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Gastrointestinal > 03.04 Abdominal Pain in Infants, Children and Adolescents > Flashcards

03.04 Abdominal Pain in Infants, Children and Adolescents Flashcards

1
Q

Step 1 in approach to diagnosis of acute abdominal pain

A

Establish emergent vs. non-emergent causes of abdominal pain

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2
Q

Sudden or unremitting pain with no prior Hx

Less than 2 weeks

A

Acute pain

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3
Q

More than 2 weeks

Persistent or current

A

Chronic

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4
Q

S/sx associated with the cause of an acute abdominal pain

A 
Intestinal inflammation (diarrhea, fever and fatigue, blood in the stool, LOA)
Perforation (severe, abdominal distention, fever, nausea and vomiiting)
Hemorrhage (weakness, lightheadedness, shortness of breath) 
Obstruction (bilious vomiting, electrolyte imbalance, borborygmi and ileus)
Peritoneal irritation (fever and chills, LOA, abdominal bloating, nausea and vomiting)
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5
Q

Vomiting that precedes a colicky type of abdominal pain suggests problem of _____

A

AGE

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6
Q

Vomiting that occurs after the onset of pain is suggestive of _______

A

Surgical condition

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7
Q

Red flag symptoms for surgical consult

A 
Progressive signs of deterioration (restlessness, confusion, weakness, dizziness, tachycardia, hypotension-late sign)
Bile-stained or feculent vomitus
Involuntary abdominal guarding
Rebound abdominal tenderness
Marked abdominal distention
Signs of acute fluid or blood loss
Significant abdominal trauma
No obvious etiology
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8
Q

Acute abdominal pain from a GI cause

A 
Appendicitis
Malrotation with volvulus
Intussusception
Intestinal adhesions
Strangulated hernia
Mesenteric vasculitis
Cholelithiasis/cholecystitis
Pancreatitis
Henoch-Schonlein purpura
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9
Q

Acute abdominal pain from a non-GI cause

A 
Pyelonephritis
Renal calculi
Ureteropelvic junction obstruction
Ovarian torsion or rupture of ovarian cyst
Tubo-ovarian abscess
Psoas abscess
Ectopic pregnancy
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10
Q

Step 2 of the approach to diagnosis of acute abdominal pain

A

Determine the possible origin of the pain

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11
Q

Most helpful clues in Hx taking for determining the cause of acute abdominal pain

A

Age (infancy - abdominal colic, 2-5 years - AGE, mesenteric lymphadenitis, acute appendicitis, school age or teenage - Mittelschmerz phenomenon, peptic disease or recurrent intussusception from Meckel’s diverticulum, polyp
Pain history, location, timing, character, duration, radiation

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12
Q

Observation that the further away the pain is from the umbilicus, the greater the likelihood of an organic disease has held up well

A

Apley’s criteria

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13
Q

Apley’s criteria

A

Location

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14
Q

Rate on a scale of 1-5, 1-10 or pointing to a series of faces graded from smile to frown

A

Intensity

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15
Q

Epigastric pain, LUQ
Back radiation
Constant, sharp, boring

A

Pancreatitis

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16
Q

Periumbilical - lower abdomen
Back radiation
Alternating cramping and painless periods

A

Intestinal obstruction

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17
Q

Periumbilical, then localized to RLQ
Back or pelvis radiation
Sharp, steady

A

Appendicitis

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18
Q

Periumbilical to lower abdomen
No radiation
Cramping with painless periods

A

Intussusception

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19
Q 
Back pain (unilateral)
Radiation to groin
Sharp, intermittent, cramping
A

