Vomiting bile in a baby

Digestive disorders and GI pathologies are common in children and adolescents. In particular, vomiting bile in a child can be associated with various conditions that require medical intervention. It is important to timely and correctly assess the condition of the child's body, find out the cause of this disorder by careful collection of anamnestic information and examination of the child.

What does bile look like when a child vomits?

The bile in the vomit masses has the appearance of an impurity or liquid of yellow or greenish color. Often the entire mass is colored in these colors.

It is characteristic that in the presence of bile in vomiting in the oral cavity there is an unpleasant bitter persistent taste, which does not disappear when rinsing the mouth.

In most children, a vomiting attack is preceded by nausea, sometimes by increased salivation.

The immediate attack is accompanied by general weakness, trembling in the hands and fingers, pallor of the face, increased sweating, decreased blood pressure, tachycardia. The condition gradually normalizes after the cessation of gagging.

Causes of the baby vomiting bile

There are many known factors that can provoke vomiting bile in a child. This can be explained by the breadth of interconnections running from all organs and systems to the vomiting center. The leading role in determining the causes of the disorder is given to the assessment of the nature of vomiting.

Conventionally, polyetiologic pathology is divided into several groups:

1. Neurogenic vomiting (causes should be sought in the brain or spinal cord, or in mechanisms of the peripheral nervous system).
2. Visceral vomiting (associated with damage to internal organs).
3. Toxic-hematogenic (caused by metabolic disorders, intoxication).

Group 1 includes conditions in which the conditioned reflex is activated by visualizing or imagining certain aversive objects (hair in food, etc.). This can also include vomiting associated with severe fatigue, impaired cerebral blood flow, concussion, meningitis, tumor processes, damage to the vestibular apparatus, glaucoma, and so on.

Group 2 includes phenomena caused by irritating effects on gastric mucous tissues (e.g., in gastritis, duodenitis, peptic ulcer, etc.), intestinal tissues (in enterocolitis, appendicitis, etc.), intestinal tissues (in enterocolitis, appendicitis etc.), liver and gallbladder (in cholecystitis, cholelithiasis, hepatitis). The same group includes disorders associated with inflammatory processes in the internal genital organs, pancreatitis, peritonitis, renal diseases, pathologies of the pharynx, pharynx, etc., as well.

Toxic-hematogenic group includes the effects of poisonous substances, some medications, microbial toxins. Thus, bile may appear in vomiting in a child after poisoning by poisons from the outside, after inhalation of chloride compounds, toxic gases, or after the use of drugs of gentian, foxglove, morphine, etc.

In the same category includes vomiting bile in a child with rotavirus: this sign is one of the first symptoms and persists for 24-48 hours.

With microbial and viral damage to the mucosa of the digestive tract activation of the gag reflex occurs even after consuming a small amount of food or plain water. Spilled stomach contents may contain both food residues and particles of mucus, gastric juice, bile thrown from the 12-rectum into the gastric cavity.

As practice shows, most often vomiting bile in a child is associated with such disorders as:

• atresia or 12-intestinal stenosis;
• atresia of the small or large intestine;
• Duodenostasis (digestive dyskinesia);
• condition duodenogastric reflux;
• meconial obstruction (ileus);
• meconial peritonitis;
• megaduodenum, megacolon.

Pathogenesis

It should be understood that vomiting, including bile, is primarily a compensatory reaction of the body. Moreover, in childhood, such reactions are activated especially quickly, providing a response to almost any stimulus. Another feature of the child's body: the function of compensation, unfortunately, as quickly "exhausted", replaced by a threatening state of decompensation. Therefore, when vomiting in a child should act immediately and competently.

Bile vomiting is a complex reflex action, which is manifested in response to excitation of the vomiting center by any external changes (irritation of vestibular, olfactory, visual and other nerve endings) or internal factors (digestive pathologies, diseases of the nervous system, kidneys, liver, etc.).

The localization of the vomiting center is the area of the lower segment of the floor of the fourth ventricle of the medulla oblongata. It is adjacent to the respiratory and cough centers. Next to it is the chemoreceptor area.

It has been studied that direct activation of the vomiting center is produced by afferent vibrations that appear in different parts of the body. In this case, the chemoreceptor area acts as an intermediary, distributing stimulus vibrations to the appropriate center. Receptors are present both in internal organs and in areas of the medulla oblongata. Regulation is carried out by the cerebral cortex.

In general, a gagging attack involves several characteristic movements after a preceding breath. Then there is a simultaneous lowering of the epiglottis, lifting of the larynx, and closure of the vocal cleft.

