35 - abdo pain in infants and children Flashcards
sx of malrotation and volvulus
- sudden onset abdo pain and bilious vomiting or
- sudden onset abdo pain in infant with transient episode of feeding intolerance and bilious vomiting
def. malrotation
- congenital non-rotation of the midgut with assoc. abnormal fixation of bowel mesentery
def. malrotation with midgut volvulos
- as above with consequent twisting of the midgut resulting in ischemis and necrosis
other obstructive process
- duodenal atresia
- intussussception
- hirshprung’s
- necrotizing enterocolitis
findings on Phx for obst
- lethargic and toxic
- mild distension and diffuse tnederness
- gross blood
initial mgmt of onst.
- ABCs
- stabilize
- NPO
- peds surg consult
invest. for obst.
- bloods
- CBC, lytes, urea, creat, VBG, cultures - abdo xray
- upper GI series
3 important points
- bilious vomiting is malrotation until proven otherwise
- stabilization is key
- surg consult is urgent
Sx of intussusception
- previously well
- 3-12 months
- intermittenty collicky pain
- vomit may be bilious
- blood per rectum
DDx for intuss
- constipation
- gastroenteritis - crampy imtermittemt pain with diarrhea
- UTI
Phx finding of intuss
- painful episodes of 5 minutes with crying and pulling in legs
- diffuse tnederness, distension, RUQ sausage shaped mass
- possible palpable rectal mass
intial mgmt of intuss
- ABCs
- stabilize
- NPO
- peds surg consult
3 invest for intuss
- abdo Xray
- abdo US
- air-barium enema
- gold standard
classic triad of intuss
- abdo pain
- vomit
- currant jelly stool
DDx for constipation
- acute (1-4weeks)
- viral or diet - chronic
- functional/mech obst
- drug induced - funcitonal
- not due to organic
4 fecal soiling - encopresis
Phx findings
- may palpate stool
- overflow may also be present
invest for constip
- minimal workup - urinalysis
mgmt of constipation
infant - corn syrup - prune juice toddlers/schoolage - mineral oil - lactulose - senna
important points for constipation
- acute can genrally be treated orally
- fleet enemas can be life threatening if used improperly, children undr 5
DDX for gastroenteritis
- rotavirus
- fever and vomiting precede non-bloody diarrhea - other viruses
- other - appy, intuss, UTI, constipation, malrotation
Phx findings for gastro
- mild to severe dehydration/shock
- soft, unremarkable abdo
- rectal soft to liquid stool, may be blood streaked
mgmt of gastra
severe dehydration
- fluid resus
mild dehydration
- oral rehydration - pedialyte
investigations
- bloods
- CBC, lytes, urea, creat - urinalysis
- dip and microscopy
important points for gastro
- 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
