Vomiting Infants

Question 1

three possible causes of vomiting in the peds popuation

Answer 1

• meningitis
• gastroenteritis
• non -reflux causes: CHF, respiratory, overfeeding self-induced…

Question 2

5 warning signs of vomiting that require medical investigation

Answer 2

GI bleeding
forceful projective emesis
difficulty swallowing
…

Question 3

Define Gastroesophageal reflux disease

Answer 3

when there is more than just GER but some underlying disease

ex) hematemesis; regurg; difficulty feeding

Question 4

work up of patient that has GERD

Answer 4

• history and physical - use growth chart!
• initial study is UPPER GI - barium swallow ( anatomic study)
• esophageal pH probe - checking for reflux disease over 24 hr period

Question 5

basic medical plan for tx of GERD

Answer 5

• lifestyle mod
• infants: increase caloric density and decrease volumes of feeding; thicken feedings with rice cereal; use a formula with rice starch or carob bean gun (thickens in the stomach)
• children: avoid high fat, spicy, caffeine, chocolate, alcohol and tobacco; maintain healthy weight
• MEDS= ANTACIDS; neurologically normal children=4 week trial of PPI (OLDER KIDS)
• H2 blockers
• Prokinetic agents

Question 6

rumination definition

Answer 6

the voluntary, habitual, and effortless regurgitation of recently ingested food

Question 7

vomiting definition

Answer 7

forceful expulsion of gastric contents

Question 8

regurgitation defintion:

Answer 8

spitting up is an effortless passage of gastric contents into the pharynx or mouth - half of infants do this at least once a day

Question 9

Gestoesophageal reflux definition:

Answer 9

passage of gastric contents into the esophagus (normal for infants) - common after eating occurence

Question 10

when does regurgitation/spiting up stop in a child?

Answer 10

by 12 mo most stop

Question 11

When is it most common for children to get meningitis?

Answer 11

<1 mo

Question 12

What are the most common bugs that cause meningitis?

Answer 12

S Pneumo
N mening
H Influen
Listeria
GBS

Question 13

How does meningitis cause vomiting?

Answer 13

Inc intracranial pressure –> vomiting somehow

Question 14

How does gastroenteritic cause vomiting?

Answer 14

distension or irritation of the GI tract from various causes - mediated by serotonin receptors

Question 15

Sandifer syndrome

Answer 15

Like a seizure but its GERD!!!

Question 16

Other GERD diagnostic tests:

Answer 16

• combined mult inraluminal impedance and pH monitioring: measures fluids, air and solids in the esophagus along with pH changes
• esophageal manometry: assesses esophageal peristalsis and upper esophageal sphincter and LES pressures
• Endoscopy with biopsy
• scintigraphy: allow for the assessment of both reflux and aspiration (nuclear tag)

Question 17

Someone has asthma and youre doing all the right things but its just not helping – what to think?

Answer 17

reflux? GERD or vice versa