4yr female child, complaining of only vomiting for 4-5times in a day for 2days,how to approach??
Rule out the cause one by one from history and clinical examination ..... 1. Gastritis/GERD : Associated with pain upper mid abdomen and heart burn. 2. Lactose intolerance : Rule out association with milk or milk product, Wheat product etc. 3. Meningitis : check for fever, r/o neck rigidity. If suspected then advice for RE blood, CSF study. 4. Intussuception/Intestinal obstruction : Severe pain abdomen, abdominal swelling, inability to pass stool and flatus, absent bowel sound or rumbling bowel sound. If suspected advice Urgent straight x-ray abdomen. 5. Sepsis/SIRS : Check for temperature, vitals, r/o systemic infections like uti & pulmonary infections. Advice CBC, CRP, LDH, Urine RE, Chest Xray. 6. UTI : Fever, pain lower mid abdomen & tenderness, frequency of urination. Advice Urine RE / CS. 7. RTI/Pneumonia : fever, chest pain, crepts in chest, increased respiratory rate. Advice Chest Xray, Blood RE. 8. Hepatitis : Yellowish urination, fever, right upper abdomen pain or tenderness, hepatomegaly. Advice Hepatitis viral panel (specially A,E), RE blood, LFT, USG W/A. 9. Constipation : Difficulty in passing stool, hard stool. 10. Appendicitis : Periumbilical or right lower abdomen pain, fever. Advice USG/CT abdomen, RE blood. 11. Worm infestation : Pain at amoebic point, perianal itching, pain abdomen, bloody diarrhoea may be present. Investigations to be advised on the basis of clinical history and examination findings.
maintaining hydration is of utmost importance with antiemetics . bilious or non bilious . associated symptoms like fever loose stool pain abdomen . urine output . all these things matters . give syp ondem 5 ml sos for vomiting as for now . can add syp taxim o forte 3 ml twice daily if u r suspecting infective etiology
Observe for high colored urine to r/o viral hepatitis, ??headache, fever, neck rigidity?? Meingitis ??worm infestation ??Gastritis, Rx tab.Lansprizole-15 mg
Find out cause, examine for urine and stool Also treat other causes like overeating etc Give antiemetic , and digestive drugs
Ask for CBC ESR RE URINE USG of whole ABDOMEN LFT RFT further treat symptomatic
Vomiting cause dehydration to child Try to find cause behind this Most probable its dyspepsia Or may be infective etiology Meanwhile you start Syrup Ondan 3 ml tds Syrup zifi 5 ml bd Ors redimix solution frequently Review next day
Avoid milk & fruits... Antiemetic & PPI
Antiemetic and digestive drug
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Common causes of abdominal pain Abdomen pain or abdominal pain is usually experienced in the area between the chest and the stomach. This kind of pain usually comes as a dull cramp that also produces shooting stabs of pains intermittently, or it may be a localised pain in one side of the stomach. This may also be accompanied by inflammation, and other diseases related to organs like intestines, kidneys, pancreas, liver, spleen and stomach. So what are the causes of stomach or abdomen pain? Read on to find out: Food Poisoning: Food poisoning can be caused due to dirty water or contaminated food. This can give rise to various infections as well as conditions like traveller's diarrhoea or loose motions. Gastro Intestinal Conditions: GERD or gastroesophaegal reflux disease and gastroenteritis, among various others can also lead to abdomen pain as a symptom along with severe acidity and nausea. Irritable bowel syndrome is another major ailment which can leave you with persistent abdominal pain. Generalised Pain: This kind of pain occurs in the overall area all around the stomach and may point at the presence of conditions like Crohn's Disease, a traumatic injury, appendicitis, flu, or even a urinary tract infection. Further, when the gas settles and tightens the stomach due to the inability to pass a motion on a normal, regular basis, this may be termed as constipation. This also leads to abdomen pain. Localised Lower Abdomen Pain: Pain that is found specifically in the lower area of the abdomen can be caused due to appendicitis, obstruction or blockage in the intestine or colon, and other ailments. This pain can also be accompanied by nausea and vomiting. Localised Upper Abdomen Pain: This kind of pain may emanate due to the presence of gallstones, liver inflammation or hepatitis, pneumonia, or even in the middle of a heart attack. Localised Centre Abdomen Pain: Pain in the centre part of the stomach or abdomen may be caused due to gastroenteritis, an injury or even the accumulation of waste products in the body, otherwise known as uraemia. Abdomen Pain and Women: For women, such localised pain may be caused due to pelvic inflammatory disease, urinary tract infection, endometriosis, ectopic pregnancy, menstrual cramps which are also called dysmenorrhoea, and fibroids. Miscarriages can also cause pain in this part of the abdomen, for women. Renal Stones: Renal stones or stone in kidney is one of the most common cause of abdomen pain. The pain caused by kidney stone is such that it can make a patient roll in bed and this pain may radiate to toward the groin as well. Persistent pain and nausea that come with vomiting and finally give rise to blood in the vomit or stool should be checked by the doctor immediately, so as to rule out any serious ailment. Imaging tests, ultrasound and an X-Ray can help in diagnosis.
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