Vomiting – Projectile

• Inflammatory
  –Gastroesophageal reflux disease
  –Peptic ulcer disease
  –Pyelonephritis
  –Meningitis
  –Encephalitis
  –Eosinophilic enteropathy
• Central nervous system
  –Brain tumor
  –Trauma
  –Lead encephalopathy
  –Acute intracranial hemorrhage
  –Hydrocephalus
• Metabolic/endocrine
  –Congenital adrenal hyperplasia
  –Hypercalcemia
  –Wolman disease
  –Phenylketonuria

Workup and Diagnosis

• Differentiating vomiting from projectile vomiting is often difficult when obtaining history
• History: Age at presentation, frequency and amount of emesis, time after feeding until emesis, bilious or nonbilious, hematemesis, weight loss, fever, diarrhea, abdominal pain, melena, hematochezia, activity level, dysuria, menses, pica, recent trauma
• Birth history: Meconium in nursery, oligohydramnios, polyhydramnios, newborn screen, birth weight
• Family history: First born
• Diet history: Formula intolerance
• Surgical history: Previous abdominal surgeries
• Social history: House built before 1965 (lead paint)
• Physical exam: Weight, height, head cirumference, vital signs, mucous membranes, fontanelle, papilledema, equal breath sounds, abdominal distension, abdominal mass (palpable olive in pyloric stenosis), bowel sounds, skin turgor, capillary refill, reflexes, tone, strength
• Chemistry panel with focus on chloride, CO2, potassium, calcium; CBC with differential for signs of infection, consider urine analysis and culture
• Abdominal films for obstruction
• Ultrasound a sensitive and specific method for pyloric stenosis; findings of elongation of pyloric channel and thickening of pyloric muscle; U/S for pelvic obstruction
• Upper GI series for malrotation, atresia, superior mesenteric artery
• CT scan for head or abdominal mass

Treatment

• Maintain fluid balance
• Correct electrolytes
• Surgical correction
  –Pyloroplasty for pyloric stenosis
  –Ladd procedure for malrotation
• Treat infections
• Superior mesenteric artery syndrome
  –May require nasojejunal feeds/TPN
• Acid blockers for gastroesophageal reflux
• Amino acid or hydrolysate formula for milk allergy
• PKU
  –Avoid phenylalanine (requires special formula, dietary restrictions until maturation, possibly lifelong)

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 Vomiting

Read excerpts from these other book chapters related to Vomiting:

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

More About Causes of Vomiting

• Back to symptom: Vomiting: Introduction (review 2586 causes)
• Next Book Extract About Vomiting: NAUSEA AND VOMITING (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Vomiting

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

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