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A Child with Vomiting (problem based approach)

A Child with Vomiting (problem based approach)






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    A Child with Vomiting (problem based approach) A Child with Vomiting (problem based approach) Presentation Transcript

    • A Vomiting Child
      Sariu Ali:
    • Introduction
      Vomiting is a symptom, presenting complaint in multitude of disorders
      Range from gastrointestinal pathology to disease in distant organ (otitis media or intracranial lesion)
      In children, especially infants, must distinguish from regurgitation – effortless expulsion of gastric contents
    • Vomiting is an active process , composed of 3 linked activities : Nausea , retching, active propulsion of stomach contents
      Control of vomiting by 2 anatomic centers in the mudulla
      • Chemoreceptor trigger zone CTZ
      • central vomiting center.
    • Physiology
    • Common causes of vomiting
    • Rare causes of vomiting
    • Causes of Vomiting by systems
    • Causes of Vomiting by systems
    • History
      • Age of the patient
      • Duration /Frequency
      • Onset
      • Associated with food intake
      • instantly : esophageal obstruction
      • After a while : stomach or duodenal obstruction
      • Nature (projectile / non projectile)
      • Color and contents
      • Non digested food :proximal obstruction
      • Semi digested food : distal obstruction
      • Billous content : distal to 2nd part of duodenum
      • Fecal material : obstruction at the large intestine
      • Associated symptoms
      • Fever / Abdominal Pain /Diarrhea /constipation/ dysphagia.
    • History
      • Respiratory – cough, chest discomfort
      • Urinary– dysuria,hematuria
      • CNS – irritability, altered sensorium,drowsy, neck stiffness, headache, visual disturbance
      • Past medical history
      Any known medical illness such as metabolic inborn error, cerebral palsy, down syndrome, neurological deficit
      • Drug and allergy history
      • Birth history
      • Nutritional history
      Recently change into cow milk/ food allerrgy/ type of food
      • Other relevant history
      Recent eating outside, recent travelling, family member or friends in school have similar illness
    • Physical Examination
      • General condition
      • Comparison of patient’s weight before and after onset of illness
      • Concious level- GCS
      • Hydration status
      • Sunken frontanelle
      • Eyes sunken and tearless
      • Dry mucous membrane
      • Prolonged capillary refill time
      • Reduced skin turgor
      • Tachycardia, tacypnea
    • Look for any evidence of any specific disorder/ disease based on history
      • Abdominal Examination
      Distension/ Visible peristalsis
      Tenderness/ hepatospelnomegaly
      abdominal masses
      Bowel sounds
      • CNS Examination
      Power, Tone, reflexes
      Changes in vision
      Physical Examination
    • Respiratory Examination
      Ear examination by otoscopy
    • Investigations
      Guided by history/ PE
      Blood Investigations
      • CXR
      • Plain Abdominal Xray
      • Barium mean
      • Barium follow through
      • Cranial CT
      • Upper GI endoscopy
      • UFEME
      • Urine C/S
    • Asses the severity of dehydration
      Rehydrate accordingly
      Correct electrolyte imbalances
      Encourage oral intake
      Treat according to the underlying cause
    • References
      Nelson Text book of Peadiatrics 17th edition
      Hand book of Hospital peadiatrics 2nd edition
      Illustrated text book of paediatrics 3rd edition
    • Thank You