What defines true vomiting by its contents and manner of ejection?
Forceful ejection of stomach or esophageal contents from the mouth.
How does regurgitation differ from true vomiting?
It is effortless or nearly effortless and is not true emesis.
What distinguishes rumination from other regurgitation?
Rumination includes rechewing regurgitated food.
How does chronic recurrent vomiting typically present in children?
It involves more than two episodes of low-intensity vomiting in children who are generally not acutely ill.
How frequent are episodes in cyclic recurrent vomiting?
Episodes occur infrequently, at most twice per week.
What should the initial evaluation of vomiting assess?
Its pattern, abdominal, respiratory, and neurologic symptoms, and diet and medication use.
What does acute vomiting with an acute abdomen require?
Immediate surgical consultation.
What symptom can indicate an acute abdomen?
Sudden severe pain.
What vomiting pattern can indicate an acute abdomen?
Bilious vomiting.
What examination findings can indicate an acute abdomen?
Point or diffuse tenderness.
What bowel pattern can indicate an acute abdomen?
Diarrhea with abdominal distention.
What bowel-sound finding can indicate an acute abdomen?
Absent bowel sounds.
What abdominal-wall findings can indicate an acute abdomen?
Involuntary guarding or a rigid abdomen.
What vomiting pattern may suggest increased intracranial pressure?
Early-morning vomiting.
What does volvulus involve, and where does the bowel twist?
The bowel twists on its mesentery.
How can intestinal malrotation present in newborns?
As volvulus with bilious vomiting and severe clinical toxicity.
How may intestinal malrotation present years later?
As intermittent vomiting.
Which lesions are congenital causes of intestinal obstruction?
Esophageal stenosis, volvulus, duodenal webs, and annular pancreas.
When may congenital obstructive lesions present later in life?
When the obstruction is partial.
What causes duodenal obstruction in superior mesenteric artery syndrome?
Compression between the anterior superior mesenteric artery and posterior aorta.
What symptoms and positions characterize superior mesenteric artery syndrome?
Bilious vomiting and epigastric pain relieved by prone or knee-chest positioning.
In rotavirus infection, when does vomiting usually precede diarrhea?
By 1 to 2 days.
How does pyloric stenosis typically present in early infancy?
Progressive, often projectile, nonbilious vomiting in the first few weeks of life.
What can mental status changes and abnormal respirations indicate?
Ingestion of a toxic drug or poison.
What symptoms commonly occur in older children with ureteropelvic junction obstruction?
Intermittent abdominal or flank pain, often with vomiting.
What examination or urinalysis findings may occur with ureteropelvic junction obstruction in older children?
Findings may be normal or show a unilateral abdominal mass or hematuria.
When do most inborn errors of metabolism present, and with what symptoms?
Early in the newborn period with vomiting and failure to thrive.
What symptoms may accompany vomiting episodes in metabolic disorders?
Acidosis, mental deterioration, and coma.
Which family-history findings may suggest a metabolic disorder?
The disorder, unexplained intellectual disability, failure to thrive, or neonatal deaths.
When should clinicians consider a metabolic workup for vomiting?
When vomiting accompanies neurologic symptoms, hepatosplenomegaly, or unusual odors from breath, urine, or ear wax.
How does gastroesophageal reflux typically appear in infants?
Near-effortless regurgitation.
What trial may help diagnose suspected reflux without life-threatening symptoms?
A trial of an H₂ blocker or proton pump inhibitor.
What symptoms may peptic ulcer disease cause?
Epigastric pain, nocturnal awakening, gastrointestinal bleeding, meal-related changes, or nonspecific symptoms.
Which foods commonly trigger food hypersensitivity-related vomiting?
Cow’s milk or soy protein.
What can cause gastric stasis or paralytic ileus?
Surgery, neuropathy, drugs, electrolyte disturbances, endocrinopathies, or injuries.
When should psychogenic vomiting be diagnosed?
Only after organic causes have been ruled out.
Which autonomic signs commonly accompany cyclic recurrent vomiting?
Pallor, lethargy, nausea, and abdominal pain.
What should be excluded in a sexually active adolescent female with vomiting?
Pregnancy.
What can cause acquired obstructive lesions?
Inflammatory bowel disease, mucosal disease, or postoperative adhesions.
Which imaging test is recommended initially for suspected obstruction?
Plain abdominal x-rays.
What can abdominal trauma cause that obstructs the duodenum?
A duodenal hematoma.
What factors are commonly associated with superior mesenteric artery syndrome?
Recent weight loss, lordosis, prolonged bed rest, or body casting.
When may a child with acute gastroenteritis symptoms need no additional workup?
When acute-onset, large-volume emesis occurs with fever and/or diarrhea consistent with acute gastroenteritis.
What complications may pyloric stenosis cause by presentation?
Dehydration, metabolic alkalosis, and hypochloremia.
How is pyloric stenosis diagnosed, and what imaging sign may appear?
Physical examination and ultrasound or upper gastrointestinal study showing the string sign.
What sinus symptoms can accompany vomiting and suggest sinusitis?
Nausea, congestion, postnasal drip, or early-morning vomiting preceded by coughing.
What does ureteropelvic junction obstruction cause during fluid loading and diuresis?
Hydronephrosis.
How may congenital ureteropelvic junction obstruction first present?
As an abdominal mass or urinary tract infection.
What symptom pattern suggests ureteropelvic junction obstruction after renal pelvic distention?
Symptoms resolve spontaneously after several hours as dehydration relieves the distention.
When should blood and urine be collected for suspected metabolic disease?
During episodes of suggestive symptoms.
Which blood tests are included in a metabolic workup?
CBC, electrolytes, pH, glucose, ammonia, lactate, carnitine, acyl carnitine, and serum amino acids.
Which urine tests are included in a metabolic workup?
Ketones, reducing substances, organic acids, and amino acids.
What symptoms may older children report with gastroesophageal reflux?
Effortless vomiting, substernal pain, or dysphagia.
Which tests should follow a family history of peptic ulcer disease or similar symptoms?
A urea breath test or stool antigen assay for Helicobacter pylori.
When should endoscopy be considered for peptic ulcer symptoms?
When symptoms are atypical or do not respond to therapy.
What symptoms characterize eosinophilic esophagitis?
Vomiting, feeding problems, pain, and dysphagia.
What additional conditions do many patients with eosinophilic esophagitis have?
Other atopic diseases.
Which specific food-related disorders may cause vomiting after certain foods are introduced?
Hereditary fructose intolerance and celiac disease.
What is pseudo-obstruction?
A rare chronic disorder of intermittent ileus, primarily caused by neuropathy or myopathy and often associated with family history.
How do patients with psychogenic vomiting often feel about the vomiting?
They are often not bothered by it.
Which symptoms characterize vestibular disorders such as motion sickness?
Nausea, dizziness, vertigo, and nystagmus.
Which tests may definitively diagnose pseudo-obstruction?
Manometry and biopsy.
Answer 24 questions on Pediatric Vomiting.
1. Which feature distinguishes true vomiting from regurgitation?
2. A child has infrequent episodes of vomiting but becomes acutely ill and vomits forcefully more than four times per hour during an episode. Which pattern best fits?
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