Vomiting in Infants and Children
Introduction
In the medical field, different diseases may have similar symptoms and doctors are supposed to come up with two or more diseases that could be causing the portrayed symptoms. The doctor then orders tests to confirm the suspected diagnosis for better treatment of the patient. Differential diagnosis is achieved by considering patient medical history, diagnostic testing and physical examination. An 18-month old baby having vomiting and diarrhea symptoms for two days is a sign of infection that should be diagnosed. Vomiting and diarrhea in children are common due to a watery diet, and thus, pediatricians should be careful and keen so as to get the correct diagnosis that will lead to the right treatment plan. This paper highlights the necessary diagnostic tests and identify patient differential diagnosis and the treatment plan.
Diagnostic Tests
The pediatrician should ask the child giver questions concerning the child’s medical history to help narrow down the diagnostic tests that can be undertaken to come up with the correct diagnosis. The caregiver should disclose any forms of allergies that can cause diarrhea and vomiting and the child’s diet before the commencement of the symptoms. The most appropriate diagnostic test for an 18-month-old having vomiting and diarrhea symptoms include; stool culture, which is conducted to identify bacteria causing infections in the lower digestive tract. The test is necessary as the symptoms have persisted for more than a day. The test will help identify the normal bacteria found in the digestive tract and pathogenic bacteria that cause infection (Hasler, et al., 2017). The other test that will be conducted is the stool acidity test, which helps identify the PH of the human feces. Human feces is usually alkaline and acidic stool is a sign of a digestive problem. A nitrazine paper is used, and the color is compared against the color scale.
Differential Diagnosis
Vital Gastroenteritis: Vomiting and diarrhea symptoms may be caused by gastroenteritis. Gastroenteritis is one of the major causes of vomiting and diarrhea among people of all ages but is quite common in young children. The disease is caused by rotavirus among young children. Other symptoms associated with the disease include mild fever, loss of appetite and headaches. The disease occurs when a child is in contact with a person with the disease. It can be spread by breathing out small vomit particles, touching contaminated surfaces, and eating contaminated food (In Koch & In Hasler, 2017). Gastroenteritis is the most common cause of vomiting and diarrhea in children as children’s hygiene depends on another person as kids cannot wash hands after touching contaminated surfaces. The diagnosis as the child has the symptoms caused by the disease. The presumptive diagnosis and test will most likely influence the pediatrician to diagnose the patient with gastroenteritis.
Inflammatory bowel: Diarrhea, abdominal pain, weight loss, fatigue, rectal bleeding, nausea and bloating are common symptoms of inflammatory bowel disease in children. The disease is classified into Crohn disease and ulcerative colitis (Benchimol, et al., 2019). The disease is associated with gastrointestinal inflammation. Crohn disease results in transmural inflammation that can affect any part of the digestive system from the mouth to the anus. A poor immune system causes the disease; thus, the body cannot fight viruses and bacteria that attack the body, resulting in inflammation of the gastrointestinal tract. A family history of inflammatory bowel disease puts the child at an increased risk of contracting the disease. The diagnosis was selected as the child portrayed some symptoms associated with the condition, but the diagnosis is ruled out as the child does not have many symptoms related to the disease.
Intussusception: Vomiting and diarrhea for two days inform the next differential diagnosis, which is intussusception. Common symptoms associated with the condition include vomiting, abdominal pain and Hematochezia (Gluckman et al., 2017). The condition occurs when a portion of the intestine is folded inside another section, especially at the junction of the large and small intestines (Heckroth et al., 2021). The condition prevents the passage of food in the digestive system, leading to intestinal infections, damages and internal bleeding. The diagnosis was selected as intussusception is the leading cause of internal obstructions in young children and vomiting symptoms. The diagnosis would be highly unlikely as the child has diarrhea which cannot be the case with internal obstruction.
Treatment plan
The most suitable treatment plan for children with vomiting and diarrhea symptoms is an oral rehydration solution. The treatment plan will help the child be hydrated as vomiting and diarrhea can lead to severe dehydration in children (Ahuja, 2017). According to the selected differential diagnosis, gastroenteritis disease seems the correct diagnosis, which can also be well treated and managed by oral rehydration solution. Antibiotics can also be recommended where the cause of the diagnosis is bacteria. The patient should also eat easy to digest foods and take plenty of fluids in small quantities and high frequency.
Conclusion
There are various diseases and conditions that are associated with vomiting and diarrhea, especially in young children. Patient medical history, diagnostic tests, and physical examinations are some of the parameters that can narrow down the list of possible diagnoses. In this case, gastroenteritis, inflammatory bowel disease and intussusception were the selected differential diagnosis. Gastroenteritis was chosen as the correct diagnosis as the patient portrayed most of the symptoms associated with the condition.
References
- Ahuja, N. K. (2017). Nutritional approaches to chronic nausea and vomiting. Practical Gastroenterology, 41(10), 34-40.
- Benchimol, E. I., Bernstein, C. N., Bitton, A., Murthy, S. K., Nguyen, G. C., Lee, K., & Kaplan, G. G. (2019). The impact of inflammatory bowel disease in Canada 2018: A scientific report from the Canadian gastro-intestinal epidemiology consortium to Crohn’s and colitis Canada. Journal of the Canadian Association of Gastroenterology, 2(Supplement_1), S1-S5.
- Gluckman, S., Karpelowsky, J., Webster, A. C., & McGee, R. G. (2017). Management for intussusception in children. Cochrane Database of Systematic Reviews, (6).
- Hasler, W. L., Li, B. U. K., Koch, K. L., Parkman, H. P., Kovacic, K., & McCallum, R. W. (2017). Methodologic considerations for studies of chronic nausea and vomiting in adults and children. Autonomic Neuroscience, 202, 28-39.
- Heckroth, M., Luckett, R. T., Moser, C., Parajuli, D., & Abell, T. L. (2021). Nausea and Vomiting in 2021: A Comprehensive Update. Journal of Clinical Gastroenterology, 55(4), 279-299.
- In Koch, K. L., & In Hasler, W. L. (2017). Nausea and vomiting: diagnosis and treatment.