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Symptoms » Nausea » Book Sections
 

Vomiting

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.

    Other Book Chapters Related to Nausea

    Read excerpts from these other book chapters related to Nausea:

    Medical Books Excerpts
    • Vomiting
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • Vomiting
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Nausea
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Vomiting
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Nausea
    • "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 ]
    • Vomiting
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Nausea
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Vomiting
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • Nausea
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
     

    Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

    More About Causes of Nausea



    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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