Abdominal Pain Flashcards
1
Q
Alarm symptoms
A
- Involuntary weight loss
- Deceleration of linear growth
- GI blood loss
- Significant vomiting
- Chronic severe diarrhoea
- Unexplained fever
- Presistent R upper or lower quadrant pain
- Family history of IBD
2
Q
When to refer to psychiatry for recurrent abominal pain
A
- Unexplained pain
- Pain in association with chronic and terminal illness
- Response to conventional treatment has been poor
- Suspected psychosocial issues
NB can provide full assessment (developmental, family, social, medical, collateral from school etc)
3
Q
Impact of chronic pain on children
A
- Ongoing anxiety, frustration and depression
- Chronic physical disability
- Sleep disturbance
- School abscence
- Social withdrawal
- Lack of external evidence of disorder
4
Q
Psychosocial approach to recurrent abdominal pain in children
A
- CBT (anxity management, work through problems in graded manner, challenge unhelpful thoughts, sleep hygiene)
- Liaison
- Medication
- Other psychotherapies
5
Q
Assessment of abdominal pain
A
- History
- Pain
- Urinary/bowel symptoms
- Remember LMP and last meal
- DHx/allergies
- Examination (observations, CRT, ENT, hernial orifices and testicles)
- How do they mobilise?
6
Q
Investigation and management of abdominal pain
A
- Bloods (FBC, U&Es, CRP, LFTs, glucose, GS, amylase)
- Urinalysis (bHCG)
- NBM
- IV fluids
- Active observation
- USS
- AXR
7
Q
Foregut, midgut and hindgut
A
- Foregut - mouth to 3rd part of duodenum, celiac artery supply, pain in epigastric region
- Midgut - 4th part of duodenum to transverse colon, SMA supply, pain in umbilical region
- Hindgut - descending colon to anus, IMA supply, pain in hypogastric region
8
Q
Intestinal obstruction
A
- Triad of symptoms
- Abdominal pain
- Bile stained vomiting
- Constipation
- Treat with ‘drip and suction’ = fluids and NG tube
- 70% resolve without surgery
9
Q
Intussuception
A
- 80% occur in terminal ileum
- Baby goes white when cries then goes limp
- Most occur between 3 months to 3 years
- Invagination of the bowel
- Colicky pain, intestinal obstruction and mesentery is dragged in and squeezed causing toxic shock type syndrome
- Best imaging is USS (target sign)
10
Q
Acute appendicitis
A
- Localisation in RIF
- McBurney’s Point is 1/3 from ASIS and 2/3 from pubic tubercle
- X-ray features
- Scoliosis due to pain
- Faecolith
- