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Vomiting

Contents
  1. Read book excerpt
  2. Hyperemesis Gravidarum: Introduction
  3. Hyperemesis Gravidarum Misdiagnosis
  4. Hyperemesis Gravidarum Causes
  5. Hyperemesis Gravidarum Complications
  6. Hyperemesis Gravidarum Treatments
  7. Latest treatments
  8. Clinical trials
  9. Hyperemesis Gravidarum Overview
  10. More book excerpts for Hyperemesis Gravidarum

Vomiting: Excerpt from In A Page: Pediatric Signs and Symptoms

Vomiting is the forceful expulsion of gastric contents through the mouth that involves an integrated and largely somatic motor response. It represents a protective reflex in the body's defense system. Vomiting may be an initial symptom of an underlying condition or a symptom complex preceded by nausea and retching. The differential diagnosis varies with age, although each diagnosis should be entertained when seeing a patient who presents with vomiting.

Differential Diagnosis

  • Infections
    –Gastroenteritis is the most common cause among all pediatric age groups; may be viral, bacterial, or parasitic
    –Urinary tract infection/pyelonephritis
    –Sepsis
    –Meningitis
    –Viral hepatitis: e.g., Hepatitis A
    –Helicobacter pylori-related ulcer
  • Anatomic
    –Esophageal: Tracheoesophageal atresia, esophageal ring/web/stricture, achalasia
    –Gastric: Pyloric stenosis, volvulus
    –Small intestine: Duodenal atresia, malrotation, meconium ileus, duodenal hematoma, SMA syndrome, duplication, intussusception, hernia
    –Colon: Hirschprung, imperforate anus
  • Gastrointestinal
    –Gastroesophageal reflux disease
    –Allergy (e.g., celiac disease, milk protein)
    –Peptic ulcer disease
    –Appendicitis
    –Foreign body
    –Pancreatitis
    –Cholecystitis
    –Eosinophilic enteropathy
    –Pseudo-obstruction
  • Neurologic
    –Intracranial mass
    –Hydrocephalus
    –Pseudotumor cerebri
    –Migraines
  • Renal
    –Obstructive uropathy
    –Nephrolithiasis
    –Glomerulonephritis
    –Renal tubular acidosis
  • Toxins/drugs
    –Aspirin, theophylline, digoxin, lead
    –Chemotherapeutics
  • Pregnancy
  • Inborn errors of metabolism
  • Endocrine
    –Diabetic ketoacidosis
    –Adrenal insufficiency
    –Congenital adrenal hyperplasia
  • Respiratory
    –Pneumonia
    –Post-tussive

Workup and Diagnosis

  • History and physical crucial because of large differential
    • History
      –Duration, frequency, bilious material, abdominal pain, diarrhea, hematemesis, hematochezia, melena, headache, fever, dysuria, weight loss, urine output
      –Sick contacts, cough, rhinorrhea, neck stiffness
    • Birth history: Polyhydramnios, passage of meconium
    • Family history: Genetic disease, early childhood deaths
      • Physical exam
        –Vitals, weight, mucous membranes, nasal discharge, breath sounds, rashes, meningismus
        –Abdominal pain/distension, hepatosplenomegaly, abdominal masses, Murphy/obturator/psoas sign
        –Skin turgor, capillary refill
        –Neuro exam including funduscopy for papilledema
      • Labs: Initial screen based on physical exam
        –Consider electrolytes, LFTs, amylase, lipase
        –U/A and culture; lactate and pyruvate
        –Serum amino acids/urine organic acids, ammonia for metabolic diseases; blood gas for acidosis
        –CBC for infections, lumbar puncture
    • KUB or obstruction series as initial X-ray
    • Contrast study with upper GI series with or without small bowel follow-through or BE for anatomic problem
    • Abdominal ultrasound for pyloric stenosis
    • Head imaging including CT/MRI
    • Upper endoscopy and colonoscopy for mucosal inflammation

    Treatment

    • Stabilize patient and fluid resuscitation as initial therapy with electrolyte correction
    • Surgical consultation if obstruction suspected
    • Oral rehydration with small amounts of liquids if tolerated
    • If signs of obstruction, nasogastric tube decompression and bowel rest
    • Treat infections if indicated
    • Remove toxins and allergens
    • Surgical interventions for volvulus, Hirschprung, intracranial masses, pyloric stenosis, other anatomic causes
    • Correct metabolic derangements
    • Lifelong gluten-free diet for celiac disease
    • Rare use of antiemetics/promotility agents for chemotherapy, motion sickness, postsurgery, gastroesophageal reflux disease

    Book Source Details

    • Book Title: In A Page: Pediatric Signs and Symptoms
    • Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
    • Year of Publication: 2007
    • Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

    More About Hyperemesis Gravidarum

    More Medical Textbooks Online about Hyperemesis Gravidarum

    Review other book chapters online related to Hyperemesis Gravidarum:

    Medical Books Excerpts
    • Vomiting
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • Nausea
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Vomiting
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Nausea
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Vomiting
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Nausea and Vomiting
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Vomiting
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Nausea
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Vomiting
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Nausea
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Vomiting
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
     

    Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.



    More About This Book:
    Title: In A Page: Pediatric Signs and Symptoms
    Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
    Publisher: Lippincott Williams & Wilkins
    Copyright: 2007
    ISBN: 1-4051-0427-9

     » Next page: Vomiting – Projectile (In A Page: Pediatric Signs and Symptoms)

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