ppt课件-cyclic vomiting syndrome- n c c pediatrics residency（周期性呕吐综合征- n c c儿科住院医师）.pptVIP

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2017-01-25 发布于四川
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ppt课件-cyclic vomiting syndrome- n c c pediatrics residency（周期性呕吐综合征- n c c儿科住院医师）.ppt

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ppt课件-cyclic vomiting syndrome- n c c pediatrics residency（周期性呕吐综合征- n c c儿科住院医师）

Cyclic Vomiting Syndrome LT Greg Gorman Features Diagnosed 3-6 times a year in tertiary hospitals. 20-30 times a year in Germany after WW2 Boys and girls equally Age of Onset Episodes Episodes are similar 85% have uniform length episodes 1-70 episodes per year (avg. 12) 50% have regular cycle Course in 5 y/o girl Duration of Episodes Timing of Episodes Charateristic timing in 76 % Usually upon awakening or middle of night Associated Symptoms Epigastric pain Nausea Saliva holding Loose stools (30 %) Headache (27 %) Fever (23 %) Occasional hypertension, tachycardia Associated Symptoms Willingness to drink water “I drink the water because sometimes vomiting helps to relieve the nausea and, as far as I know I’m going to vomit anyway, it is far less unpleasant to bring up a dilute solution than to vomit concentrated hydrochloric acid…” Associated Symptoms Triggers (75 %) Parental conflict (most common) Non-noxious excitement (birthdays etc) URIs Others: Menstruation, hot weather, exhaustion, motion sickness, specific foods, asthma attacks Family History IBS (67 %) (2-6x normal prevalence) Migraine (11%) Motion Sickness (46%) Type A Personality (76%) Epilepsy (6%) (10x normal prevalence) Course Over half symptom free 1 yr later Others last decades ? End at puberty Pathogenesis Migraine equivalent Fits pattern and family history Eipileptic equivalent Case report of 5 seizure patients with CVS pattern Differential Diagnosis Brain Stem Glioma Obstructive Uropathy Others Management Anti-emetics Induction of sleep Resolution with consultation alone Psychosocial support * * 2.5 2.5 2.5 2 2 2 2 2 2 27.5 20 27 29 26.5 35 26 42 In hours; green boxes are episodes Course in 12 y/o girl 1 2 2 2 1/2 11 wks 14 wks 12 wks 10.6 wks In hours; green boxes are episodes 12th birthday 1st day of school Parents out of town Parents went to Dineyland without her Course in 8 y/o girl 2.5 2.5 2.5 2 2 2 2 2 2 27.5 20 27 29 26.5 35 26 42 In hours; green boxes are episodes Course in 14 y/o b