Деякі причини блювоти у немовлят, дітей та підлітків
Cause* | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Vomiting in infants | ||
Viral gastroenteritis | Usually with diarrhea Sometimes fever and/or contact with a person who has similar symptoms | Clinical evaluation Sometimes rapid immunoassays for viral antigens or PCR testing for enteric pathogens (eg, rotavirus, adenovirus) |
Gastroesophageal reflux disease | Recurrent fussiness during or after feedings Possibly poor weight gain, arching of the back, recurrent respiratory symptoms (eg, cough, stridor, wheezing) | Empiric trial of acid suppression Sometimes upper GI contrast study, a milk scan, esophageal pH monitoring and/or impedance study, or endoscopy |
Bacterial enteritis or colitis | Usually with diarrhea (often bloody), fever, crampy abdominal pain, distention Often contact with a person who has similar symptoms | Clinical evaluation Sometimes stool examination for white blood cell count and culture or PCR testing for enteric pathogens |
Recurrent projectile vomiting immediately after feeding in neonates aged 2–12 weeks, infrequent stools May be emaciated and dehydrated Sometimes palpable “olive” in right upper quadrant | Ultrasonography of pylorus Upper GI contrast study if ultrasonography is unavailable or uncertain | |
Congenital atresias or stenoses | Abdominal distention Bilious emesis in first 24–48 hours of life (with lesser degrees of stenosis, vomiting can be delayed) Sometimes polyhydramnios during pregnancy, Down syndrome, jaundice | Abdominal x-ray Upper GI series or contrast enema depending on findings |
Colicky abdominal pain, inconsolable crying, lethargy, drawing of legs up to chest Later, bloody ("currant jelly") stool Typically age 3–36 months, but can be outside this range | Abdominal ultrasonography If ultrasonography is positive or nondiagnostic, air or contrast enema (unless patient has signs of peritonitis or perforation) | |
In neonates, delayed passage of meconium, abdominal distention, bilious emesis | Abdominal x-ray Contrast enema Rectal biopsy | |
Malrotation with volvulus | In neonates, bilious emesis, abdominal distention and pain Bloody stool | Abdominal x-ray Contrast enema or upper GI series |
Fever, lethargy, tachycardia, tachypnea Widened pulse pressure, hypotension | Cell counts and cultures (blood, urine, cerebrospinal fluid) Chest x-ray if pulmonary symptoms are present | |
Abdominal pain, diarrhea Possibly eczematous rash or urticaria | Elimination diet Sometimes skin testing and/or radioallergosorbent testing (RAST) | |
Poor feeding, failure to thrive, lethargy, hepatosplenomegaly, jaundice Sometimes unusual odor, cataracts | Electrolytes, ammonia, liver tests, blood urea nitrogen (BUN), creatinine, serum glucose, total and direct bilirubin, complete blood count, prothrombin time/partial thromboplastin time (PT/PTT) Neonatal metabolic screening Further specific tests based on findings | |
Vomiting in children and adolescents | ||
Viral gastroenteritis | Usually with diarrhea Sometimes fever, contact with a person who has similar symptoms, or history of travel | Clinical evaluation Sometimes rapid immunoassays for viral antigens or PCR testing for enteric pathogens (eg, rotavirus, adenovirus) |
Bacterial enteritis or colitis | Usually with diarrhea (often bloody), fever, crampy abdominal pain, distention, fecal urgency Often contact with a person who has similar symptoms or history of travel | Clinical evaluation Sometimes stool for white blood cell count and culture or PCR testing for enteric pathogens |
Cannabinoid hyperemesis syndrome | Cyclic episodes of nausea and vomiting in frequent cannabis users | Clinical evaluation |
Non-GI infection | Fever Often localizing findings (eg, headache, ear pain, sore throat, cervical adenopathy, dysuria, flank pain, nasal discharge) depending on cause | Clinical evaluation Testing as needed for suspected cause |
Initial general malaise and periumbilical discomfort followed by pain localizing to right lower quadrant, vomiting after pain manifestation, anorexia, fever, tenderness at McBurney point, decreased bowel sounds | Ultrasonography (preferred over CT to limit radiation exposure) | |
Serious infection | Fever, toxic appearance, back pain, dysuria (pyelonephritis) Nuchal rigidity, photophobia (meningitis) Listlessness, hypotension, tachycardia (sepsis) | Cell counts and cultures (blood, urine, cerebrospinal fluid) as indicated by findings |
≥ 3 episodes of intense acute nausea and unremitting vomiting and sometimes abdominal pain or headache lasting hours to days Intervening symptom-free intervals lasting weeks to months | Exclusion of metabolic, GI (eg, malrotation), or central nervous system (eg, brain tumor) disorders | |
Intracranial hypertension (caused by tumor or trauma) | Chronic, progressive headache; nocturnal awakenings; morning vomiting; headache worsened by coughing or Valsalva maneuver; vision changes | Brain CT (without contrast) |
Binge and purge cycles, erosion of tooth enamel, weight loss or gain Sometimes skin lesions on hand from inducing vomiting (Russell sign) | Clinical evaluation | |
Amenorrhea, morning sickness, bloating, breast tenderness History of unprotected sexual activity† | Urine pregnancy test | |
Toxic ingestions (eg, acetaminophen, iron, ethanol) | Often history of ingestion Various findings depending on ingested substance | Qualitative and sometimes quantitative serum drug levels (depending on substance) |
Adverse drug reaction (eg, to chemotherapeutic drugs) | Exposure to a specific drug | Clinical evaluation |
* Causes are listed in order of frequency. | ||
† Many adolescents do not admit to sexual activity. | ||
GI = gastrointestinal; PCR = polymerase chain reaction. | ||