🤢 Vomiting · Schwartz Chapter 82

Bilious vs non‑bilious · age-specific · surgical abdomen · GERD · pyloric stenosis · malrotation · cyclic vomiting · appendicitis · DKA

Bilious vomiting in a neonate = surgical emergency until malrotation with volvulus is excluded. Non‑bilious vomiting suggests obstruction proximal to ampulla of Vater (pyloric stenosis, GERD) or medical causes. Use age, bilious color, abdominal distension, and associated symptoms to narrow differential.

📋 Step 1 — Vomiting characteristics & clinical clues
📌 Diagnostic approach & next steps
📖 Schwartz Ch 82 (Vomiting)

Select age (infant, child, adolescent), bilious vs non‑bilious, associated abdominal distension, fever, headache, or signs of increased ICP → tool generates focused differential (GERD, pyloric stenosis, malrotation, intussusception, appendicitis, cyclic vomiting, pregnancy, diabetic ketoacidosis, increased ICP) and suggests diagnostic studies and treatment.

⚠️ Neonatal bilious emesis → immediate upper GI series / surgery consult.
✔️ Projectile non‑bilious at 4–8 weeks → pyloric stenosis (olive, hypochloremic alkalosis).
✔️ Episodic vomiting + migraine family history → cyclic vomiting.
✔️ Morning vomiting + headache → increased ICP (pseudotumor, tumor).
✔️ Abdominal pain + vomiting + anorexia → appendicitis.
📘 Schwartz management pearls
• Bilious vomiting in first months → malrotation with volvulus until proven otherwise. Emergent upper GI series.
• Pyloric stenosis: ultrasound, correct metabolic alkalosis before pyloromyotomy.
• GERD: conservative (positioning, thickened feeds) + acid suppression if esophagitis.
• Cyclic vomiting: rule out metabolic disorders, treat with prophylactic cyproheptadine / amitriptyline.
• Intussusception: air enema (diagnostic + therapeutic).
• Appendicitis: surgical consult; CT/US if equivocal.