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Persistent Vomiting

Vomiting is defined as the forceful expulsion of gastric contents through the mouth. Vomiting can be caused by a benign, self-limited process or it may be indicative of a serious underlying disorder, such as malrotation of bowel, volvulus, intestinal atresia, Hirschsprung disease or intussusception.

Pathophysiology of Vomiting

Vomiting is usually preceded by nausea, increased salivation, and retching. It is distinct from regurgitation, which is characterized by passive movement of gastric contents into the esophagus.

Projectile vomiting results from intense gastric peristaltic waves, usually secondary to gastric outlet obstruction caused by hypertrophic pyloric stenosis or pylorospasm.

Retching often precedes vomiting, and it is characterized by spasmodic contraction of the expiratory muscles with simultaneous abdominal contraction.

Nausea is an imminent desire to vomit, usually induced by visceral stimuli.

Clinical Evaluation of Vomiting

The age of the patient at presentation suggests the differential diagnoses of persistent vomiting.

Etiology of Vomiting by Age
	Newborn	Infant	Older Child
Obstruction	Malrotation of bow el Volvulus Intestinal atresia Intestinal stenosis Meconium ileus Meconium plug Hirschsprung dis ease Imperforate anus Incarcerated hernia	Pyloric stenosis Foreign bodies Malrotation (volvulus) Duplication of alimentary tract Intussusception