VOMITING

Vomiting

overt reflux

passage of gastric contents into the mouth

Reflux

Movement of gastric contents retrograde Into esophagus or more proximal

Food/ Drink

Gases

Gastric Acid

REFLUX

OVERT

OCCULT

INTO THE MOUTH

INTO THE ESOPHAGUS

TO RESP. TRACT

VOMITING

LARYNGITIS

PNEUMONIA ASPIRATION

REFLUX
GASTRIC PRESS. > ESOPH. PRESS. GASTRIC PRESS. = ESOPH. PRESS.

OBSTRUCTION PERISTALSIS

FUNCTION

HIATAL HERNIA

IN

OUT

Lower Esophageal Sphincter (LES) RELAXATION

Gastric Outlet Obstruc. Pyloric Stenosis

AbdomInal Tumor

LES RELAXATION

TRANSIENT

CONTINOUS

Gastroesophageal reflux

Chalasia

SLIDING HIATUS HERNIA

HIATAL HERNIA = PARTIAL THORACIC STOMACH PARAESOPHAGEAL HERNIA = ROLLING

REFLUX
FOOD/DRINK

GASES

GASTRIC ACID = ACID REFLUX

ERUCTATION

HICCUP = SINGULTUS = CEKUKAN

HEART BURN = PYROSIS = SENDAWA

Metaplasia Epithel of esophagus Barrets esophagus

ULCUS
bleeding stricture

CONSEQUENCES OF REFLUX
1.- SINGULTUS - ERUCTATION 2. HEART BURN = SENDAWA 3. ESOPHAGITIS & BARRETS ESOPHAGUS 4. CHRONIC PNEUMONIA ASPIRATION 5. FAILURE TO THRIVE (FTT) 6. LARYNGITIS 7. RUMINATION 8. SANDIFERS SYNDROME 9. FOOD REFUSAL

VOMITING

RETURN OF FOOD/DRINK FROM THE STOMACH TO THE MOUTH

TRUE VOMITING

REGURGITATION = SPITTING = MINTAR = GUMOH PATHOLOGIC COMPLICATION (GASTROESOPHAGEAL DISEASE = GER Disease)

PHYSIOLOGIC
GER

Gastroesophageal reflux (GER)

Physiologic passage of gastric content to esophagus Transient LES relaxation

Gastroesophageal reflux - 50% of infant 0-3 months of age - 25% of infant 3-6 months of age - 5% of infant 10-12 months of age

Resolving in most by 12 months and nearly all by 24 months

Gastro Esophageal Reflux Disease (GERD)

GER that causes symptoms or complications that effect quality of life

GERD VOMITING - Not all vomiting are GERD - Many GERD children do not vomit

TRUE VOMITING
NAUSEA RETCHING FORCEFUL GASTRIC CONTENTS/ INTRA ABDOMINAL PRESSURE SYMPTOMS OF AUTONOMIC NERVUS SYSTEM (+)

REGURGITATION
THE YOUNG BABY NOT MATURE L.E.S. NAUSEA (-) NOT FORCEFUL SYMPTOMS OF ANS (-)

RUMINATION
- RETURN OF FOODS INTO THE MOUTH - FOODS RECHEWED - FOODS REINGESTED

NAUSEA
- UNPLEASANT SENSATION & OFTEN CULMINATING IN VOMITING - CONTRACTION OF PYLORIC ANTRAL - SYMPTOMS OF ANS (+)

VOMITING IN INCREASE INTRACRANIAL PRESSURE

- PROJECTILE - NAUSEA (-) - RETCHING (-)

DIAGNOSIS GER
1. History 2. Body weight poor weight gain ? 3. Diagnostic Test - Upper GI series rule out anatomical abnormalities - pH probe (12-24 hours) GOLD STANDARD - Scintigraphy - Endoscopy complication

TREATMENT GER 1. Conservative therapy 2. Pharmacotherapy 3. Surgery Nissen Fundoplication

Conservative Therapy 1. Prone position and upright position : - The infant is awake and observed
SIDS 2. Small frequent feeding 3. Thickening of formula

Pharmacotherapy 1. Acid Neutralization : Antacids 2. Antisecretory ( Cimetidine, Ranitidine, Omeprazole, etc) 3. Prokinetic - Metoclopramide Extrapyramidal Symptoms - Bethanechole Bronchospasme - Cisapride : 0,2 mg/kg/dose 3 or 4 x daily Arrythmia

VOMITING

SURVIVAL VALUE

DEFENSE

- UNDERLYING - COMPLICATION

TOXIC

THREATENING

COMPLICATION OF TRUE VOMITING

1. Body Fluids Imbalance - dehydration - hyponatremia - hypokalemia - hypochloremia - hypocalcemia ==> tetany - metabolic alkalosis 2. Mallory Weiss Syndrome 3. Pneumonia aspiration 4. Intake - hypoglicemia - starvation - Failure To Thrive - Metabolic acidosis

VOMITING
Na+ Hyponatremia H+ Water K+ Cl-

Met. Alk.

dehydration Hypokalemia Hypochloremia hypovolemia

hypocalcemia

RBF
Renin

Loss of H+

Aldosteron

Loss of K+

Retention of Na+ & Water

VOMITING

DIGESTIVE TRACT

OUTSIDE

Surgery

Medical - psychogenic - neurogenic: int.cran. press. - systemic:sepsis - hemodynamic

- obstruction - inflammation - perforation

- gastritis - peptic ulcer - Gastroenteritis

MANAGEMENT 1. STABILIZATION OF GENERAL CONDITION Body Fluids Imbalance

2. PROTECTION AGAINST ASPIRATION 3. CAUSAL ABDOMINAL EMERGENCY

4. CALORI/ PROTEIN
PNEUMONIA ASP. 5. COMPLICATIONS

CEREBRAL EDEMA
6. ANTIEMETIC DRUGS NO RECOMMENDED

ANTI EMETIC

1. DOPAMINE receptor antagonist - metoclopramide - domperidone 2. Cannabinoid (dronabinol) 3. Anticholinergic (Scopolamine) 4. 5HT3 receptor antagonist - ondansetron 5. Phenothiazine dan anti histamin - phenergan, benadryl - largactil 6. Corticosteroid

COMPLETE

INVAGINATION

BOWEL OBSTRUCTI0N
INCOMPLETE PYLORIC STENOSIS

INVAGINATION = INTUSSUSCEPTION

PROXIMAL BOWEL (INTUSSUSCEPTUM)

DISTAL BOWEL (INTUSSUSCIPIENS) SPONTANEUS REDUCTION CONTINUING

3 months - 3 years

TYPE OF INVAGINATION

- ILEOCOLIC > > > - ILEOILEIC - CECOCOLIC - COLICOCOLIC - ILEOILEOCOLIC

SIGNS & SYMPTOMS

- SUDDEN ONSET - PAROXYSMAL PAIN - VOMITING - BLEEDING PERANUM - TUMOR - SIGNE de DANCE - ABDOMINAL DISTENTION - DEFECATION & FLATUS (-)

Th / :

- WATER & ELECTROLYTES - HYDROSTATIC - OPERATIVE

CLINIC
PLAIN OF ABDOMINAL PHOTO

DIAGNOSTIC
SIGN OF OBSTRUCTION

RADIOLOGIC
BARIUM ENEMA - CUPPING - COIL SPRING