Beruflich Dokumente
Kultur Dokumente
in Infant
Summary
Pediatrics
Deni%ons
Encompasses
all
retrograde
ejec5on
of
gastrointes5nal,
or
esophageal
,
contents
from
the
mouth
Subdivided
according
to
its
forcefulness
None
Minimal
Moderate
Severe
Esophageal
emptying
Regurgita5on
Vomi5ng
Projec5le
vomi5ng
with
retching
Pediatrics
Vomi%ng
in
Infant
Clinical History
Physical Examina%on
Hospitaliza%on
Pediatrics
Clinical
History
ant?
ld
is
the
inf How
o
ealth?
e
general
h h How
is
t ng
like?
the
vomi% What
is Volume
cy
Frequen
Content
d
of
the
day Perio ons
ral
associa5 i5ng
Tempo
reduce
vom res
to Procedu ms?
ted
sympto
associa Are
there
Pediatrics
on hydra5 i5ng re de Seve trollable vom on Unc to feed n f u se ydra5o o reh Re rance t le Into ng ethiology i5 Vom environment al Soci
Pediatrics
Complica%ons
of
Vomi%ng
Pediatrics
Pediatrics
Vomi%ng
in
Infant
Pathologies
Neurologic
Neurosurgery
Surgical
Gastrointes%nal
Infec%ous
Metabolic
Pediatrics
Vomi%ng
in
Infant
Pathologies
Neurologic
Neurosurgery
Surgical
Gastrointes%nal
Infec%ous
Metabolic
Pediatrics
Surgical Pathology
Pediatrics
Surgical Pathology
Pediatrics
Surgical Pathology
Pediatrics
Surgical Pathology
Nonbilious vomi5ng AQer 3 weeks of age 1st week 5th month Progressive Imediately acer feeding May follow each feeding Intermibent
Pediatrics
Surgical Pathology
Ultrasound
Contrast studies
Double Pyloric lenght > 14 m the Mid epigastrum The diagnosis can be established clinically 60-80% of m %me by an tract sign
experienced examiner
Pediatrics
Surgical Pathology
Preopera%ve treatment
Pediatrics
Surgical
Pathology
Intes%nal
obstruc%on
Nonbilious vomi5ng
Bilious emesis
Pediatrics
Surgical
Pathology
Malrota%on/volvulus
Pediatrics
Surgical
Pathology
Malrota%on/volvulus
Bilious emesis
Abdominal pain
Pa%ents of any age with a rota%onal anomaly can develop acute bowel threatening volvulus without pre-exis%ng symptoms
Pediatrics
Surgical
Pathology
Malrota%on/volvulus
Ultrasound
Inversion
of
the
superior
mesenteric
artery
and
vein
Malrota%on
with
volvulus
Duodenal
obstruc5on
Thickened
bowel
loops
to
the
right
of
the
spine
Free
peritoneal
uid
Contrast studies
Pediatrics
Surgical
Pathology
Malrota%on/volvulus
Surgical treatment
Persistent symptoms
Pediatrics
Vomi%ng
in
Infant
Pathologies
Neurologic
Neurosurgery
Surgical
Gastrointes%nal
Infec%ous
Metabolic
Pediatrics
Gastrointes%nal
Pathology
Gastroesophageal
reux
Recurrent post-prandial spi\ng and vomi%ng in healthy infants that resolves spontaneously
Evident at 1st months of life (peak 4mo) Resolve in most cases by 12mo Pediatrics
Gastrointes%nal
Pathology
Gastroesophageal
reux
Thickened Feeds
Hypoallergenic Diet
Pediatrics
Gastrointes%nal
Pathology
Gastroesophageal
reux
disease
Irritability
Feeding refusal
Pediatrics
Gastrointes%nal
Pathology
Gastroesophageal
reux
disease
Radiographic studies
Endoscopic studies
Pediatrics
Gastrointes%nal
