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VOMITING AFTER THE NEWBORN PERIOD

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  • distinguish from regurgitation (passive ejection of gastric contents
    secondary to reflux)
Infectious

GI causes:

  1. gastroenteritis
  2. peritonitis
  3. appendicitis
  4. hepatitis
  5. ulcers
  6. pancreatitis

Non-GI causes:

  1. UTI
  2. otitis media
  3. CNS infection
  4. raised ICP
  5. almost any infection
  6. drugs
  7. foreign body

Anatomic

GI tract obstruction
  1. intussusception (see below)
  2. foreign body e.g. bezoar

Gastroesophageal reflux
  1. usually temporary relaxation of lower esophageal sphincter
    ----> decreased gastric emptying
  2. presents with recurrent vomiting after feeds and FTT
  3. most outgrow reflux by 18 months of age
  4. conservative management: thickened feeds, elevate bed to 30 degrees
  5. esophagograms may miss, pH studies are preferred
  6. treat only if symptomatic or poor weight gain medication e.g. cisapride, H2 blockers
  7. if unresponsive to medication: surgery - Nissen fundoplication
  8. complications: aspiration, esophageal bleeding, stricture formation, apnea
Central Nervous System

  1. increased ICP
    • hydrocephalus
    • neoplasm 
  2. drugs/intoxicants 
  3. migraine
  4. meningitis, encephalitis

Other 

  1. metabolic/endocrine e.g. DKA, inborn errors, liver failure 
  2. poisons/drugs: e.g. lead, digoxin, erythromycin, theophylline 
  3. psychogenic: e.g. rumination syndrome, bulimia, anorexia, cyclic vomiting 
  4. food allergy 
  5. regurgitation
  6. overfeeding
VOMITING AFTER THE NEWBORN PERIOD VOMITING AFTER THE NEWBORN PERIOD Reviewed by Radiology Madeeasy on December 29, 2010 Rating: 5
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