointes%nalPathologyGastroenteri%s
Oral/intravenousfluidtherapy
Pediatrics
Enteralfeeding
Zincsupplementa%on
Probio%cs
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Gastrointes%nalPathologyGastroenteri%s
Pediatrics
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Surgical Gastrointes%nal Infec%ousNeurologic
NeurosurgeryMetabolic
Pathologies
Vomi%nginInfant
Pediatrics
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Infec%ousPathologyUrinarytractinfec%on
E5ology
Ecoli(>8%)
ClinicalManifesta5ons
Nonspecific
Diagnosis
Urinalysis
Uroculture
Pediatrics
Epidemiology
8%ofgirlsand2%ofboyswillacquireUTIsinchildhood
Treatment
An5bio5c
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Surgical Gastrointes%nal Infec%ousNeurologic
NeurosurgeryMetabolic
Pathologies
Vomi%nginInfant
Pediatrics
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Neurologic&NeurosurgicalPathology
HydrocephalusSubduralhematoma Cerebraledema
Pediatrics
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Surgical Gastrointes%nal Infec%ousNeurologic
NeurosurgeryMetabolic
Pathologies
Vomi%nginInfant
Pediatrics
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MetabolicPathologies
Symptoms Diseases
Progressivevomi5ng Diabe%cketoacidosisAdrenalinsufficiencySeveredehydra5on
Cyclicvomi5ng
Galactosemia,fructosemiaChangesinconsciousness
Neurologicalsignsandsymptoms
Pediatrics
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Keepinmind
Pediatrics
Vomi5ngandregurgita5onarecommonlyencounteredsymptomsinchildrens
Mostcommonlyvomi5ngistheresultofacute,self-resolvingilnesses
Insomecases,thefeaturesofvomi5ngallowtodis5nguishthemaincauses
Hypertrophicpyloricstenosis,gastroenteri5sandEGRarethemostcommondiseasesininfants
AlwayskeepinmindREDFLAGS!
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Bibliography
Pediatrics
Pediatrics:CurrentDiagnosis&Ttreatment.WilliamHay,Myron
Levin,JudithSondheimerandRobinDeterding,19thEdi5on,Lange
LangePaediatricsandChildHealth.MaryRudolfandMalcolm
Levene,2ndEdi5on,BlackwellPublishing2006
Prac9calStrategiesinPediatricDiagnosisandTherapy.LarryA.
GreenbaumandPatriciaS.Lye,2ndEdi5on,ElsevierInc.2004
Kliegman:NelsonTextbookofPediatrics.RobertM.Kliegman,
RichardE.BehrmanHalB.Jenson,BonitaF.Stanton,18thEdi5on,
Elsevier2007
UrgnciaPeditricaIntegradadoPortoUPIP.Administrao
RegionaldeSadedoNorte,I.P,2008
UpToDateinPediatrics.SheldonKaplanet.al,WoltersKlower2012
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Vomi%nginInfant
Pediatrics,May2012
HugoSousa
RafaelaParreira
SlviaFarraposo
Ta5anaQueirs