Urolithiasis

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20
Q

Back pain, radiating to bladder

Dull to sharp

A

UTI

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21
Q

Step 3 in the approach to diagnosis of acute abdominal pain

A

Clinical evaluation

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22
Q

Fever in AGE

A

Pain follows vomiting
48-72 hours
Rotavirus

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23
Q

Fever in UTI

A

Painful urination and tenderness in suprapubic area

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24
Q

Triad for diagnosis pneumonia

A

Fever
Tachypnea
Cough

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25
Q

Abdominal pain in pneumonia

A

Referred pain

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26
Q

Fever + throat pain + abdominal pain

A

Acute tonsillopharyngitis

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27
Q

Post-surgery fever + abdominal pain

A

Intraabdominal abscess

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28
Q

Fever + vomiting + prominent lymph nodes on CT scan

A

Mesenteric lymphadenitis

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29
Q

Fever + bloody diarrhea + tenesmus + abdominal pain + vomiting

A

Shigella dysentery

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30
Q

Bilious vomiting, abdominal distention and hypoactive sounds

A

Intestinal obstruction

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31
Q

Most common causes of vomiting in infancy

A

Ingestion of mother’s blood in passing out and vomits this when given milk
Gastritis secondary to drugs

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32
Q

Vomiting similar to family members and friends

Diarrhea

A

Food poisoning

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33
Q

Oral or pharyngeal burns
History of suicidal ideation
Tablets in vomitus

A

Toxin ingestion

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34
Q

History of NSAID intake
Epigastric tenderness
Blood in vomitus

A

Gastritis

Peptic ulcer disease

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35
Q

Bilious vomiting + history of abdominal trauma

A

Duodenal hematoma

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36
Q

Causes splenomegaly

Bleeding from esophageal varices

A

Portal hypertension

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37
Q

Colickly RUQ pain + fever + vomiting

A

Acute cholecystitis

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38
Q

Upper abdominal pain + history of drug intake

A

Erosive gastritis

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39
Q

Upper abdominal pain + tenesmus + severe vomiting

A

Pancreatitis

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40
Q

Epigastric tenderness + heartburn + eating meals

A

Peptic ulcer disease

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41
Q

One of the most common functional abdominal diseases showing periumbilical pain
Hx of constipation and soiling
Stool at rectal vault
Palpable sigmoid

A

Constipation

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42
Q

Periumbilical pain + fever + point tenderness

A

Acute appendicitis

43
Q

Hx of chronic abdominal pain
Incongruent signs and symptoms
Normal screening tests

A

Functional abdominal pain

44
Q

The most common cause of blood in the stools in infant would be ____
Lower abdomen pain

A

Anal fissure (treated with lubricant)

45
Q

Second most common cause of blood in the stools is ____

Lower abdomen pain

A

AGE

Infectious diarrhea

46
Q

Third most common cause of blood in the stools

A

Allergic proctocolitis

47
Q

Lower abdomen pain
Hx of constipation and soiling
Stool at rectal vault
Palpable sigmoid

A

Constipation

48
Q

Lower abdomen pain
Blood in stools
Tenesmus
Fever

A

Colitis

49
Q

History of sexual activity
Vaginal discharge
Rectal or vaginal tenderness
Lower abdomen pain

A

Pelvic inflammatory disease

50
Q

Dysuria
Hematuria
Suprapubic tenderness
Lower abdomen pain

A

Cystitis

51
Q

Diagnostic tests

A

Hema: CBC, blood smear and ESR
Urinalysis, stool exam
CXR, AXR, Scout film (volvulus), CT scan (appendix - fat stranding), US (to rule out choledochal cyst)

52
Q

Severe constipation
Abdominal distention
Bilious emesis
Increased bowel sounds

A

Obstipation

53
Q

Choledochal cysts triad

A

Abdominal pain
Jaundice
Abdominal mass

54
Q

Long-lasting intermittent or constant abdominal pain that is functional or organic

A

Chronic abdominal pain

55
Q

A disorder caused by a detectable physiological or structural change in an organ

A

Organic pain

56
Q

ABdominal pain without demonstrable evidence of pathologic condition, e.g. anatomic, metabolic, infectious, etc
Functional dyspepsia, irritable bowel syndrome, abdominal migraine

