Abdo pain Flashcards
DDx of Abdo pain: Infancy (< 2 years)
Common, Less Common, Very Uncommon
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
DDx of Abdo pain: Preschool (2-5 years)
Common, Less Common, Very Uncommon
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
DDx of Abdo pain: SCHOOL AGE (> 5 years)
Common, Less Common, Very Uncommon
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
DDx of Abdo pain: ADOLESCENT
Common, Less Common, Very Uncommon
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
Life threatening causes of abdominal pain
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)
Extra-intestinal causes of abdo pain
Pneumonia
Scrotal pathology - testicular torsion, epipdidymitis
Strep pharyngitis
Diabtetes mellitus
Sickle cell disease with vasoocclusive crisises
2 most common causes of acute abdominal emergencies in kids
Appendicitis - most common
Intussusception
What are the clinical features of appendicitis?
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)
Conflicting signs making diagnosis of appendicitis challenging
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
US and CT test Sn/Sp
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%
Risk factors for appendiceal perforation
Young children
Atypical presentation
Present early in their clinical course
Classic triad for intussusception
Abdo pain
Currant jelly stools
Abdo mass on palpation
Intestinal obstruction – venous congestion – arterial insufficiency
Features of Intussusception
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
Imaging for Intussusception
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
Features of abdo FBs that are reassuring that they will pass spontaneously
Move beyond the GE junction
< 5 cm in length
not sharp (not needles)
Kid is Asmxtc
Why are button battery FBs so conerning?
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
Why are magnet FBs concerning?
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
Name the features of Fitz-Hugh-Curtis Syndrome
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
Describe the management of an acute abdomen?
Airway Breathing Circulation IV access Fluid resuscitation with 20cc/kg NS Lab studies - CBC, Lytes, Glucose, Liver enzymes, Broad spectrum antibiotics Surgical consult
Describe the features and types of functional abdominal pain
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
