Abdominal pain Flashcards
treatment of pyloric stenosis
- Resuscitate
- surgery (division of the hypertrophic muscle)
aetiology of pyloric stenosis
due to the progressive hypertrophy of the circumferential muscle layer of the pylorus –> outlet obstruction
medical causes of constipation in children
cows milk allergy
coeliac disease
hypercalcaemia
hypothyroidism
“typical” patient demographics with pyloric stenosis
male, 3-6 weeks of age with a family history
a double bubble sign on xray is pointing to which Dx
malrotation with volvulus or dueodenal atresia
clinical presentation of malrotation with volvulus
bile stained vomiting!
- feeding difficulties, typically in the first week
late signs: PR bleeding, abdominal distension, abdominal tenderness
7 most common causes of abdominal pain in neonates
Hirschprung's intussuception incarcerated hernia irritable infant Meckel's diverticulum UTI volvulus
what is Meckel’s diverticulum
remnant of vitelline duct that connects the yolk sac with the primitive midgut
signs on examination of pyloric stenosis
visible peristalsis
palpable olive at the pylorus
dehydration
what is intussusception
invagination of the proximal bowel into the distal bowel
most common cause of intussusception
inflamed peyer’s patches in the terminal ileum
what is the ABG derrangement that pyloric stenosis can cause
hypochloraemic, hypokalaemic, metabolic alkalosis
treatment for malrotation with volvulus
Surgery!
- deliver the bowel through the tummy
- untwist in an anticlockwise rotation
- place the gut back in
- widen the mesentry
- appendectomy
DDx of non-bilious vomiting in neonatal period
- pyloric stenosis
- sepsis
- reflux
- over feeding
- metabolic diseases - rare
- CAH - rare
gold standard investigation for intussusception
ultrasound - see target sign
Age group for intussusception
3 months to 3 years
- Peaks at 5-11 months
clinical presentation of intussusception
- intermittent abdominal pain
- vomiting
- lethargy
- red currant stools (late sign)
what are some pathological lead points that can lead to intussusception
Meckel’s diverticulum
polyp
vascular malformation
duplication cyst
6 most common causes of abdominal pain in infants/preschool
appendicitis gastroenteritis pneumonia UTI volvulus constipation
classical presentation of appendicitis
- periumbilical pain moving to the RIF
- vomiting
- anorexia
- guarding RIF
- fever
- lying still
what degree of twist of malrotation with cause arterial ischaemia
720 degrees
surgical causes of constipation in children
hirschprung disease
meconium ileus
anatomical malformation of the anus
spinal cord abnormalities
what time of the year is intussusception most common
spring and autumn
investigations for malrotation and voluvlus
upper GI contrast study - gold standard
DDx of BILIOUS vomiting
- malrotation with volvulus
- duodenal atresia
- jejunoileal atresia
- meconium ileus
- necrotizing enterocolitis
- intussusception
- incarcerated hernia
- Hirschprung’s disease
treatment of intussusception
- simple intussusception = air enema reduction
- complicated intussusception = laparotomy
what signs on examination point to intussusception
palpable mass
pulling their legs up
pallor
dehydration
consequences of intussusception
- dehydration
- bowel obstruction
- bowel ischaemia –> perforation
peak age group of appendicitis
10-12
aeitology of malrotation with volvulus
narrow base of mesentry between the ileocaecal junction and the duodeno-jejunal junction –> allowing the gut to twist around the superior mesenteric vessels
when should you start feeds again after pyloric stenosis surgery
6 hours
clinical presentation of pyloric stenosis
- forceful, projectile, non bilious vomiting
- vomiting after every feed
- effortless
- hungry straight afterwoods
- decreased stooling
- weight loss
