Vomiting in the child

Vomiting is the eruption of gastric or intestinal contents through the mouth and nasal passages to the outside. Vomiting is a frequent symptom in children, and the smaller the child, the easier it is. The mechanism of vomiting consists in a sharp relaxation of the diaphragm and a simultaneous, sharp contraction of the musculature of the abdominal wall, when the gastric contents are forcefully pushed into the esophagus. Vomiting occurs when the vomiting center is stimulated in the brainstem where there are chemoreceptors that react to circulating substances in the blood. Therefore, vomiting can occur almost with any disease and especially with brain damage.

Causes of vomiting in the child

The cause of vomiting in a child can be:

• obstruction of the digestive tract at the level of the esophagus (atresia, haldzia, achalasia, diffuse spasm, stenosis, foreign body, pereezophagitis, etc.);
• spasm of the pylorus (pilorospasm, congenital hypertrophic pyloric stenosis);
• spasm of the duodenum (atresia, Ledd's syndrome, annular pancreas, etc.);
• spasm of the small and large intestine (atresia and stenosis, meconium ileus and its equivalents);
• intussusception;
• Malnutrition syndromes;
• chronic pseudo-intestinal obstruction, etc.).

Vomiting and other gastrointestinal diseases in children are accompanied by vomiting, namely: hepatitis, cholelithiasis, pancreatitis, appendicitis, peritonitis, Hirschsprung and Crohn's diseases, food allergies, celiac disease, intolerance to cow's milk proteins and other malabsorption syndromes. Vomiting is often observed in sepsis, severe pneumonia, otitis media, urinary tract infections, adrenal insufficiency, renal tubular acidosis, metabolic disorders (phenylketonuria, lactic acidosis, organic aciduria, galactosemia, fructose intolerance, tyrosinosis, etc.).

Repeated acetonemic vomiting occurs usually in young children, with significant disruption of water-electrolyte metabolism and the equilibrium of acids and bases. Acetonemic vomiting should be distinguished from kepyacidosis, which can develop in diabetes mellitus. Suddenly, vomiting that occurs without a previous feeling of nausea is observed in the pathology of the central nervous system (intracranial hypertension, hydrocephalus, hemorrhages, tumors, meningitis, etc.). Severe uncontrollable vomiting occurs when the brain is swollen, caused by metabolic disorders (eg, Ray's syndrome, poisoning, intoxication). In some cases, violent vomiting itself can cause damage to the mucous membrane of the cardiac part of the stomach, accompanied by bleeding (the Méplory-Weiss Syndrome).

Allocate so-called psychogenic vomiting and psychogenic nausea, which are divided into the following options:

• Vomiting due to increased anxiety (as a manifestation of fear of any important events);
• Reactive vomiting (unpleasant associations: sausage-feces, wine-blood, macaroni-worms, etc.);
• Neurotic vomiting (manifested in two versions: hysterical vomiting that occurs in stressful and conflict situations, and habitual vomiting, as an expression of suppressed emotions);
• Psychotic vomiting in psychosis.

Neurotic vomiting is more characteristic of the day of older children. If a child is forced to eat, the usual vomiting can appear not only in the breast, but also in the preschool age. Sometimes a child just needs to look at food to provoke vomiting. Signs of diagnostic significance include:

• time of onset - on an empty stomach for diseases with portal hypertension; immediately or soon after eating with acute gastritis and peptic ulcer; at the end of the day with violations of evacuation from the stomach;
• odor vomit - rancid oil due to increased formation of fatty acids in hypo- and achlorhydria; rotten, putrid when food stagnates in the stomach; Ammonia or reminiscent of urine odor in patients with chronic renal insufficiency; fecal with gastrointestinal fistula and intestinal obstruction;
• impurities in the vomit - mucus (gastritis), pus (phlegmon of the stomach), bile (duodenogastric reflux, chronic duodenal obstruction). Blood veins with strong multiple vomit movements; abundant clearing of clean blood in cases of ulcers, Mallory-Weiss syndrome. Blood vomiting is usually combined with tar stool.

[1], [2], [3]