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Gastroenterology

What is the most common cause of nonbilious emesis in infants 3 to 4 months old?

A. Hypertrophic pyloric stenosis

B. Gastroesophageal reflux

C. Gastroenteritis

D. Intestinal volvulus

Answer: B

Gastrointestinal reflux (GER) is the most common cause of nonbilious emesis in infants and peaks at 3 to 4 months old (up to 67% of infants). Hypertrophic pyloric stenosis occurs in 2 to 3 infants per 1000 live births, and is much less common than (GER). Although gastroenteritis may occur in infancy, it is less common than GER and more likely to occur in older children. Intestinal volvulus is an uncommon cause of emesis in infants but requires urgent evaluation when suspected. Children with intestinal obstruction are more likely to be toddlers or older children and present with abdominal pain with distension, nausea, and bilious emesis.

Reference: Parashette KR, Croffie J. Vomiting. Pediatr Rev. 2013;34(7):307-319. Pubmed ID: 23818085.

Which of the following should be used for oral replacement therapy in a child with moderate volume depletion secondary to gastroenteritis?

A. Water

B. Sports drinks with vitamins

C. Apple or orange juice

D. Oral rehydration solutions with sodium, potassium, bicarbonate, and carbohydrate

Answer: D

Children with mild to moderate volume depletion secondary to gastrointestinal losses from gastroenteritis should have volume repletion orally if possible. Oral rehydration solutions containing sodium, potassium, bicarbonate, and carbohydrate are recommended by the World Health Organization (WHO) for treatment of volume depletion in diarrheal illness throughout the world. In general, food and drink with simple sugars, such as sports drinks and juice, should be avoided as the high osmotic load may increase diarrhea. For children with moderate dehydration secondary to gastroenteritis, water would be insufficient to resupply the electrolytes lost through vomiting and diarrhea.

Reference: King CK, Glass R, Bresee JS, Duggan C; Centers for Disease Control and Prevention. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. 2003;52(RR-16):1-16. Pubmed ID: 14627948.

What is the most common cause of vomiting in children older than 1 year?

A. Eosinophilic esophagitis

B. Gastrointestinal reflux

C. Intestinal malrotation

D. Viral gastroenteritis

Answer: D

Acute viral gastroenteritis is the ...

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