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PEM RC Exam > Abdo pain > Flashcards

Abdo pain Flashcards

1
Q

DDx of Abdo pain: Infancy (< 2 years)

Common, Less Common, Very Uncommon

A 
INFANCY ( <2 years)
Common
- Colic (< 3 mo)
- GERD
- Acute gastro
-  Viral Syndromes

Less Common

  • Trauma (possible child abuse)
  • Intussusception
  • Incarcerated hernia
  • Sickling syndromes
  • Milk protein allergy

Very Uncommon

  • Appendicitis
  • Volvulous
  • Tumors (ex. Wilms’ tumor)
  • Toxin (heavy metal, lead)
  • Malabsorptive syndromes
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2
Q

DDx of Abdo pain: Preschool (2-5 years)

Common, Less Common, Very Uncommon

A 
PRESCHOOL (2-5 years)
Common
- Acute gastro
- UTI
- Trauma
- Appendicitis
- Pneumonia
- Asthma
- Sickling syndromes
- Viral syndromes
- Constipation

Less Common

  • Meckel’s diverticulum
  • HSP
  • Cystic Fibrosis
  • Intussusception
  • Nephrotic syndrome

Very Uncommon

  • Incarcerated hernia
  • Neoplasm
  • Hemolytic Uremic Syndrome
  • Rheumatic fever
  • Myocarditis
  • Pericarditis
  • Hepatitis
  • Inflammatory bowel disease
  • Choledochal cyst
  • Hemolytic anemia
  • Diabetes
  • Porphyria
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3
Q

DDx of Abdo pain: SCHOOL AGE (> 5 years)

Common, Less Common, Very Uncommon

A 
SCHOOL AGE (> 5 years)
Common
- Acute gastro
- Trauma
- Appendicitis
- UTI 
- Functional abdo pain
- Sickling syndromes
- Constipation
- Viral Syndromes

Less Common

  • Pneumonia
  • Asthma
  • Cystic Fibrosis
  • IBD
  • Peptic Ulcer disease
  • Cholecystitis
  • Pancreatitis
  • Diabetes
  • Collagen vascular disease
  • Testicular torsion

Very Uncommon

  • Rheumatic fever
  • Toxin
  • Renal calculi
  • Ovarian torsion
  • Meconium ileus (cystic fibrosis)
  • Intussuception
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4
Q

DDx of Abdo pain: ADOLESCENT

Common, Less Common, Very Uncommon

A 
ADOLESCENT
Common
- Acute gastro
- Gastritis
- Colitis
- GERD
 - Trauma
- Constipation
- Appendicits
- Pelvic Inflammatory disease
- UTI
- Pneumonia
- Asthma
- Viral Syndromes
- Dysmenorrhea
- Epididymitis
- Lactose intolerance
- Sickling syndromes
- Mittleschmertz

Less Common

  • Ectopic pregnancy
  • Testicular torsion
  • Ovarian torsion
  • Renal Calculi
  • Peptic Ulcer disease
  • Hepatitis
  • Cholecystitis
  • Pancreatic disease
  • Meconium ileus (Cystic fibrosis)
  • Collagen vascular disease
  • IBD
  • Toxin

Very Uncommon

  • Rheumatic fever
  • Tumor
  • Abdominal abcess
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5
Q

Life threatening causes of abdominal pain

A 
Appendicitis
Intussusception
Incarcerated hernia
Trauma (accidental or inflicted)
Tumors
Sepsis
Malrotation/Volvulus
Ectopic pregnancy
DKA
Intra-abdominal abscess (pelvic, inflammatory disease, IBD)
HUS
Intestinal obstruction
Pancreatitis
Megacolon
Metabolic acidosis / Inborn error of metabolism
Aortic aneurysm
Toxic ingestion (lead, iron, aspirin)
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6
Q

Extra-intestinal causes of abdo pain

A

Pneumonia
Scrotal pathology - testicular torsion, epipdidymitis
Strep pharyngitis
Diabtetes mellitus
Sickle cell disease with vasoocclusive crisises

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7
Q

2 most common causes of acute abdominal emergencies in kids

A

Appendicitis - most common

Intussusception

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8
Q

What are the clinical features of appendicitis?

A

Periumbilical pain initially
then the onset of vomiting
Associated with low grade fever, N/V, anorexia
then RLQ deveops

Abdo pain before vomiting helps differentiate between acute gastro (vomiting - pain)

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9
Q

Conflicting signs making diagnosis of appendicitis challenging

A

Atypical locations of pain
- flank pain (appendix in the lateral gutter)
- hypogastric pain (appendix on the left)
- pelvic pain and deep pain (retrocecal appendix)
Diarrhea
- from direct sigmoid irritation
Pyruia or dysuria
- from bladder/ureteral irritation

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10
Q

US and CT test Sn/Sp

A

US - Sn 90% Sp 97%
CT - Sn 97% Sp 97%

CT needs IV contrast - not PO
MRI - Sn 100%, Sp 96%, PPV 88%, NPV 100%

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11
Q

Risk factors for appendiceal perforation

A

Young children
Atypical presentation
Present early in their clinical course

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12
Q

Classic triad for intussusception

A

Abdo pain
Currant jelly stools
Abdo mass on palpation

Intestinal obstruction – venous congestion – arterial insufficiency

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13
Q

Features of Intussusception

A 
Kids 3 mo to 3 years
Intermittent colicky pain
Legs drawn up while crying
Vomiting
Sausage shaped abdo mass
Lethargy or altered LOC
Bloody stools - late
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14
Q

Imaging for Intussusception

A

XR - may show absence of air in RLQ/RUQ or soft tissue density - lack sensitivity - cannot rule out
US - Sn 98-100% Sp 88-100%
Contrast enema - standard of care - often air enema is used more - safer, cheaper, more effective

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15
Q

Features of abdo FBs that are reassuring that they will pass spontaneously

A

Move beyond the GE junction
< 5 cm in length
not sharp (not needles)
Kid is Asmxtc

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16
Q

Why are button battery FBs so conerning?

A

Because they can become lodged against mucosa in the nose or esophagus and have the potential to cause necrosis, perforation, and life-threatening GI bleed

17
Q

Why are magnet FBs concerning?

A

Because the attraction across the bowel wall can lead to necrosis leading to obstruction
Always important to get 2 views on XR - two attached magnets can look like 1 on a single view

18
Q

Name the features of Fitz-Hugh-Curtis Syndrome

A

RUQ abdominal pain
Low grade fever
Young female
Sexually active

Often in 5-10% of patients with chlamydial or gonococcal pelvic inflammatory disease

None of the following:
N/V/D
Dysuria
Vaginal disharge
No cervical motion/adnexal tenderness
No jaundice

Definitive diagnosis - only made laparoscopically
Sometimes cervical cultures can be negative
Liver enzymes may be up
Tx - Antibiotics

19
Q

Describe the management of an acute abdomen?

A 
Airway
Breathing
Circulation
IV access
Fluid resuscitation with 20cc/kg NS
Lab studies - CBC, Lytes, Glucose, Liver enzymes, 
Broad spectrum antibiotics
Surgical consult
20
Q

Describe the features and types of functional abdominal pain

A

Types: General functional abdo pain, IBS, abdominal migraines

Features:
Episodic pain
Periumbilical
Rarely occurs during sleep
Rarely associated with eating or activities
No systemic illness - fever, N/V/D, rash, joint pain
Normal growth and development
Normal exam except periumbilical tenderness
No signs of peritonitis

PEM RC Exam (25 decks)

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