Acute vomiting in infants and children: Viva

Branch 1: Recognising the time-critical problem

The candidate must immediately recognise that bilious vomiting in a neonate is malrotation with midgut volvulus until proven otherwise, and that this is a surgical emergency rather than a cause for reassurance or an outpatient referral. The green vomit, the fullness of the abdomen, the change from a well-feeding baby, and the failure to pass stool all point to obstruction, and a volvulus can infarct the entire midgut within hours. The single most important statement is that any delay costs bowel. ^[1]

The candidate should state the first actions in parallel: make the baby nil by mouth, place a nasogastric tube on free drainage to decompress the stomach, obtain intravenous access, start fluid resuscitation, check a glucose, and call the paediatric surgical team immediately. Investigations follow but do not delay the surgical call in an unwell baby. ^[1]