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Pediatrics > Abdominal pain > Flashcards

Abdominal pain Flashcards

1
Q

Key components of GIT history overview

A 
Nutrition
Vomiting
Bowel habits
Pain
Family history
GU symptoms
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2
Q

History of nutrition (11)

A

Infant feeding patterns- duration of breast feeding
Any breast feeding problems
Key professional support for breast feeding
If formula fed- type and volume
Review intake- typical is 150ml/kg/24 hours
Age at weaning to semi solids, any choking problems, foods taken
Detail what the child eats in a typical day
Review calorie intake and nutritional balance
Level of appetite and difficult feeding behaviours
Pattern of weight gain
Review parent hand held health record

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3
Q

Volume of one fluid oz to ml

A

one fluid oz is 28 ml

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4
Q

Typical infant intake of milk

A

100-150ml/kg/24 hours

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5
Q

History of vomiting

A

Vomiting frequency and colour

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6
Q

What does green, posseting, blood in vomit of small and older children

A

Green= bile
Posseting= vomiting milk
Blood in vomit of infant->maternal blood in milk
In older children blood may suggest esophageal bleeding due to vomiting

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7
Q

History of bowel habits

A

Feces->frequency, consistency, colour, mucus, blood, greasy
Diarrhea->frequency, urgency, consistency, blood, link with diet
Meconium passed
Age of potty training
Constipation->straining, pain, reduced frequency, hard faeces
Soiling of faeces in underwear
Encopresis

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8
Q

In newborns when should meconium be passed

A

Within the first 24 hours

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9
Q

What is encopresis

A

Behavioural problem of passing faeces in inappropriate places

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10
Q

Components of abdominal examination

A 
Observation
Palpation
Percussion
Auscultation
Genitalia and anus
Rectal examination
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11
Q

Observation

A 
Child should be relaxed
Assess nutritional status->percentiles, BMI, HC, AC
Jaundice
Pallor
Abdominal distension
Wasting of buttocks
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12
Q

Organs to be palpated on abdominal examination

A

Liver
Spleen
Kidneys

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13
Q

What is to be examined for on genitals in boys

A 
Hypospadias
Epispadias
Undescended testes
Hydrocele
Hernia
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14
Q

Causes of acute abdominal pain in neonates

A 
Hirschprung's enterocolitis
Incarcerated hernia
Intussusception
Irritable/unsettled infant
Meckel's diverticulum
UTI
Volvulus
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15
Q

Causes of acute abdominal pain in infants and preschool

A 
Appendicitis
Gastroenteritis
Intussusception
Pneumonia
UTI
Volvulus
Constipation
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16
Q

Causes of acute abdominal pain in school aged children

A 
Appendicitis
Gastroenteritis
DKA
Henoch-schnolein purpura
Mesenteric adenitis
Migraine
Ovarian pathology
Pneumonia
Constipation
Testicular torsion
UTI
Viral illness
17
Q

Causes of acute abdominal pain in adolescents

A 
Appendicitis
DKA
Ectopic
Cholecystitis
Gastroenteritis
IBD
Ovarian cyst torsion/rupture
Pancreatitis
Pelvic inflammatory disease
Renal calculi
Testicular torsion
UTI
Viral illness
18
Q

History in acute abdomen

A 
SOCRATES
Billous vomiting->obstruction
Pallor and lethargy->intussusception
Rash and purpura on extensor surfaces->HSP
Cough and fever->pneumonia
Dysuria and frequency->UTI
Polyuria polydipsia, loss of weight->DKA
Menstural history in post pubertal->ectopic, torsion
Loss of appetite
Blood in stool

Past medical history

  • Hirschsprungs, CF complicated by enterocolitis->sudden painful abdominal distension and bloody diarrhea
  • Primary bacterial peritonitis->liver disease, nephrotic syndrome, splenectomy, ascites, VP shunt.
  • Pancreatitis->chemotherapy, immunosuppressants
  • IBD->toxic megacolon
19
Q

What should you suspect when acute onset of pain

A

Testicular/ovarian torsion
Intussusception
Perforated viscus

20
Q

What should you suspect with episodic severe pain

A

Intussusception
Mesenteric adenitis
Gastroenteritis
Constipation

21
Q

Important associated features

A 
Billous vomiting
Pallor and lethargy
Rash and purpura on extensor surfaces
Cough and fever
Dysuria and frequency
Polyuria polydipsia, loss of weight
Menstural history in post pubertal
22
Q