A

Functional abdominal pain

57
Q

Includes variable combination of age dependent, chronic or recurrent GI symptoms
Potentially debilitating group of disorders which can affect the quality of life of patient and family

A

Functional GI disorders

58
Q

Pain for more than 2 weeks duration and a child must meet a certain criterion

A

Recurrent abdominal pain

59
Q

Pain with poor relation to gut function and decreased activities of daily living

A

Functional abdominal pain

60
Q

Pain that persists for greater than 6 months without evidence of physiologic events and also interferes with daily functioning

A

Functional abdominal pain syndrome

61
Q

Functional dyspepsia, functional abdominal pain
Abdominal migraine
Irritable bowel syndrome

A

FGIDs

62
Q

Acute persistent pain increasing in intensity
Sharply localized
Awakens at night
Further away
Fever, anorexia, vomiting, weight loss, anemia, elevated ESR

A

Organic

63
Q 
Less likely to change
Various locations
No effect in sleep
At umbilicus
Headache, dizziness, multiple system complaints
With psychological stress
A

Functional

64
Q

FGIDs are best understood from a _______

A

Biophychosocial perspective

65
Q

Criteria for childhood FGID

A

Rome III Criteria

66
Q

FGIDs in neonates and toddlers may present with abdominal pain

A

Infant colic
Infant dyschezia
Functional constipation

67
Q

Unclear etiology
Part of the normal distribution of crying
Painful gut contractions, lactose intolerance, gas or parental misinterpretation of normal crying

A

Infant colic

68
Q

Infant colic Dx criteria

A

All in infants 0-4 months of age: paroxysms of irritability, fussing or crying that start and stop with obvious cause, episodes lasting 3 or more hours a day, occurring at least 3 days per week for at least 1 week, no failure to thrive

69
Q

Clinical evaluation of infant colic

A 
Younger than 4-5 months
Crying with temporal features
No CNS abnormalities
No developmental deficiencies
Normal PE
Normal growth patterns
70
Q

Treatment of infant colic

A

Non-analgesic, non-nutritive soothing maneuvers (rocking, patting)
Self-limiting
Milk intolerance or esophagitis (hyrolyzed protein formula)

71
Q

Disorder of defecation

Grunting baby syndrome

A

Infant dyschezia

72
Q

Infant dyschezia Dx criteria

A

Both in younger than 6 months: at least 10 minutes of straining and crying before successful passage of stools
No other health problems

73
Q

Failure to coordinate increased intaabdominal pressure with pelvic floor relaxation

A

Infant dyschezia

74
Q

Clinical evaluation of infant dyschezia

A

Hx
PE (rectal exam)
Anthropometrics

75
Q

Management of infant dyschezia

A

Avoid rectal stimulation and use of laxatives

76
Q

Functional constipation Dx criteria

A

Must include 1 month of at least 2 of the following in infants up to 4 years of age

  • = 2 defecations per week
  • at least 1 episode per week of incontinence after acquisition of toileting skills
  • Hx of excessive stool retention
  • Hx of painful or hard bowel movements
  • Presence of a large fecal mass in the rectum
  • Hx of large-diameter stools that may obstruct the toilet
77
Q

Functional constipation typically occurs in any of the three periods

A
  • in infants with hard stools, often following dietary change
  • in toddlers acquiring toilet skills and find defecation painful
  • as school starts and children avoid defecation
78
Q

PE of functional constipation

A

Incontinence, fecal soiling, palpating fecal mass, rectal exam

79
Q

Tx of functional constipation

A

Family education
Avoid coercive toilet training tactics
Stool evacuation: mineral oil, lactulose, polyethylene glycol
Behavior modification

80
Q

Developmental issue and not a disease

Involuntary return of previously swallowed food or secretions into or out of the mouth

