Vomiting and Gastroesophageal Reflux

Chapter 41 Vomiting and Gastroesophageal Reflux





ETIOLOGY





How Do I Categorize Causes of Vomiting?


It is useful to classify causes of vomiting depending on the age of children. Table 41-1 lists some common and uncommon causes of vomiting in three different age groups. Remember that regurgitation or spitting up is common in infants and indicates physiologic gastroesophageal reflux, not true vomiting. Viral gastroenteritis and gastroesophageal reflux are common causes at all ages, although they tend to occur predominantly in infants and younger children. Infections outside the gastrointestinal tract (extraintestinal infections), such as otitis media, pneumonia, and urinary tract infection, are more likely to cause vomiting in younger children than in adolescents. Persistent vomiting in neonates or infants should raise suspicion about anatomic obstructions in the gastrointestinal tract such as intestinal atresia, malrotation, or pyloric stenosis. Peptic disorders such as Helicobacter gastritis or duodenal ulcer are seen most often in adolescents. Raised intracranial pressure is an important condition that can cause vomiting at any age. The likely causes of raised intracranial pressure are meningitis and hydrocephalus in infants and brain tumors in older children. Motion sickness can cause vomiting in children and adolescents. Cyclic vomiting syndrome is an uncommon disorder characterized by recurrent episodes of vomiting separated by symptom-free intervals, without any obvious organic cause.


Table 41-1 Causes of Vomiting According to Age



































































































Infant (< 1 yr) Child (1–12 yrs) Adolescent (> 12 yrs)
Common
Gastroesophageal reflux Gastroesophageal reflux Gastroesophageal reflux
Gastroenteritis Gastroenteritis Peptic disorders
Viral (rotavirus) Viral (rotavirus) Duodenal ulcer
Bacterial Bacterial Gastritis (Helicobacter)
Anatomic obstruction Extraintestinal infections Gastroenteritis
  Pyloric stenosis   Otitis media Toxic/medications
  Intestinal atresia   Urinary tract infection Extraintestinal infections
  Intussusception   Sinusitis   Sinusitis
  Malrotation   Pneumonia   Pyelonephritis
Extraintestinal infections
  Otitis media    
  Urinary infection    
  Pneumonia    
Uncommon
↑Intracranial pressure Anatomic obstruction ↑Intracranial pressure
Meningitis Malrotation Meningitis
Hydrocephalus ↑Intracranial pressure Brain tumor
Inborn errors of metabolism Meningitis Pancreatitis
Milk protein intolerance Brain tumor Appendicitis
Pancreatitis Cancer chemotherapy
Appendicitis Cyclic vomiting syndrome
Cancer chemotherapy Pregnancy
Cyclic vomiting syndrome Migraine
Motion sickness Motion sickness
Psychogenic  



EVALUATION


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Jun 19, 2016 | Posted by in PEDIATRICS | Comments Off on Vomiting and Gastroesophageal Reflux

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