Vomiting

Question 1

What are the differentials for bilious vomiting in neonates?

Answer 1

1) Duodenal atresia
2) Malrotation with volvulus
3) Jejunoileal atresia
4) Meconium Ileus
5) Necrotizing ileus

Question 2

What is posseting?

Answer 2

The return of small amounts of milk, often accompanying the return of swallowed air (wind)

Question 3

What are the differentials for persistent vomiting in isolation?

Answer 3

1) Normal posseting
2) Over-feeding
3) GORD
4) Pyloric stenosis

Question 4

What causes GORD in infants?

Answer 4

Functional immaturity of the LOS - episodes result from inappropriate relaxation

Question 5

How is mild GORD managed?

Answer 5

Addition of thickening agents to food and adjusting position after feeds

Question 6

How is severe GORD managed?

Answer 6

Drugs that enhance gastric emptying, e.g. domperidone

Question 7

What are the complications of GORD?

Answer 7

1. Failure to thrive
2. Feeding problems
3. Oesophagitis
4. Pulmonary aspiration, leading to pneumonia
5. Oesophageal stricture
6. Dystonic movements of the neck - Sandifer’s syndrome
7. Apnoea - in pre-term infants

Question 8

During what age range does pyloric stenosis present?

Answer 8

2-7 weeks

Question 9

What is pyloric stenosis?

Answer 9

Hypertrophy of the pylorus causing gastric outlet obstruction

Question 10

What is the sign on palpation of pyloric stenosis?

Answer 10

An ‘olive’ mass. Palpable in the RUQ, but because the stomach will be distended with air, suctioning via NG tube may be necessary to allow palpation

Question 11

How is pyloric stenosis Dx?

Answer 11

USS

Question 12

How is pyloric stenosis managed?

Answer 12

Pyloromyotomy - when the muscle of the pylorus, but not the mucosa, is cut