Abdominal Pain Flashcards
What is infant colic?
Paroxysmal inconsolable crying or screaming with drawing up of knees and excessive flatus
Several times a day
Condition is benign
Support and reassurance should be given
May be due to cow’s milk protein allergy if severe and persistent - 2 week trial of protein hydrolysate formula
What are surgical causes of abdominal pain?
Acute appendicitis Intestinal osbtruction Inguinal hernia Intussusception Peritonitis - seen in patients with ascites from nephrotic syndrome or liver disease Meckel's diverticulum - bulge in lower small intestine Pancreatitis Trauma
What are medical causes of abdominal pain?
Non-specific Gastroenteritis UTI Acute pyelonephritis Renal calculus Hydronephrosis Henoch Schonlein purpurn DKA Sickle cell disease - Africa descent? Hepatiits IBD Constipation - hard faeces? Gynae Psychologial Lead poisoning
What are extra abdominal causes of abdo pain?
URTI
Lower lobe pneumonia
Testicular torsion
Hip and spine
What are clinical features of acute appendicitis?
Anorexia
Vomtiing
Abdominal pain - initially central and colicky then localising to RIF
Fever
Abdominal pain aggravated by movement
Persistent tenderness and guarding in RIF
Rovsing’s sign
What investigations in acute appendicitis?
Clinical diagnosis
What management in acute appendicitis?
Appendicetctomy
IF complicated by mass, abscess or perforation - fluid resuscitation, IV abx prior to laparotomy
What is intussusception? Common site?
Invagination of proximal bowel into a distal segment
Most commonly ileum passing into the caecum through ileocaecal valve
When does intussusception present? Clinical features of intussusception? Risk?
3m to 2y of age
Paroxysmal severe colicky pain with pallor
May refuse feds
May vomit
Sausage shaped mass palpable in abdomen
Redcurrant jelly stool - blood stained mucus
Abdominal distension and shock
Compression of the mesenteric venous supply can cause engorgement and bleeding from bowel mucosa and perforation
Diagnosis of intussusception
X-ray of abdomen may show distended small bowel and absence of gas in distal colon
Abdominal USS:
Taget sign
Management of intussusception?
Rectal air insufflation
following resuscitation
If fails, surgery
What is Meckel diverticulum? Management?
Ileal remnant of vitello-intestinal duct
Contains ectopic gastric mucosa or pancreatic tissue
Can present with severe rectal bleeding but most asymptomatic (or intussusception)
Surgical resection
What is malrotation?
During rotation of the small bowel in fetal life, fi the mesentery is not fixed at the duodenojejunal flexure or in ileocaecal region, its base is shorter than normal and is predisposed to volvulus
Clinical features of malrotation?
Obstruction OR
Obstruction with compromised blood supply - volvulus causes superior mesenteric arterial blood supply to small and proximal large intestine to compromise resulting in infarction
Bilious vomiting in first few days of life - dark green vomtiing
Diagnosis of malrotation?
Upper GI contrast study to assess intestinal rotation
USS
If vascular compromise:
Urgent laparotomy
Management of malrotation?
Laparotomy
Volvulus untwisted
Duodenum mobilised
Malrotation not corrected but mesentery broadened
What is abdominal migraine?
Abdominal pain in addition to headaches
Attacks of abdominal pain are midline associated with vomiting and facial pallor
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Personal or FHx of migraine
History is characteristic with long periods of no symptoms then shorter period (12-48h) of non-specific abdominal pain and pallor
Clinical features of PUD?
Epigastric pain
Wakes at night
Pain radiates through to back
Hx of peptic ulceration in first degree relative
What causes PUD?
H. pylori (GRam negative)
What test for H pylori?
C-13 breath test following administration of C13 labelled urea by mouth - H pylori produces urease which converts urea to CO2
Stool antigen for H pylori may be positive
How should PUD in children be treated?
PPI - omeprazole
Eradication therapy:
Amoxicillin + metronidazole/clarithromycin + omeprazole
