Vomiting in Children
Vomiting in Children
Vomiting in Children
Definition
Vomiting stomach is evisceration
with active force due to the
contraction of the abdomen , pylorus ,
elevation cardia with the lower
esophageal sphincter relaxation and
dilation of the esophagus
Rumination is conscious
food expenditure to
chew then swallow back
Etiology
Vomiting
in
Neonatus
Non organik
Vomiting in
Neonatus
Organik
Traktus
Gastrointestinalis
Obstruksi
Non Obstruksi
Chalasia,
gastroenteritis,
irritation of
stomach acid
Vomiting
in
Neonatus
Ekstragastrointestinal
Meningitis, increased
intracranial pressure,
subdural effusion,
hidrosefalus.
Organik
Vomiting in Infants
Etiology
Non organik
eating technique
, erofagi , motion
sickness , drug
Obstruksi
Organik
Traktus
Gastrointestinalis
Non Obstruksi
pyloric stenosis ,
antral web ,
intussusception ,
volvulus
GER , lactose
intolerance ,
gastroenteritis , peptic
ulcer disease , celiac
disease , appendicitis ,
peritonitis
Ekstra gastrointestinal
Vomiting
in Infants
pertusis, tonsilofaringitis,
OMA, Uremia, Asidosis,
hepatitis, Inborn errors of
metabolism
Organik
Meningitis, Ensefalitis,
increased intracranial
pressure
Non
organik
Vomiting
in child
Obstruksi
Organik
intussusception ,
intestinal
obstruction ,
aklasia ,
appendicitis
Traktus
Gastrointestinalis
Non Obstruksi
gastroenteritis ,
appendicitis ,
gastritis , peptic
ulcer , poisoning
eating
Ekstra gastrointestinal
Vomiting
in child
Organik
Central nervous
systemSP
hidrosefalus, increased
intracranial pressure,
infection of the central
nervous system.
Pathophysiology
vomiting process consists of :
1. Nausea : This phase is characterized by a
sense of want to throw up in the stomach
and esophagus with various autonomic
symptoms such as increased salivation ,
sweating , pale , tachycardia
2. Retching:
Respiratory
muscle
spasm before vomiting occurs
Classification
Vomiting can be classified according to its nature and
cause as well as by the character of the vomitus. The
nature of the vomiting may be projectile or non projectile.
Projectile vomiting refers to forceful vomiting and may
indicate increased intracranial pressure, especially if it
occurs early in the morning. Projectile vomiting also is a
classic feature of pyloric stenosis. Non projectile vomiting is
seen more commonly in gastroesophageal reflux.
Classification
Emesis often is classified based on its quality. The
vomitus may be bilious, bloody, or non bloody and non
bilious. Emesis originating from the stomach usually is
characterized as being clear or yellow and often contains
remmants of previously ingested food. Emesis that is dark
green is referred to as bilious because it indicates the
presence of bile. Bilious vomiting frequently is pathologic
because it may be a sign of an underlying abdominal
problem such as intestinal obstruction beyond the
duodenal ampulla of Vater, where the common bile duct
emptics.
Classification
The presence of blood in the emesis, also know as
hematemesis, indicates acute bleeding from the upper
portion of the GI tract, as can occur with gastritis,
Mallory-Weiss tears, or peptic ulcer disease. Coffee
ground like material often is representative of and old GI
hemorrhage because blood darkens to a black or dark
brown color when exposed to the acidity of the gastric
secretions. The more massive or proximal the bleeding,
the more likely is it to be bright red
Clinical Manifestations
One important also to be understood in a child
who is experiencing vomiting is to determine
abnormalities requiring immediate surgery. These
disorders are generally classified into groups of acute
abdominal disease.
Sign suspicion against these disorders, :
1. Abdominal pain arising preceded by vomiting
and / or lasts for more than 3 hours.
2. Vomiting mixed with gall.
3. Abdominal distension.
Diagnosis
Approach to the identification of very important
issues, including:
1. Age and sex
2. Decide in advance what is encountered: vomiting
or other
3. How the nutritional state of children
4. Is there a predisposing factor
5. Is there a disease that strikes children interkuten
6. What form (content) vomit, whether as milk /
food origin (the sign of the esophagus), or have a
milk clot (stomach contents), containing bile
(duodenal contents) or is there blood
Laboratory Tests
Urine :
Urine complete, reduction, culture
Blood tests :
complete blood count, BUN, serum creatinine, blood
gas analysis, amino acid analysis, blood glucose,
ammonia
Treatment
1. Local effects.
Mallory-Weiss tear usually only cause minor
bleeding so that no action was necessary.
Instead rips esophagus require radical action.
2. Metabolic Effects In patients with
recurrent and prolonged vomiting can occur
fluid and electrolyte balance disorders that
require fluid and electrolyte replacement
3. Aspiration
Apirasi massive gastric contents require
anibiotika and sometimes corticosteroids
Drug Antiemetic
Symptomatic management to
reduce or eliminate symptoms of
vomiting often needs to be done
first
Phenothiazines :
Proklorperazine (Stenetil). Pervanazine (Avomit)
Tietilperazine maleate (Torecan)
Increasing acetylcholine :
Metoclopramide (Vomitrol)
Motility stimulants
Prokinetic drugs
-
receptors
Metoklopramid,
Domperidon
Increasing acetylcholine
Metoklopramid,
Cisaprid
1. Metoclopramide
Quite effective, way of working is the blockade of
dopamine receptors in the CTZ, so it can control
nausea and vomiting both centrally.
2. Domperidone
3. Cisapride
New
prokinetic
drug,
increased
spending
physiologically selective acetylcholine at the level of
post-ganglionic nerves in myenteric plexus. Do not
have the nature of the blockade of dopamine
receptors, but the increase peristaltic gastroduodenal.
in children are also effective in preventing reflux and
repair klerens of reflux in the esophagus. Dose 0,20,4mg/kg.bb/day.
4. Betanekhol
A selective kholinester with the workings of
the muscarinic receptor. In children RGE used
for therapy, a dose of 0.6 mg/kg.bb/day,
divided into 3 doses, orally 0.15 to 0.2
mg/kg.bb/day sub-cutaneous.
COMPLICATIONS
Loss of fluids and electrolytes ,
aspiration of gastric contents , malnutrition
and failure to thrive , Mallory - Weiss
syndrome
(
tear
in
epithelial
gastroesophageal junction due to repeated
vomiting ) , Boerhave syndrome ( rupture of
the esophagus ) , and peptic esophagitis.
PROGNOSIS
The prognosis of patients with symptoms of
vomiting depends on the degree of
dehydration and treatment of dehydration,
the etiology of the disease which causes
vomiting, as well as complications of vomiting
itself.
Prevention
Prevention is meant here is the
prevention of complications due to vomiting ,
such as fluid and electrolyte balance disorders
( dehydration , acidosis / metabolic alkalosis ,
hypokalemia , hyponatremia ) , aspiration ,
nutritional disorders , peptic esophagitis ,
Mallory - Weiss syndrome .
Conclusion
Vomiting is one of the most common clinical
manifestations shown by a child with disorders of
the digestive tract and out of the digestive tract .
The causes of vomiting in children vary widely ,
therefore the introduction of specific clinical
manifestations of each disease as the cause of
vomiting that often needs to be understood by a
physician . Proper approach and speedy diagnosis
would lead to optimal management .
THANK YOU