Brief discussion about vomiting in the pediatric age group

1. VOMITING IN THE
PEDIATRIC AGE
GROUP
MARIA, MEDICAL STUDENT, TSMU

2. INTRODUCTION
 Forceful oral emptying of gastric contents
 Common problem in children
 Vomiting is usually preceded by nausea and is accompanied by
forceful gagging and retching.
 Vomiting should be distinguished from regurgitation of stomach
contents.
 Regurgitation is effortless and not preceded by nausea.

3. ETIOLOGY
 Obstruction of GI tract
1) Esophageal atresia
2) Foreign bodies
3) Achalasia
4) Chagas disease
5) Pyloric stenosis
6) Eosinophilic gastroenteritis
7) Crohn disease
8) Meconium ileus
9) Meckel diverticulum with
volvulus or intussusception
10) Inguinal hernia
11) Hirschsprung disease
12) Ulcerative colitis
 Non obstructive lesions of GI
-diseases of
1) Pancreas
2) Liver
3) Biliary tree
 CNS derangements
 Migraine-related mechanism
 Mitochondrial disorders
 Sympathetic autonomic
dysfunction

4.  If obstruction occurs below the second part of the duodenum,
vomitus is usually bile stained.
 Emesis can also be bile stained with repeated vomiting in absence
of obstruction when duodenal contents are refluxed into stomach.
 Cycle of vomiting
 numerous episodes of vomiting interpersed with well intervals.
 Due to infections, physical stress, psychologic stress

5. PATHOPHYSIOLOGY
 Highly coordinated reflex process that may be preceded by increased
salivation and begins with involuntary retching.
 Violent descent of the diaphragm and constriction of abdominal muscles
with relaxation of gastric cardia actively force gastric contents back up
the esophagus.
 This process is coordinated in the medullary vomiting center
 Directly influenced by afferent innervation
 Indirectly influenced by
1. Chemoreceptors in the trigger zone
2. Higher CNS centers

6. DIFFERENTIAL DIAGNOSIS

7. DIFFERENTIAL DIAGNOSIS

8. COMPLICATIONS
 METABOLIC DISORDERS
 Dehydration
 Alkalosis
 Hypochloremia
 Hyponatremia
 NUTRITIONAL DISORDERS
 Malnutrition
 MALLORY-WEISS TEAR
 ESOPHAGITIS
 ASPIRATION
 Pneumonia
 SHOCK
 PNEUMOMEDIASTINUM
 PNEUMOTHORAX
 PETECHIAE
 RETINAL HEMORRHAGES

9. DIAGNOSIS
 History
 Physical examination
 Abdominal x-ray
 Foreign body obstruction
 Volvulus
 Endoscopy
 Ultrasonography
 Pyloric stenosis
 Intussusception
 Inguinal hernia
 Contrast GI radiography
 Brain MRI
 Metabolic studies
 Lactate
 Organic acids
 ammonia

10. TREATMENT
 Anti-emesis drug
 Ondansetron
 GER
 Dopamine antagonist – Metoclopramide
 Intestinal pseudo obstruction
 Octreotide
 Motion sickness and vestibular disorders
 Antihistamine – dimenhydrinate
 Anticholinergic – scopolamine

11. TREATMENT
 Antimigraine antiepileptic – Phenobarbital and erythromycin
 Pyloric stenosis – Pyloromyotomy
 Appendicitis - Appendectomy
 Volvulus - Antibiotics and Elective laparoscopic sigmoid resection and
right hemicolectomy after laparoscopic decompression
 Acute gastritis – ondansetron or metoclopramide

12. SUPPORTIVE AND NONPHARMACOLOGICAL
TREATMENT
 Rehydration
 IV fluids
 Electrolytes
 Transfusion
 Malnutrition – NG or NJ drip feeding
 Esophagitis
 Proton pump inhibitors
 H2 blockers
 Famotidine
 Cimetidine
 Ranitidine
 Intussusception - Air reduction enema

13. PREVENTION
 Lifestyle changes
 Prophylactic medications
 Cyproheptadine
 Propranolol
 Amitriptyline
 Phenobarbital

14. REFERENCES
 https://www.medscape.com/viewarticle/711641_3
 Nelson pediatrics book 19th edition