The gatekeeper contracts, the gastric fundus relaxes, the food mass together with bile, due to the strong contraction of the diaphragm and abdominal muscles, rapidly spills out.

Forms

Vomiting in early and older childhood is of the following types:

• of central origin (as a result of baroreceptor excitation);
• of psychogenic origin;
• viscero-visceral or vegeto-visceral genesis;
• resulting from a disorder of homeostasis;
• mechanical origin (in organic or functional diseases of the digestive system).

In turn, vomiting of mechanical origin is subdivided into organic (caused by developmental disorders) and functional (associated with a failure of function).

If a child vomits bile without diarrhea, but with headache, photophobia, it may indicate a problem of central genesis. The cause of this condition is often head trauma, intracranial hemorrhage, cerebral edema and other pathologies that are accompanied by increased intracranial pressure.

Vomiting bile in a child without fever can be a consequence of overexcitement or fear. Often such a phenomenon is noted against the background of children's tantrums, emotional outbursts, caprices.

If a child has abdominal pain, vomiting bile may indicate different variations of gastrointestinal dyskinesias. There is persistent vomiting, impaired coordination of the esophageal-gastric sphincter. Pylorospasm may develop, and duodenospasm is less common.

After vomiting in a child, bile can continue to be secreted, which provokes new repeated attacks. In such a situation, it is necessary, without delay, to consult a doctor, since the problem can be aggravated by the development of uremic state, which is manifested by the smell of ammonia, accompanied by impaired kidney function.

Vomiting bile in a child with fever can be directly related to hyperthermia: this often happens in small children against the background of viral infections. If it is a violation of homeostasis, then here the chemoreceptor area located near the vomiting center is irritated. In such situations, it is possible to consider both infectious and non-infectious variants of vomiting attacks.

Fever, diarrhea, vomiting bile in a child - these are frequent symptoms of infectious pathologies, where the "culprits" are both exogenous and endogenous toxins. In infants, the problem is often found in infectious lesions of the upper digestive tract - for example, against the background of gastritis, gastroenteritis of viral, staphylococcal, salmonellosis origin. Vomiting bile in a child and diarrhea often occur as initial symptoms of scarlet fever, encephalitis, meningitis, acute otitis media.

Vomiting bile in a child in the morning may indicate pathologic hypersecretion. Depending on the amount of impurity, it is often possible to conclude about the strength of the attack and the completeness of gatekeeper closure.

Diagnostics of the baby vomiting bile

Quite a lot of valuable information the doctor can get by carefully examining the vomit masses. In particular, the diagnostic value is:

• volume;
• The extent and nature of alteration of food particles;
• presence of certain impurities and odors.

If the doctor suspects the development of a toxic-infectious process, vomit masses are sent for laboratory analysis. If the volume of the masses exceeds the volume of food consumed before the attack, it may indicate inhibition of gastric evacuation and enlargement of the organ. A dark brown or green color indicates a prolonged presence of food inside the stomach. Unchanged chewed food consumed several hours before the attack indicates a weak digestive system.

During the physical examination, the specialist feels the abdominal organs of the child, identifies possible signs of infectious disease (fever, weakness, fever, diarrhea, etc.).

Important information about the state of the gastrointestinal tract provides instrumental diagnostics:

• gastroscopy (endoscopic examination of the mucous tissues of the esophagus and stomach);
• radiographs with contrast;
• ultrasound, computerized tomography of the abdominal cavity;
• esophageal pressure measurements (esophageal manometry).

If there is repeated vomiting of bile in a child, it is recommended to perform an ultrasound of the liver and gallbladder. There may be indications for duodenal probing with examination of the contents of the 12-intestine.

Differential diagnosis

Type of vomiting	Possible pathologies
Esophageal	Occurs during meals, caused by burns or esophageal stenosis, congenital short esophagus.
Gastric	"Fountain" vomiting, is associated with pylorostenosis, pylorospasm, gastritis, peptic ulcer disease.
Gallstone	Characterized by persistence, persistence, accompanied by subcostal pain on the right side.
Associated with dyskinesia of the 12-intestine.	Has a distinctly noticeable admixture of bile.
Pancreatitis	Persistent, compulsive, accompanied by increased salivation and nausea.
Associated with bowel obstruction	In addition to bile bitterness, the masses may have a fecal odor.

Treatment of the baby vomiting bile

If vomiting bile in a child is limited to one episode of an attack, and the cause is banal overeating (especially the consumption of large amounts of fatty foods), then treatment is usually not required.

