HA 3RD YEAR NEPAL CTEVT

2. DR. MAHESH BOKATI
 HEALTH ASSISTANT 3 RD YEAR
PEDIATRICS

3. VOMITING:

4. VOMITING
Vomiting/Emesis, is the forceful retrograde expulsion of gastric
contents.
Nausea is the unpleasant sensation that may precede vomiting.
Vomiting is somehow different from regurgitation which has been
defined as ejection of gastric contents to the mouth effortlessly.

5. Vomiting is just a Symptom in Multiple disorders, ranging from GI Pathology to
disease in distant organ(otitis media /Intracranial lesion)
In children, especially infants ,must distinguish from Regurgitation.
Vomiting occurs in three phases:
 Nausea
 Retching
 Emesis

6. Causes/Etiology:
 Acute Gastritis/Gastroenteritis
 Rota viral diarrhea
 Acute Hepatitis
 Acute Appendicitis
 Acute Pancreatitis
 Acute Cholecystitis
 Intestinal Obstruction

7. However apart from GI tract disorders ,other causes of vomiting
are-
 Acute Tonsillitis
 Motion Sickness
 Brain tumor
 Meningitis
 Hydrocephalus
 Renal Failure

8.  Approach to a patientspresenting withvomiting:
 Relevant History (Frequency,Amount,Colour & content , Blood vomiting ,
Headache/vertigo, Associated loose motion)
 Clinical Assessment
Hydration( Eyes, skin pinch, thirst)
Hemodynamic Status( Pulse, BP ,CRT)
U/O
Screening laboratory tests should include
 Electrolytes,
 CBC , RBS
 S . Creatinine
 Plain X-ray abdomen(Erect Posture)
 USG(A+P), CT/MRI Brain , CSF Study
Additional testing should be based upon the history and physical examination

9. Principles of Management:
 Fluid Replacement accordingly:
Most children can be rehydrated orally with ORS . Along with ORS feeding should be
continued(including breastfeeding) unless child is severely dehydrated or vomits everything.
However in severe dehydration/severe vomiting appropriate IV fluids(NS,DNS) is mandatory.
 Antemetic
 Treatment of the underlying disease.

10. Q. LIST THE COMMON CAUSES AND MANAGEMENT OF VOMITING

11.  It accounts for around 10% of pediatric deaths, estimating 70 million deaths per year.
Major cause of morbidity and hospitalizations.
>1.5million outpatient visits.
200,000 hospitalizations
dehydration and malnutrition
Children under 5 years of age are the most affected population, and diarrheal episodes
happen more frequently in Asia and Africa, accounting for 80% of annual incidence
Gastroenteritis in children

12. MOST COMMON CAUSES OF INFANT AND
CHILD MORTALITY IN DEVELOPING COUNTRIES.
FIRST CAUSE ? (RTI/PNEUMONIA)
DIARRHOEA:
 TYPES(Clinical)

13. Transmission of diarrhea-Feco-oral route :
Sanitation, primary
barrier can isolate the
fecal pathogens to stop
them from reaching the
environment.
Secondary barriers,
such as water treatment
and handwashing , stop
fecal pathogens in the
environment from
multiplying and reaching
new hosts and
Tertiary barriers stop
fecal pathogens , such as
household utensils ,
from reaching the host.

14. ACUTE DIARRHOEA (Commonest type) : Change in consistency and frequency of stools i.e
Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of
bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking-water,
or from person-to-person as a result of poor hygiene.
Common Organism: Rotavirus ,
Vibrio cholera, E. coli, Salmonella , Shigella
Reservoir :
Host factor : Poor hygiene, Malnutrition, Immuno-compromised , supplementary feeds , Male
Environmental factor:
Type of water source, Sanitation(safe disposal of human waste) facilities, solid waste disposal system and
floor type in the kitchen
.

15. Assessment of A Patient with Diarrhoea:
 History:
#Stools( Frequency, duration of diarrhea, and presence of Blood
etc )
#Vomiting
#Urine output
#About foods and fluid intake
# Related to recent use of antibiotic or other drugs
# H/O diarrhea or diarrhoeal deaths in family or neighbourhood
 Physical Examination: In particular to look for--
Signs of dehydration

16. Howto assessa childwithdiarrhea :

18. SKIN PINCH

21. TREATMENT FOR DEHYDRATION:
There are 3 treatment plans for treating children with dehydration
and for diarrhea.
PLAN C: SEVERE DEHYDRATION
PLAN B: SOME DEHYDRATION
PLAN A: NO DEHYDRATION

29. THE END