Sma & Cyclic Vomiting 11.23.09

Cyclic Vomiting & SMA Syndrome Kevin E. Nelson Morning Report November 23, 2009

Cyclic Vomiting 

Explosive, severe, episodic attacks  Up

6 time per hour  +/- Bilious or bloody vomitus 

Dehydration, weight loss, difficulty ambulating



Girls > boys



Regular intervals in ~50% (2-4 weeks)



Associated with migraine headaches 



Frequent progression from vomiting to migraine headaches

Treatment: Propanolol, periactin, TCAs, phenobarb

Superior Mesenteric Artery Syndrome

SMA Syndrome 

Weight loss/under ideal body weight



Decreased retroperitoneal fat



Postprandial epigastric discomfort, eructation, fullness, and large volume emesis



Late childhood/adolescence; female > male



UGI: Duodenum dilated proximal to the third portion



Treatment: NJ feeds, prokinetics

Acknowledgements/References Dr. W. Daniel Jackson Dr. Linda S. Book Dr. John Pohl Reynolds EW, J Pediatr Gastroenterology and Nutr, 2008:46;92–95. Li BU, Gastroenterol Clin N Am, 2003:32;997–1019