7/27/2019 Vomiting Baby

1/3

Vomiting Baby

Hx:1) Ask: age of patient, duration of sx, what is being vomited, fever

2) Age limits DDx

3) Bilious distal to pylorus; non-bilious proximal to pylorus

4) Fever infection

5) Hunger evaluates how sick patient is6) Tearing, skin turgor, UOP (diapers), lethargy evaluates volume status

PE:1) palpable pyloric obstruction?2) does NGT go down?3) Signs of shock/dehydration4) Palpable mass?

DDx:

1) Overfeeding and not allowing child to burp most common causes of vomiting

2) Esophageal atresia without tracheoesophageal fistulaa. Sx: vomiting with first feed, lots of salivab. Cant get NGT downc. Rad: CXR to see coiled NGT and (-) gas in abdomend. Tx:

i. Suction blind pouchii. IVFsiii. Stretch esophagus before anastomosis with stomach

3) Esophageal atresia with TEFa. 90% of esoph. atresia cases have fistulasb. Type A: no fistula

c. Type B: fistula to trachea from proximal esophagusd. Type C: fistula from distal esophagus (most common type)e. Type D: fistula from both proximal and distal esophagusf. Type E: H-type fistula from continuous esophagusg. Sx: excessive oral secretions, vomitingh. Signs: respiratory compromise, aspiration pneumonia, gastric distensioni. Rad:

i. CXR to see coiled NGii. Abdominal xray (+) gas in abdomeniii. U/S of kidneys (renal problems associated with TEF)iv. Cardiac echo (cardiac problems associated with TEF)

j. Tx: i. Initial: prevent pneumonia1. suction the pouch2. Abx3. upright position4. stretching of esophagus

ii. Surgery:1. thoracotomy: division of fistula + esophageal anastomosis2. if Type E, then right neck incision to sever fistula

4) Hiatal hernia

a. pressure in stomach GERD

7/27/2019 Vomiting Baby

2/3

7/27/2019 Vomiting Baby

3/3

i. abdominal xray showing Neuhausers sign (soap bubble appreance ofmeconium mixing with air)

ii. barium enema showing microcolon from disusee. Tx:

i. Gastrografin enema: contrast is hypertonic drawing fluid into lumen, releasingmeconium

9) Volvulusa. Sx: bilious vomiting

b. Rad:i. UGI with SB followthrough shows ligament of Treitz shifted to Rii. Barium enema shows abnormal position of cecum

10)Hirschsprungs dz/toxic megacolona. Most common cause of neonatal colon obstructionb. Sx: no stools, bilious emesisc. Rad: abdominal xray shows dilated colond. Bx: (-) gland cellse. Tx: limited lap with multiple bx

11)Intussusceptiona. Sx: irritable, crampy abdominal pain,oral intake, current jelly stool (blood + sloughed

mucosa)b. Signs: (-) BS in RLQ b/c cecum pushed out of RLQc. Mechanism: Ileum telescoping into cecum; can get so bad that patient presents with

rectal prolapsed. Age: 10 month old, range = 6 mon 3 yrs (usually b/c of hyperplasia of lymphoid tissue

in distal ileum or Meckels diverticulum acting as a lead point); in adults with suspectedintussusception, think of cancer or Meckels diverticulum as a lead point; if recurrentintussusception, think about lead points (i.e. Meckels diverticulum) and do surgery

e. Tx:i. Fluids + Abxii. Reduction via barium/air enema (contraindicated in pts with perforation or

peritoneal signs)iii. Reduction via surgery (squeeze colon distally so that SB comes out)iv. Concurrent appendectomy if surgery is indicated

12)Others: foreign bodies, chemicals13)Note: the lower in GI tract obstruction if located, longer after birth it takes to vomit