Abdominal Case Presentation

Question 1

localization of pain in abdomen

Answer 1

visceral hard to localize

parietal localized

Question 2

visceral pain

Answer 2

bilateral pain fibers, unmyelinated

• enter spinal cord at multiple levels
• tension, stretching, and ischemia

dull, poorly localized, midline

Question 3

parietal pain

Answer 3

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

Question 4

referred to pain

Answer 4

like parietal
-felt in remote area

bc supplied by same dermatome as affected organ

share central pathway for afferent neurons from different sites

Question 5

acute abdomen pain DDx birth to 1 year

Answer 5

colic
gastroenteritis
constipation
UTI
intussussception
volvulus
incarcerated hernia
hirshprungs dx**

Question 6

acute abdomen pain DDx 2-5 years

Answer 6

gastroenteritis
trauma
appendicitis
pharyngitis
constipation
UTI
intussussception
sickle cell
henoch-schonlein purpura
volvulus
mesenteric lymphadenitis

Question 7

acute abdomen pain DDx 6-11 years

Answer 7

gastroenteritis
trauma
appendicitis
pharyngitis
constipation
UTI
pneumonia
sickle cells
henoch-schonlein
functional pain
mesenteric lymphadenitis

Question 8

acute abdomen pain DDx 12-18 years

Answer 8

appendicitis
gastroenteritis
constipation
dysmenorrhea**
mittelschermz**
pelvic inflammatory disease
threatened abortion
ectopic pregnancy
ovarian/testicular torsion

Question 9

UTI

Answer 9

birth to 11 yo common

Question 10

appendicitis

Answer 10

2- older common

Question 11

mesenteric lymphadenitis

Answer 11

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

Question 12

palmar grasp reflex

Answer 12

birth to 3-4 months

Question 13

plantar grasp reflex (babinski)

Answer 13

toes curl out and up

birth to 6-8 months

Question 14

rooting reflex

Answer 14

stroke mouth corner
-head turns and opens mouth to that side

birth to 3-4 months

Question 15

moro reflex

Answer 15

startle reflex

lay back, lower quickly
-arms abduct and extend/hands open and legs flex

birth to 4 months

Question 16

trunk incurvation

Answer 16

galants reflex

stroke down back
-spine curves toward stimulus

birth to 2 months

Question 17

neonatal hyperbilirubinemia

Answer 17

increased bilirubin load
-hemolytic or nonhemolytic

decreased bilirubin conjugation

impaired bilirubin excretion

Question 18

newborn bilirubin

Answer 18

produced at 2x adult rate

declines to normal levels by 10-14 days after birth

Question 19

increased enterohepatic circulation

Answer 19

more bilirubin reabsorption

some bacteria convert to absorbable form

Question 20

jaundice

Answer 20

begins on face - goes caudal

regresses up to face

Question 21

nomogram

Answer 21

for jaundice risk

looks at serum bilirubin levels postnatally

Question 22

physiologic jaundice

Answer 22

levels of 12 mg/dl by 3 days of life

Question 23

physiologic jaundice overview

Answer 23

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

Question 24

breastfeeding jaundice

Answer 24

24-72 hour of age
peaks 5-15 days
disappears 3rd week of life

Question 25

breast milk jaundice

Answer 25

appears 3-4 days
peaks 6-14 days
to third week of life

Question 26

pathological jaundice

Answer 26

problem
less than 24 hours
increase fast
levels peak
jaundice beyond 2 weeks

elevated conjugated bilirubin

Question 27

bilirubin toxicity

Answer 27

can damage brain tissue

kernicterus

Question 28

phototherapy

Answer 28

trans unconjugated to cis

can pee it out

Question 29

exchange transfusion

Answer 29

rapidly reduce bilirubin blood

if phototherapy doesn’t work - more extreme

Question 30

important for history in acute abdomen pain with children

Answer 30

age of onset
pain history
recent trauma
alleviate/provoking
associated Sx
gynecologic Hx
past health
drug use
family Hx

Question 31

pathologic jaundice

Answer 31

if is before 24 hours after birth
total rises more than 5mg/dl per day
higher than 17 mg/dl

Question 32

neonatal hyperbilirubinemia

Answer 32

above 5 mg/dl

Question 33

physiologic jaundice

Answer 33

peaks 5-6 after third or fourth day old

Question 34

breast feeding jaundice

Answer 34

decreased volume of feeding
-dehydration

appears early

Question 35

breast milk jaundice

Answer 35

later - peaks 6-14 days

possibly substances in milk - inhibit bilirubin metabolism

Question 36

contraindication of phototherapy

Answer 36

elevated conjugated bilirubin
-can’t be converted

might cause bronze baby syndrome