Examination in acute abdomen

A

Assess hydration
Assess overt signs of peritonism: not moving, not walking comfortably, tender to percussioin
Examine the abdomen
Respiratory examination
Inguinoscrotal examination
Rectal/vaginal examination avoided in children

23
Q

Investigations that may be required in acute abdomen

A 
FBC
Urine MCS
Glucose
UEC
LFTs
Lipase
Urine bHCG

Imaging:
AXR if obstruction suspected, dilated=obstruction, abnormal gas in intussusception, fecal loading in constipation
CXR if pneumonia suspected
USS->discuss with senior, renal tract abnormals

24
Q

Acute management of acute abdomen

A 
ABC
Early referral if surgery likelye
Fluid resuscitation
IV/IO access
Measure UEC and glucose if appear deH
NBM
Analgesia- morphnine/fentanyl may be required
NGT if BO suspected
IV antibiotics in surgical
25
Q

D/C advise following acute abdomen

A

Many can be d/c after good H/E/urine

Clear f/u plan, with GP

26
Q

Conditions which may present with recurrent abdominal pain only

A

Inflammatory bowel disease
Chronic urine infections
Parasites

27
Q

Management of “recurrent abdominal pain”- as functional problem

A

Assure parents no major illness
Cause is unknown, pain is very real
Do not communicate to the parent that the child is malingering
Identify those signs and symptoms to watch for and which would suggest need for re-evaluation
Develop a schedule for re-visits to monitor symptoms. Have family keep a diary of pain episodes and related symptoms
During return visits, allow patient and parents to express concerns and stresses
Make every effort to normalise the life of the child, encourage attendance and participation in activities
Liase with school to ensure attendance

28
Q

Psychogenic abdominal pain

A

Psychosomatic->related to stress at home/school
Assure parents of no major illness
Link pain with the stresses

29
Q

Causes of recurrent abdominal pain

A

Idiopathic recurrent abdominal pain
Hepatic->hepatitis
Pancreatic->pancreatitis

GIT:
IBS
Esophagitis
Peptic ulcer
IBD
Constipationn
Malabsorption
Giardia
Celiac

UTI
Psychogeni, abdominal migraine, sickle cell

Gynaecological:
Dysmenorrhea
PID
Hematocolpos
Ovarian cyst
30
Q

History in recurrent abdominal pain

A 
SOCRATES
Affect daily activities
Constitutional symptoms/red flags->vomiting, diarrhea, weight loss, lethargy
GIT, GU, gynaecological symptoms
Psychosocial history
School

Must ask parents if they are specifically concerned that their child has a serious disease not being investigated/being missed

31
Q

Examination in recurrent abdominal pain

A

Growth->++percentile
General examination: jaundice, palor, deficiencies
Abdominal examination
Anorectal->not routine

32
Q

Investigations and significance in chronic abdominal pain->if suspect organic cause

A 
Bloods:
FBC->anemia, eosinophils, infection
CRP->add stool test for H pylori antigen
LFTs
Celiac screen
UEC
Amylase

Urinalysis and culture
Stool for OCP
Occult blood

Imaging:
Abdominal and pelvic USS: urinary obstruction, organomegaly, abscess, pregnancy, cyst/torsion
AXR: constipation, renal calculi, lead poisening
Barium swallow->esophagitis, GORD, peptic ulcer, crohns, congenital malformations

Endoscopy: esphagitis, reflux, peptic ulcer, IBD

33
Q

Red flags in abdominal pain

A

 Pain not confined to periumbilical area (the further the
pain is from the umbilicus the less likely it is to be
functional).
 Pain at night / waking from sleep
 Change in bowel habit or blood in the stools
 Vomiting
 Intermittent fever
 Weight loss
 Lethargy
 Poor growth
 Involvement of other system e.g. rash, joint pain
 Anaemia or raised acute phase reactants

34
Q

Information to gain re school

A

School:
 Academic progress, any change?
 Peer relationships: does he have a good friend, any change in friends?
 Is there bullying at his school?
 Does he feel mostly happy or sad?
 How would he rate his mood on a scale of 1 – 10 where 1 is very happy and 10 is very sad

35
Q

Abdominal masses in children

A

Common abdominal masses in children include faecal masses, neuroblastoma, nephroblastoma (Wilm’s tumour) and lymphoma.

Pediatrics (58 decks)

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