Flashcards in EXAM #2: VOMITING IN INFANTS & CHILDREN Deck (28)
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1
What is the definition of apnea in infants?
Apnea lasting longer than 20 seconds
2
What is GER?
Gastroesophageal Reflux--passage of gastric contents into the esophagus
*Normal process
3
What is regurgitation?
Effortless spitting up of gastric contents
4
Is pea-soup emesis worrisome? Why?
Yes--bilious emesis
5
Is projectile vomiting worriesome? Why?
Yes--pyloric stenosis
6
What are the red flags of emesis in the pediatric population?
- Bilious emesis
- GI Bleeding
- Failure to thrive
- Forceful projectile emesis
- Emesis after 6 months (should be getting better)
- Lethargy
- Bulging fontanelle
7
Where is the emetic center located?
Reticular formation of the medulla
8
Where is the chemoreceptor trigger zone?
Floor of the 4th ventricle
9
What are the signs of Gastroenteritis?
- History of ill contacts
- Fever
- Abdominal pain i.e. irritability in kids
- Diarrhea
- Nausea vomiting
- Acute onset
10
What are the common viral causes of Gastroenteritis in the pediatric population?
Rotavirus
- Adenovirus
- Norwalk virus
- Astrovirus
- Calcivirus
11
What viral cause of gastroenteritis has a vaccine?
Rotavirus
12
How is Gastroenteritis treated?
1) Hydration
2) Fever control
3) Tincture of Time
13
What are the signs of meningitis?
- Fever (high)
- Irritability
- Lethargy
- Headache
- Vomiting
- Petechia
14
What is the common viral cause of meningitis in kids?
Enterovirus
15
How does meningitis cause vomiting?
- Meningeal inflammation
- Increased ICP
16
What is the definition of GERD?
- Passage of gastric contents into the esophagus
- + symptoms
17
What are the signs of GERD in infants?
1) Feeding difficulty
2) Hematemesis
3) Failure to thrive
4) Wheezing--aspiration, lower
5) Stridor--aspiration, lower
6) Apnea
18
Why does GERD cause apnea?
Laryngospasm--airway protection mechanism
19
What is Sandifer Syndrome?
Reflux resulting in a seizure-like presentation
- Pain
- Rhythmic tensing/ alternating head movements
*This puts GERD in the differential for infantile seizures*
20
How should you begin to work-up of GERD for a child?
1) History and physical
2) Review growth chart
21
What is the initial diagnostic study for GERD?
Upper GI Series to rule out anatomic anomaly
22
What is a secondary study to perform in the initial work-up GERD?
Esophageal pH probe
23
What lifestyle modifications can be made to treat GERD in infants?
1) Increase caloric density and decrease volume
2) Thicken feeding with rice cereal
3) Use formula with rice starch or carob bean that THICKENS IN THE STOMACH
24
What medications can be used to treat GERD?
1) Antacids
2) PPI
3) H2 blockers
4) Prokinetic agents
25
What is the utility of a PPI in the diagnosis and treatment of GERD?
4 week trial can be used for diagnosis and treatment
26
What is the surgical intervention for GERD?
Nissen Fundoplication
27
What is a Nissen Fundoplication?
- Upper stomach sutured around the esophagus
- Increases the tone of the LES
28
