Regurgitation/GERD


Background

Pathophysiology

History/Symptoms

Physical Exam

Diagnostic Testing

Differential Diagnosis

Treatment

  1. Conservative measures
  2. Medical therapy
  3. Surgical treatment

Disposition

  1. Admit for respiratory compromise
  2. Otherwise discharge with primary MD follow-up in 1-2 wks
  3. Pediatric GI follow-up evaluation
  4. Parental education, lifestyle modifications and ressurance

 
DDx Vomiting in Pediatrics
TE Fistula /
Esophageal Atresia
GERD Pyloric Stenosis Duodenal Atresia Malrotation/
Volvulus
Necrotizing  Enterocolitis Intussusception Intersitnal Atresia
- Frothing, Bubbling
- Excessive salivation
- Chocking w/ 1st feed
- 20-30 miin after feeding
- Spitting up
- Present since birth
 
- Non-Bilious
- Projectile
- NOT present at birth
- Hungry baby
- HypoChloremic, Hypokalemic
- Metabolic Alkalosis
- Present AT BIRTH
- Vomit with feed
- BILIOUS
- Associated w/ Down Syndrome
 
-Bilious vomiting
-infant age <1 year
-dark blood in diaper
-abdominal distension
- Pre-term Baby
- Intramural Air
- Distended Abdomne
- (+) Blood in stool
-age 6 to 12 months
-male gender
-abdominal pain
-vomiting
-lethargy/irritability
-blood per rectum/currant jelly stool
-hypovolemic shock

 

MC site: Jejunal Atresia
- Bilious vomit at birth
- Distended Abdomen
  Dx:
- 24 hr pH monitoring
- Reflux scan
Dx:
US
Dx:
- Abd XR = Double Bubble
Dx:
-
Upper GI contrast series
-CT abdomen (WITH oral and IV contrast)
-Abdominal plain films
-CBC, ABG
-
Ultrasound
- lower GI contrast series
Dx:
- ABD XR = pneumonitis intestinalis or free air.
Dx:
- abdominal plain-film x-ray
-ultrasound
- diagnostic enema
- CT Abd
DX:
- Abd XR = Triple Bubble
  Tx:
Reglan 0.2mg/kg/dose

Ranitadine 10mg/kg/day
Tx:
Surgery
Tx:
- NG, Surgery
Tx:
Surgery
Tx:
- Bowel rest (NPO)
-
cefotaxime
- Pediatric surgeon Consult
Tx:
-IV Fluid
-Barium enema
-ABx
-Surgery