Pathology
Gastroesophageal
reux
disease
Lifestyle changes
Surgery
Pediatrics
Gastrointes%nal
Pathology
Gastroenteri%s
Parasi5c agents
Bacterial agents
Pediatrics
Gastrointes%nal
Pathology
Gastroenteri%s
Pediatrics
Gastrointes%nal
Pathology
Gastroenteri%s
Pediatrics
Gastrointes%nal
Pathology
Gastroenteri%s
Absence of gross blood, mucus and fecal leukocytes Water diarrhea Stool pH <6
Age <2
Virus
Reducing Substances
Pediatrics
Gastrointes%nal
Pathology
Gastroenteri%s
Pediatrics
Gastrointes%nal
Pathology
Gastroenteri%s
Pediatrics
Vomi%ng
in
Infant
Pathologies
Neurologic
Neurosurgery
Surgical
Gastrointes%nal
Infec%ous
Metabolic
Pediatrics
Infec%ous
Pathology
Urinary
t
ract
infec%on
Clinical Manifesta5ons Epidemiology 8% of girls and 2% of boys will acquire UTIs in childhood Diagnosis Urinalysis Uroculture E5ology E coli (>85%) Treatment An5bio5c Non specic
Pediatrics
Vomi%ng
in
Infant
Pathologies
Neurologic
Neurosurgery
Surgical
Gastrointes%nal
Infec%ous
Metabolic
Pediatrics
Subdural hematoma
Hydrocephalus
Cerebral edema
Pediatrics
Vomi%ng
in
Infant
Pathologies
Neurologic
Neurosurgery
Surgical
Gastrointes%nal
Infec%ous
Metabolic
Pediatrics
Metabolic
Pathologies
Symptoms Progressive vomi5ng Severe dehydra5on Cyclic vomi5ng Changes in consciousness Neurological signs and symptoms
Galactosemia, fructosemia
Pediatrics
Conclusion
Vomi5ng
Clinical
history
Physical
examina5on
Level
of
dehydra5on
Vomi5ng
with
symptoms
No
red
ags
Fever,
diarrhea,
respiratory
symptoms,
ORL,
urinary
Isolated vomi5ng Dehydra5on Mild Moderate Frac5onated oral hydra5on Persistent vomi5ng Severe Urinary test Ionogram Renal func5on Fluid therapy
Red ags Shock Bilious emesis Hematemesis Drowsiness Severe abdominal pain/disten5on Acute liver dysfunc5on Respiratory troubles Refusal to feed Malnutri5on Dehydra5on
Keep
in
mind
Vomi5ng and regurgita5on are commonly encountered symptoms in childrens Most commonly vomi5ng is the result of acute, self-resolving ilnesses In some cases, the features of vomi5ng allow to dis5nguish the main causes Hypertrophic pyloric stenosis, gastroenteri5s and EGR are the most common diseases in infants Always keep in mind RED FLAGS!
Pediatrics
Bibliography
Pediatrics:
Current
Diagnosis
&Ttreatment.
William
Hay,
Myron
Levin,
Judith
Sondheimer
and
Robin
Deterding,
19th
Edi5on
,
Lange
LangePaediatrics
and
Child
Health.
Mary
Rudolf
and
Malcolm
Levene,
2nd
Edi5on,
Blackwell
Publishing
2006
Prac9cal
Strategies
in
Pediatric
Diagnosis
and
Therapy.
Larry
A.
Greenbaum
and
Patricia
S.
Lye,
2nd
Edi5on,
Elsevier
Inc.
2004
Kliegman:
Nelson
Textbook
of
Pediatrics.
Robert
M.
Kliegman,
Richard
E.
Behrman
Hal
B.
Jenson,
Bonita
F.
Stanton,
18th
Edi5on,
Elsevier
2007
Urgncia
Peditrica
Integrada
do
Porto
UPIP.
Administrao
Regional
de
Sade
do
Norte,
I.P,
2008
UpToDate
in
Pediatrics.
Sheldon
Kaplan
et.
al,
Wolters
Klower
2012
Pediatrics
Vomi%ng in Infant