If there is reason to suspect food intoxication, then all necessary help should be given:

• perform gastric lavage (until clear lavage water);
• if necessary, a cleansing enema;
• Ensure adequate intake of clean drinking water into the body;
• put the child on a special diet.

It is recommended to take sorbent medications to eliminate toxic substances and metabolites from the digestive system.

Changing the diet, first of all, involves the exclusion of fatty, fried, salty, spicy food, smoked meats, spices and sweets. To reduce the load on the gastrointestinal tract, practice frequent meals in small portions. If the "culprit" is a disease of the pancreas, it is recommended that older children abstain from food for several days at all.

How to stop bile vomiting in a child?

With repeated vomiting episodes, the child's body loses a large amount of fluid. In young children, this quickly causes the development of dehydration, so it is important to offer the baby to drink - every 5-10 minutes, 5 ml. Sometimes it is more convenient to give water not with a teaspoon, but with a dosing syringe (for example, from some medicine in syrup) or an ordinary syringe without a needle.

Normal water is suitable for drinking, but if possible, it is better to use combined salt and glucose mixtures (such as Rehydron, etc.).

Any special medicines for children with bile vomiting do not need to be taken. Only a doctor can prescribe antiemetic drugs.

For breastfed babies, it is recommended to continue to give breast milk and even increase the frequency of breastfeeding.

For older children, the diet (not drinking) is restricted, feeding small portions, but more often than usual. Long periods of fasting should not be tolerated. Such pauses may cause a drop in blood sugar levels and, consequently, a recurrence of the vomiting episode.

If a young child is likely to have a repeated episode of vomiting with bile, it is better to lay him on his side so that the vomit does not enter the respiratory system.

Drug treatment

Drug therapy is aimed at neutralizing the factors of irritation of the vomiting center, affecting the underlying pathology and preventing the development of complications. Based on the results of diagnosis, the doctor determines an individualized scheme of drug treatment.

A commonly accepted range of medications that are most commonly used for bile vomiting in a child may include these drugs:

• Prokinetics (Motilium, Motilac, Ganaton, Itomed, etc.) - optimize the work of the stomach, reduce the frequency of gagging. In pediatrics most often prescribed Motilium treatment course of 1-2 weeks in a dosage of 0.25 mg per kilogram of weight of the child 3-4 times a day for half an hour before meals. Also from the age of 5 years prescribe Domperidone 10 mg three times a day half an hour before meals.
• Antacids (Maalox, Fosfalyugel, Almagel etc.) - neutralize the acidic environment of the stomach, irritating its walls and activating the gag reflex.
• Anti-infective drugs (Ampicillin 250 mg, Biseptol 480, Furazolidone 50 mg, Enterofuril capsules 100 mg, etc.) - prescribed to patients with proven intestinal infection taking into account the sensitivity of pathogens, in an individually selected dosage.
• Enzyme agents (Lactase, Lactazar, Trimedate, Creon) - stabilize the course of digestive reactions, facilitate the breakdown of proteins, fats and carbohydrates, normalize the absorption of useful elements. Usually taken for a long time, in an individually selected dosage.

Antiemetics are only indicated in difficult cases, such as children with painful, recurrent gagging. These medications affect the response of the vomiting center, which helps prevent recurrent urges.

If there are signs of dehydration, rehydration with special liquid compositions is prescribed. If dehydration is pronounced - for example, in patients with repeated vomiting - to normalize the water-electrolyte balance intravenous saline solutions, glucose are administered.

Vomiting attack of psychogenic origin is treated for a long time, using psychotherapy, acupuncture. Phenothiazine, antihistamines, prokinetics, and vitamin _B6 intravenously (up to 100 mg per day in adolescence) may be used among medications.

Herbal treatment

The use of herbal remedies should be coordinated with the attending physician, since vomiting bile in a child is a serious enough sign of any disorder in the body. In mild cases, after preliminary medical consultation, you can use the following remedies:

• Peppermint tea, 1-2 tsp. Every 10-15 minutes;
• infusion of chamomile or calendula, or decoction of birch buds 4 tsp. Every half hour, until the condition improves;
• apple compote (without added sugar) three times a day 50-150 ml;
• Infusion of raspberries (upper sprigs) by sip in case of nausea;
• drink an infusion of a medicinal mixture based on mint leaves, melissa, calendula flowers, oregano herb, birch leaves, horsetail herb, as well as sage, basil, raspberry shoots.

If vomiting bile in a child is associated with mild food poisoning, he can be offered chamomile tea, dill water, infusion of blackberry sprigs.