35 - abdo pain in infants and children

Question 1

sx of malrotation and volvulus

Answer 1

• sudden onset abdo pain and bilious vomiting or

- sudden onset abdo pain in infant with transient episode of feeding intolerance and bilious vomiting

Question 2

def. malrotation

Answer 2

• congenital non-rotation of the midgut with assoc. abnormal fixation of bowel mesentery

Question 3

def. malrotation with midgut volvulos

Answer 3

• as above with consequent twisting of the midgut resulting in ischemis and necrosis

Question 4

other obstructive process

Answer 4

• duodenal atresia
• intussussception
• hirshprung’s
• necrotizing enterocolitis

Question 5

findings on Phx for obst

Answer 5

• lethargic and toxic
• mild distension and diffuse tnederness
• gross blood

Question 6

initial mgmt of onst.

Answer 6

1. ABCs
2. stabilize
3. NPO
4. peds surg consult

Question 7

invest. for obst.

Answer 7

1. bloods
   - CBC, lytes, urea, creat, VBG, cultures
2. abdo xray
3. upper GI series

Question 8

3 important points

Answer 8

1. bilious vomiting is malrotation until proven otherwise
2. stabilization is key
3. surg consult is urgent

Question 9

Sx of intussusception

Answer 9

• previously well
• 3-12 months
• intermittenty collicky pain
• vomit may be bilious
• blood per rectum

Question 10

DDx for intuss

Answer 10

• constipation
• gastroenteritis - crampy imtermittemt pain with diarrhea
• UTI

Question 11

Phx finding of intuss

Answer 11

• painful episodes of 5 minutes with crying and pulling in legs
• diffuse tnederness, distension, RUQ sausage shaped mass
• possible palpable rectal mass

Question 12

intial mgmt of intuss

Answer 12

1. ABCs
2. stabilize
3. NPO
4. peds surg consult

Question 13

3 invest for intuss

Answer 13

1. abdo Xray
2. abdo US
3. air-barium enema
   - gold standard

Question 14

classic triad of intuss

Answer 14

1. abdo pain
2. vomit
3. currant jelly stool

Question 15

DDx for constipation

Answer 15

1. acute (1-4weeks)
   - viral or diet
2. chronic
   - functional/mech obst
   - drug induced
3. funcitonal
   - not due to organic
   4 fecal soiling
4. encopresis

Question 16

Phx findings

Answer 16

• may palpate stool

- overflow may also be present

Question 17

invest for constip

Answer 17

• minimal workup - urinalysis

Question 18

mgmt of constipation

Answer 18

infant
- corn syrup
- prune juice
toddlers/schoolage
- mineral oil
- lactulose
- senna

Question 19

important points for constipation

Answer 19

• acute can genrally be treated orally

- fleet enemas can be life threatening if used improperly, children undr 5

Question 20

DDX for gastroenteritis

Answer 20

1. rotavirus
   - fever and vomiting precede non-bloody diarrhea
2. other viruses
3. other - appy, intuss, UTI, constipation, malrotation

Question 21

Phx findings for gastro

Answer 21

• mild to severe dehydration/shock
• soft, unremarkable abdo
• rectal soft to liquid stool, may be blood streaked

Question 22

mgmt of gastra

Answer 22

severe dehydration
- fluid resus
mild dehydration
- oral rehydration - pedialyte

Question 23

investigations

Answer 23

1. bloods
   - CBC, lytes, urea, creat
2. urinalysis
   - dip and microscopy

Question 24

important points for gastro

Answer 24

• under 3 months must be carefully monitored for dehydration
• no role for anti-diahhreal agents
• be cautious and rule out other causes before labeling gastro