abdo pain + groin swelling

Question 1

ddx for neonates with acute abdo pain

Answer 1

• hirschspprungs disease
• volvulus
• incarcerated hernia
• meckels diverticulum
• colic
  uti

Question 2

ddx for infants with acute abdo pain

Answer 2

• appendidicits
• gastroenteritis
  intussusception
• uti

Question 3

ddx for school age with acute abdo pain

Answer 3

• appendicitis
• mesenteric adenitits
• DKA
• gastroenteritits
• HSP
  ovarian or test pathology

Question 4

ddx for adolescents with acute abdo

Answer 4

• appendicitis
• DKA
• ectopic
  pid
  uti
  panc

Question 5

what is mesenteric adenitis

Answer 5

intra-abdominal LN swelling
follows viral infection or gastroenteritits
can mimic appendicitis however no peritonism or guarding
dx of exclusion
mx: simple anaglesia, rolves

Question 6

what is hirschsprungs disease

Answer 6

congenital, assocaited with trisomy 21
failue of ganglion cells to migrate to hindgut
absence of bowel peristalsis
functional intestinal obstruction
80% transition zone in rectum/sigmoid - short segment disease, 20% TZ involves entire colon

CF 
first few days of life
no mec passed!!
bile stained vomit 
abdo dsitension 

ix
rectal biopsi, absence of ganglion cells

mx
surgery
75% gain normal bowel control, 5% no control

Question 7

what is a complication of hirschsprungs disease

Answer 7

hirschsprungs enterocolitis
assocaited with c. dif
10% mrtality
abdo distension, bloody watery diarrhoea. circulator collapse, septicaemia

Question 8

what is meckels diverticulum

Answer 8

congenital true diverticulum 
remnant of vitellien duct 
mostly asymtpomatic 
CF
- gi bleed 
- obstruction 
- inflammation 
- umbilical discharge

Question 9

gastroenteritits organisms

Answer 9

vital - rotavirus, enterovirus

bacterial - e.coli, shigella, salmonella, c diff

Question 10

gastroenterititis

Answer 10

CF

• diarrhoea
• abdo pain
• vomititng
• dehydration

ix
ususally none, sttol mcs or pcr

Question 11

gastroenteritits mx

Answer 11

• ondansetron once unless <6mo or <8kg
• oral rehydration (stop fortification to feeds, encourage oral intake icy pole, ice cube, breast feeding, introduce food as soon as not dehydrated)
• trial of fluids in ED (10-20ml/kg over 1hr)
• nasogastric resuscitation (most can tolerate rapid 25ml/kg over 4hrs unless <6mo/comorbidiities/signidficant abdo pain over 6 hrs)
• IVF if severely dehydrated or NG fails (bolus of 20ml/kg)

monitor bsl, k, na

Question 12

red flags for abdo pain/diarrhoea

Answer 12

• severe abdo pain or abdo sx
• diarrhoea >10days
  blood in stool
  vomitign but no diarrhoea
  toxic
  billious vomit

Question 13

intussusception

Answer 13

telescopign of proximal bowel into distal
most commonly ileum into colon through iliocaecal valve
common age 2mo-2y
often preceeding viral infection - peyers patch acts as lead point

CF

• intermittient colickly pain
• vomit
• blood/mucus stool

late
red current jelly and billious vomit

Ix
AXR - crescent sign target sign, SBO
USS unless high suspcioin
air enema - diagnositc and therapeutic

mx 
IVF 
analgesia 
NBM 
NG tube 
IV ABX

Question 14

what is the criteria for DKA

Answer 14

bsl >11.1
pH <7.3
urinary or blood ketones

Question 15

DKA IX

Answer 15

• FBC
• UEC
• blood ketones
• urine ketones
• vbg
  consider septic work up

Question 16

IX for newly dx diabetic

Answer 16

• insulin Abs
• GAD
• coeliac screen (total IgA, anti-gliadin Ab, tissue transglutamine Ab)
• TFT

Question 17

MX of DKA

Answer 17

ABC 
supportive 
- oxygen, intubate if necessary 
- 2x large PIVC
- cardiac monitoring 
\+/- abx 
\+/- IDC

fluids

• 10mg/kg bolus if neccessary (acidosis can cause poor perfusion/dehydration, deydration resolves when acidosis fixed)
• when BGL 12-15mmol switch to NS + 5% dextrose + k

bsl

• keep bsl between 5-12mmol
• if drops give dextrose dont stop influsion
• insulin infusion 50U in 49.5 0.9% NS
• > 0.1u/kg/hr in newly dx or old with bsl >15
• > 0.05u/kg/hr in old with bsl <15

k replacement

ongoing monitoring

• fluid balance
• hrly obs, bsl and blood ketones
• recheck k within 1hr of starting insulin vbg, uec and temp 2hrly

Question 18

what are the cx of DKA

Answer 18

• cerebral oedema
• hypovolemic shock
• aspiration pneumonia
• hypokalemia

Question 19

red flags for organic chronic abdo pain

Answer 19

pain not confined to periumbilical area
wakes with pain in night 
change to bowels 
vomit
fever
lethargy 
wt loss 
poor growth 
other systems involved

Question 20

ddx of chronic pain

Answer 20

fucntional pain 
IBS 
IBD 
PUD 
constipation 
malasorption 
uti 
gynae

Question 21

what is teh difference between an inguinal hernia and a hydrocele

Answer 21

inguinal hernia

• common in prems, boys, under wt
• INDIRECT
• reducible
• more noticeable when move, cough
• interrmittent lump

hydrocele 
- due to patietn processus vaginalis
- transilluminates
- cant get above it
- irreducible 
most reolve by 2 yrs

Question 22

coeliac disease CF and IX

Answer 22

CF

• FTT
• poor growht
• diarrhoea
• steatorrhoea
• abdo distension
• anaemia

Ix
- IgA level (raised)
- anti gliadin Ab 
- tisssue transglutaminase Ab
jejunal bx - villous atrophy, crypt hypertrophy