Vomit versus spit up

i lyk gastroenterology , i will talk alot , forgive me

a golden rule:

starting with red flags is very nice approach to know weither its a pt u will run with in ER or sit and chat till u solve the puzzle

if a mother came to me saying my baby vomited

the first thing i would do is flex his neck .. exclude meningitis

search for signs of raised ICP .. exlude brain tumors , intracranial hemorrhage

ask if he's diabetic, check his glucose ... exclude DKA

ask if its a red jelly stool and search for signs of intussusception
many ppl will disagree but i will go directly for deep palpatation and search for sausage mass in the rt upper quadrant

if not

i will sit , and start clarifying

1: wat do u mean ?

is it forceful , with forceful abdominal contraction ( vomiting ) ,
or is it nonforceful with no ab contraction ( regurgitation )
or is it only small amounts of milk accompanying return of swallowed air ( posseting )

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2nd , clues to vomiting :

projectile - not bile stained --- think pyloric stenosis from which u can zoom into wt loss , onset after meals etc ..
bile stained --- exclude other types of intestinal obstruction--
with transient sympotms lyk fever / diarrhea or cough ---URTI / GE most likely
is there hematemesis with the vomiting ? --maybe its hiatus hernia
did the baby pass meconium ? --- maybe imperforate anus
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3rd , if its regurgitation :

pls describe for me how do u feed your baby ?
is it a feeding error ? -- overfeeding ?excess handling after feeding ?

if the baby sits upright for a while after feeding does it prevent regurge ? ---think of GERD--zoom into aspiration , wheezez etc..

does the baby cry excesssively on feeding due to heartburn ? -- maybe GERD complicated with esophagitis

( many pts say min zaman and doctors skip , 6ayyeb min mata hal min zaman , maybe we're dealing with an acute on top of chronic , maybe a complication of an undiagnosed disease)

is there excess saliva , choking , cyanosis ? --- congenital esophageal atresia +- tracheoesophageal fistula

many other causes

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