Paediatric-History taking & Physical examination of patient with recurrent vomiting

Paediatric-History taking & Physical examination of patient with recurrent vomitingCreated OnApril 23, 2020Last Updated OnApril 23, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of patient with recurrent vomiting < All Topics Table of Contents History taking: History of presenting illness vomiting Onset Acute Gastroenteritis Pyloric stenosis Hirschsprung’s disease Sepsis and non-GI infection Metabolic disorders appendicitis Chronic Gastroesophageal reflux disease Food intolerance Congenital atresia and stenosis Malrotation Intussusception Duration of vomiting (bilious or prolonged) Frequency of vomiting Activity before vomiting Amount of vomitus Small amount of milk in infants = posseting Larger amount = regurgitation Color of vomitus Blood (bright red/dark red/coffee-ground) or bilious Food taken before the onset Family history of allergy and food intolerance Presence of fever, running nose, cough (infection in GI tract, respiratory tract, urinary tract, central nervous system) If child’s growth is faltering Intestinal obstruction History of recent travelling Infectious gastroenteritis Red flag clinical features Haematemesis Oesophagitis, Peptic ulceration Oral/nasal bleeding Oesophageal variceal bleeding Projectile vomiting, in first few weeks of life Pyloric stenosis Vomiting at the end of paroxysmal coughing Whooping cough (pertussis) Abdominal tenderness/abdominal pain on movement Surgical abdomen Abdominal distension Intestinal obstruction, including strangulated inguinal hernia Hepatosplenomegaly Chronic liver disease, inborn error of metabolism Blood in the stool Intussusception bacterial gastroenteritis Severe dehydration, shock Severe gastroenteritis systemic infection (urinary tract infection, meningitis), diabetic ketoacidosis Bulging fontanelle or seizures Raised intracranial pressure Faltering growth GERD coeliac disease other chronic gastrointestinal conditions HYDRATION STATUS IS VERY IMPORTANT IN VOMITING CASES, HENCE, ORAL INTAKE, URINE OUTPUT, TEAR PRODUCTION, AND WEIGHT CHANGES should be asked always Physical examination: Vital signs evaluation From vital signs, check whether the child is well or unwell? Fever – sign of infection Hypotension, tachycardia – volume loss General examination Inspection Consciousness – increased ICP, meningitis, metabolic disorders, toxic ingestion Weight loss – eating disorders, obstruction Head and Neck Red, bulging tympanic membrane – ear infection Bulging anterior fontanelle and nuchal rigidity – meningitis Erythematous tonsils – upper respiratory tract infection Skin and extremities Petechiae or purpura – serious infection Skin turgor, capillary...

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