19. Abdo pain and vomiting Flashcards
What happens in malrotation and when does it typically occur?
Volvulus usually happens with malrotation, typically occurs in 1st wk/mth of life
Malrotation= DJ flexure stays on the right, and so does the small bowel so it’s easier for the bowel to twist
presentation of malrotation with volvulus?
bile coloured vomiting.
Why is vomited bile green?
bile is naturally yellow but if goes through stomach acid makes it green
What is the best invx for malrotation with volvulus?
upper GI contrast study to see orientation of gut and duodenum (normal C shape- S is malrotation)
Tx of malrotation
surgery- Ladd’s procedure - derotate all gut, widen mesentery, but small bowel on right side and large bowel on left.
What happens if kids present with malrotation and volvulus late?
passing blood PR - indication that gut is dying
What is the most common bowel obstruction?
pyloric stenosis - 1/300- most common cause of non bilious vomiting other than sepsis
typical age, type of vomiting for pyloric stenosis
3-6 wks - non bilius projectile vomiting (stomach strong, peristaltic wave projects back on itself), hungry afterwards (unlike gastro)
metabolic derangements with pyloric stenosis?
metabolic alkalosis, hypochloremic, hypokalemic- vomited out NaCL and K+
Not hyponatremic because Na is the most important electrolyte to have and will be conserved til the laslt moment.
Urine in pyloric stenosis?
is actually acidotic cause desparately holding onto sodium- Na/H shunt - shunt out H+ and keep Na
Fixing pyloric stenosis?
medical first: rehydrate, K and Cl back to normal (danger of cardiac arrest)
surgery:tear pylorus- division of hypertrophic muscle
What is the most common obstruction outside the pyloric area?
intussusception- invagination of proximal into distal bowel
age of intussusception- why?
3mths to 3 yrs, peak incidence 6 mths due to introduction of solid foods and increase in MALT proliferation (pushing LNs along > intussusception)
presentation of intussusception?
pain, hot, pale, nausea, sweaty, look terrible- in waves as contractions come and go. pull legs up to decrease pain.
May have palpable mass, redcurrent jelly stool is a late sign
dx intuss
US- see small bowel into small/big- usually on right side
how to tx intuss
gas reduction enema in radiology- fluid, abx, pain> then rubber cather up bottom> pushgas up bowel- works quite well
pathological reasons for intuss?
meckel's diverticulum (slight bulge in small intestine at birth due to incomplete omphalomesenteric duct obliteration) polyp HSP vascular malformation ca
Fluid regime with pyloric stenosis
150ml/kg/day: 0.45% NaCl with 5% dextrose, add 20mmol KCl/L after confirming K level
sequelae of intussusception
- dehydration
- bowel obstruction
- bowel ischaemia leading to perforation
differential dx intuss
colic gastroenteritis mesenteric adenitis meckel's ing hernia
investigation of choice for intuss
U/s> see ‘target sign”
peak incidence of appendicitis
10-12 yrs
signs of appendicitis
abdo pain lasting> 4 hrs
diarrhoea 24hrs
infant who prefers to lie still
diff dx appendicits
gastroenteritis mesenteric adenitis UTI right lower lobe pneumonia testicular torsion constipation
‘medical student’ presentation of appendicitis
- periumbilical pain with shift to RIF +/- vomiting, anorexia signs: - lying still - pallor - fetor - low grade fever - guarding RIF
presentation of retrocaecal appendicitis
vague non localising RIF pain with deep RIF tenderness - often without guarding. Differential diagnosis from mesenteric adenitis can be difficult
presentation pelvic appendicitis
lower abdo pain and tenderness
urinary sxs
small vol diarrhoea
How does perforated appendicitis present? in who is the risk of this greater?
generalised peritonitis
greater in young ppl - communication difficult, assumed to be viral
imagin with appendicitis
US, AXR
treatment of app
- Important: correct dehydrationand electrolyte disturbance first
- lap app
What is mesenteric adenitis?
inflammation of mesenteric lymph nodes
