🆘 Surgical Emergencies
• Bilious vomiting = obstruction until proven otherwise
• Acute abdomen: sudden severe pain, rigidity, rebound, absent bowel sounds
• Volvulus from malrotation: bilious vomiting, severe toxicity
• Intussusception: colicky pain, currant jelly stool
👶 Infant Vomiting
• Pyloric stenosis: 3-6 weeks, non-bilious projectile vomiting, metabolic alkalosis, olive sign, US diagnosis
• GER: effortless regurgitation, normal growth, resolves by 12-18 months
• Malrotation with volvulus: bilious vomiting → emergency
• Inborn errors of metabolism: vomiting + acidosis/neurologic changes
🔄 Cyclic Vomiting Syndrome (CVS)
• Criteria: ≥5 attacks or ≥3 attacks in 6 months, episodes 1h-10d, stereotypical, ≥4 vomits/hour, return to baseline between episodes
• Associated with migraines, family history of migraines
• Triggers: stress, infections, certain foods
🧠 CNS Causes
• Increased ICP: early morning vomiting without nausea, headache, papilledema, bulging fontanel
• Migraine variants: abdominal migraine (pain predominant), CVS (vomiting predominant)
📌 Decision strategy: Bilious vomiting = surgical emergency until proven otherwise (malrotation/volvulus). Pyloric stenosis: progressive projectile non-bilious vomiting in first 2 months. CVS: episodic vomiting with normal inter-episode health.