Abdo Pain/Vomiting Flashcards
What is functional abdo pain? How often does it occur?
- Non-specific pain, no organic cause
- 10-15% cases
What are some DDx for abdo pain in: neonates
Congenital:
- Hirschsprung’s
- Meckel’s diverticulum
Surgical:
- Incarcerated hernia
- Intussusception
- Pyloric stenosis
- Volvulus
Other:
- Irritable/ unsettled (colic)
- Colic
- GORD
- UTI
What are some DDx for abdo pain in: infants/pre-school
GIT:
- Appendicitis
- Gastroenteritis
- Intussusception
- Volvulus
- Constipation
Other:
- Pneumonia
- UTI
What are some DDx for abdo pain in: school-aged
GIT:
- Appendicitis
- Gastroenteritis
- Mesenteric adenitis
- Constipation
Repro: 5. Testicular torsion 6. Ovarian pathology I nfection: 7. Pneumonia 8. UTI 9. Viral illness
Other:
- DKA
- HSP
- Migraine
What are some DDx for abdo pain in: adolescents
GIT:
- Appendicitis
- Ectopic pregnancy
- Cholecystitis/ cholelithiasis
- Gastroenteritis
- IBD
- Pancreatitis
Repro:
- Ovarian cyst–torsion, rupture
- PID
- Testicular torsion
Infection:
- UTI
- Viral illness
Other:
- DKA
- Renal calculi
What does episodic abdo pain point towards?
intussusception, mesenteric adenitis, gastroenteritis, constipation
What does bilious vomiting imply? What should you do next with this info?
• Bilious vomiting implies volvulus or bowel obstruction and warrants surgical review.
Signs of peritonism
○ Won’t want to move
○ Can’t walk/fail hop test
○ Abdominal tenderness with percussion
○ Internal rotation of the right hip can irritate an inflamed appendix.
What are some Ix you could do to investigate abdo pain?
• urine MCS
• blood sugar for DKA
• electrolytes +/- LFTs
• Lipase (pancreatitis)
• urine pregnancy test/ quantitative beta hCG
• Coeliac serology and total IgA - consider for chronic abdo pain
• Imaging
○ AXR if obstruction suspected. Not helpful in diagnosing constipation.
○ CXR if pneumonia suspected
○ Ultrasound
DDx for neonatal bilious vomiting
- Malrotation with volvulus
- Duodenal atresia
- Intussusception (late presentation)
- Strangulated inguinal hernia (late presentation)
- Hirschprung’s disease (late presentation)
- Meconium ileus
DDx for neonatal non-bilious vomiting
- Gastroenteritis
- GOR/GORD
- Pyloric stenosis
- Infection (UTI, meningitis, pneumonia, OM, septic arthritis, sepsis)
DDx for acute vomiting in children
• Gastroenteritis
• Appendicitis (Uncommon in <5yo)
• DKA
• Infection (UTI, meningitis, pneumonia, OM, septic arthritis, sepsis)
• Causes of raised ICP (hydrocephalus, haematoma, tumour, meningitis)
• Migraine
• Intussusception
Malrotation with volvulus (90% Px in first year)
DDx for chronic vomiting in children
- CMPI
* GOR/GORD
