Value of ultrasound in differentiating causes of persistent vomiting in infants

Article Abstract:

The first stages of digestion take place in the stomach prior to passage of the food into the intestine. During this period, food is prevented from entering the intestine by closure of a ring of muscle, the pyloric sphincter, which regulates the passage of materials from stomach to intestine. A condition known as infantile hypertrophic pyloric stenosis, which sometimes afflicts infants, is characterized by excessive thickening of the pyloric sphincter; in such cases, food cannot pass normally into the intestine. This results in severe persistent projectile vomiting (forceful ejection of the stomach's contents). It is important to be able to distinguish this cause of vomiting from other causes that could lead to similar symptoms, particularly in cases where classical symptoms of hypertrophic pyloric stenosis are not present. To determine whether ultrasound, a noninvasive approach, is useful in diagnosing pyloric stenosis, a study was carried out of 100 infants younger than 3 months hospitalized because of persistent vomiting (5 to 90 days). They were studied using ultrasound during feeding. Forty-four infants were diagnosed as having hypertrophic pyloric stenosis, of whom 38 showed classical signs of hypertrophic pyloric stenosis (projectile vomiting, abnormal stomach movements, palpable tumor). The diagnosis in six cases was based on ultrasound findings. Of the remaining 56 cases, 6 stopped vomiting after admission to the hospital, 3 had normal test results, 44 were diagnosed with gastroesophageal reflux (in which the stomach contents flow backwards up into the esophagus), and 3 had anatomical abnormalities of the digestive tract. The results show that abdominal ultrasound in infants, which can be administered at cribside, is a reliable and accurate screening method to detect some common causes of severe vomiting. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Diseases, Infants, Pyloric stenosis, Diagnosis, Ultrasonic, Diagnostic ultrasonography

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Testing the psychogenic vomiting diagnosis: four pediatric patients

Article Abstract:

Vomiting, or the ejection of stomach contents from the mouth, may be caused by organic or physical disorders, and psychogenic or psychological factors. Determining the cause of vomiting may be difficult, and the identification of a psychiatric cause of vomiting may result in discontinuing diagnostic tests for organic causes of vomiting. The determination of the cause of vomiting is based on findings from the medical history, physical examination, X-rays, and inspection of the gastrointestinal tract by endoscopy (the internal examination of a cavity using a tube-like instrument with an optical system). If vomiting can not be related to disorders of the central nervous system, the inner ear structures (which function to maintain body balance), or the mind, it was suggested that treatment of vomiting should be started or more specialized tests should be performed. These specialized tests consist of monitoring the emptying of the stomach or pressures within the stomach. Cases are described of four patients who were initially diagnosed with psychogenic vomiting. All patients had psychiatric difficulties. Based on responses to treatment and continuing observations of three patients, the results from organic tests were reassessed and an organic factor contributing to vomiting was identified in each case. Physical disorders included achalasia (failure of the muscle to relax) in the esophagus, the tube connecting the mouth to the stomach; inflammation of the esophagus and reverse muscle movement in the small intestine; and infection of the gastrointestinal tract with Giardia lamblia. Tests examining stomach emptying helped to confirm a diagnosis of psychogenic vomiting in a fourth patient. The appropriate diagnosis is essential in determining the need for family and individual psychotherapy and treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Pediatrics

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Increased incidence of respiratory distress syndrome in babies of hypertensive mothers

Article Abstract:

Hypertension is a common complication in pregnancy. It is unclear, however, whether maternal hypertension increases or decreases the risk of respiratory distress syndrome in the infant, or whether there is no effect on occurrence of the disorder. Lack of agreement among previous studies may have been partly due to use of small groups of subjects, or other poor study designs. The association between maternal hypertension and subsequent respiratory distress syndrome in 268 very-low-birth-weight (very premature) infants was evaluated from medical records. Of this group, 134 mothers had hypertension. Respiratory distress syndrome was associated with significantly lower birth weight and gestational age, while absence of the syndrome was significantly associated with growth retardation. Sixty-five percent of babies in the hypertensive group and 51 percent of those in the normotensive group had respiratory distress syndrome, a significant difference. This difference remained significant after accounting for gestational age, birth weight, growth retardation, and prolonged membrane rupture. However, when type of delivery (vaginal or cesarean section) and presence of labor were accounted for, the association between hypertension and the syndrome became insignificant. These factors were not significantly associated with respiratory distress syndrome in the entire group, and may reflect the linkage between hypertension and a medical need for emergency delivery by cesarean section. Further research is needed to determine the relationship between maternal hypertension, childbirth and delivery practices for such women, and incidence of respiratory distress syndrome in the infant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Hypertension in pregnancy, Gestational hypertension, Respiratory distress syndrome

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