Abdominal Case Presentation Flashcards
localization of pain in abdomen
visceral hard to localize
parietal localized
visceral pain
bilateral pain fibers, unmyelinated
- enter spinal cord at multiple levels
- tension, stretching, and ischemia
dull, poorly localized, midline
parietal pain
noxious stimuli to parietal peritoneum
myelinated afferent fibers to specific root ganglia
-same side and same dermatomal level as original pain
sharp pain, localized, intense, coughing can aggravate
referred to pain
like parietal
-felt in remote area
bc supplied by same dermatome as affected organ
share central pathway for afferent neurons from different sites
acute abdomen pain DDx birth to 1 year
colic gastroenteritis constipation UTI intussussception volvulus incarcerated hernia hirshprungs dx**
acute abdomen pain DDx 2-5 years
gastroenteritis trauma appendicitis pharyngitis constipation UTI intussussception sickle cell henoch-schonlein purpura volvulus mesenteric lymphadenitis
acute abdomen pain DDx 6-11 years
gastroenteritis trauma appendicitis pharyngitis constipation UTI pneumonia sickle cells henoch-schonlein functional pain mesenteric lymphadenitis
acute abdomen pain DDx 12-18 years
appendicitis gastroenteritis constipation dysmenorrhea** mittelschermz** pelvic inflammatory disease threatened abortion ectopic pregnancy ovarian/testicular torsion
UTI
birth to 11 yo common
appendicitis
2- older common
mesenteric lymphadenitis
similar to appendicitis
-inflammation of mesenteric lymph nodes
need good image to determine not appendicitis
supportive care - hydration and pain
-will typically go away in a couple weeks
palmar grasp reflex
birth to 3-4 months
plantar grasp reflex (babinski)
toes curl out and up
birth to 6-8 months
rooting reflex
stroke mouth corner
-head turns and opens mouth to that side
birth to 3-4 months
moro reflex
startle reflex
lay back, lower quickly
-arms abduct and extend/hands open and legs flex
birth to 4 months
trunk incurvation
galants reflex
stroke down back
-spine curves toward stimulus
birth to 2 months
neonatal hyperbilirubinemia
increased bilirubin load
-hemolytic or nonhemolytic
decreased bilirubin conjugation
impaired bilirubin excretion
newborn bilirubin
produced at 2x adult rate
declines to normal levels by 10-14 days after birth
increased enterohepatic circulation
more bilirubin reabsorption
some bacteria convert to absorbable form
jaundice
begins on face - goes caudal
regresses up to face
nomogram
for jaundice risk
looks at serum bilirubin levels postnatally
physiologic jaundice
levels of 12 mg/dl by 3 days of life
physiologic jaundice overview
physiological immaturity
- appears 24-72 hours of age
- peaks 4-5 days
- disappears 10-14 days
predominantly unconjugated and does not exceed 12 mg/dl
breastfeeding jaundice
24-72 hour of age
peaks 5-15 days
disappears 3rd week of life
breast milk jaundice
appears 3-4 days
peaks 6-14 days
to third week of life
pathological jaundice
problem less than 24 hours increase fast levels peak jaundice beyond 2 weeks
elevated conjugated bilirubin
bilirubin toxicity
can damage brain tissue
kernicterus
phototherapy
trans unconjugated to cis
can pee it out
exchange transfusion
rapidly reduce bilirubin blood
if phototherapy doesn’t work - more extreme
important for history in acute abdomen pain with children
age of onset pain history recent trauma alleviate/provoking associated Sx gynecologic Hx past health drug use family Hx
pathologic jaundice
if is before 24 hours after birth
total rises more than 5mg/dl per day
higher than 17 mg/dl
neonatal hyperbilirubinemia
above 5 mg/dl
physiologic jaundice
peaks 5-6 after third or fourth day old
breast feeding jaundice
decreased volume of feeding
-dehydration
appears early
breast milk jaundice
later - peaks 6-14 days
possibly substances in milk - inhibit bilirubin metabolism
contraindication of phototherapy
elevated conjugated bilirubin
-can’t be converted
might cause bronze baby syndrome