A

Infant regurgitation

81
Q

Retrograde movement of gastric contents and out of stomach

A

GER

82
Q

RF of infant regurgitation

A

Prematurity
Developmental delay
Congenital anomalities of the oropharynx, chest, lungs, CNS, heart GIT
Milk allergy

83
Q

Infant regurgitation Dx criteria

A

Both in healthy 3 week to 12 months of age

  • regurgitation of 2 or more times per day for 3 or more weeks
  • no retching, hematemesis, aspiration, apnea, faillure to thrive, feeding or swallowing difficulties
84
Q

Infant regurgitation s/sx that need further evaluation

A 
Failure to thrive
Hematemesis
FOBT
Anemia
Food refusal
Swallowing difficulties
Persistence > 1 year of age
85
Q

Management of infant regurgitation

A

Effective reassurance
Symptom relief
Improved maternal-child interaction

86
Q

FGIDs in children and adolescents

A 
Functional dyspepsia
Irritable bowel syndrome
Abdominal migraine
Childhood functional abdominal pain
Childhoold functional abdominal pain syndrome
Constipation and incontinence
87
Q

Most common FGID in children and adolescents

A

Irritable bowel syndrome

88
Q

Cyclic vomiting Dx criteria

A

All

  • 2 or more periods of intense nausea and unremitting or retching lalsting hours to days
  • return to usual state of health lasting weeks to months
89
Q

Recurrent, stereotypic episodes of intense nausea and vomiting
Begins at the same time of the day
Prompt recovery

A

Cyclic vomiting

90
Q

Tx for frequent, severe and prolonged episodes

A

Amitriptyline, pizotifen, cyproheptadine, phenobarbital, propanolol
Avoid food, emotional and physical stressors

91
Q

Treatment during prodrome

A

Ondansetron to reduce nausea/vomiting
H2 blockers/PPI
Deep sedation: lorazepam

92
Q

Treatment during attack

A

Sedation

IVF, electrolytes, H2 blockers

93
Q

Functional constipation Dx criteria

A

Must include 2 or more in a child with a developmental age of at least 4 years

  • 2 or fewer defecations in the toilet per week
  • at least 1 episode of fecal incontinence per week
  • Hx of painful or hard bowel movements
  • presence of a large mass in rectum
  • Hx of large diameter stool that may obstruct the toilet
94
Q

PE of functional dyspepsia

A

Exam of perineum and perianal area

Rectal exam

95
Q

Treatment of functional dyspepsia

A

Address myths and fears
Manage fecal impaction
Stool softeners preferred over laxative
Rewards for success in toilet training

96
Q

Persistent or recurrent pain centered in upper abdomen

Not relieved by defecation or associated with change in form or frequency of bowel action

A

Functional dyspepsia

97
Q

Abdominal discomfort or pain associated in 25% of the time or more, with 2 or more of:

  • improvement with defecation
  • change in frequency of stool
  • change in form or appearance of stool
A

Irritable bowel syndrome

98
Q

Episodic or continuous abdominal pain

Insufficient criteria for other functional GI disorders

A

Functional abdominal pain

99
Q

Functional abdominal pain with one or more of the following:

  • some loss of daily functioning
  • additional somatic symptoms (headache, limb pain, sleep difficulty)
A

Functional abdominal pain syndrome

100
Q

Paroxysmal episodes of intense periumbilical pain lasting 1 or more hours (2 or more times in the preceding 12 months)
Healthy in between for weeks or months
Interferes with normal activities

A

Abdominal migraine

101
Q

Abdominal migraine pain is associated with 2 or more of:

A 
Anorexia
Nausea
Vomiting
Headache
Photophobia
Pallor
102
Q

RF of abdominal pain-related in FGID

A

Parental anxiety in the first year of life

Family facotrs

103
Q

Appears to be beneficial for abdominal migraine

A

Pizotifen

Gastrointestinal (9 decks)

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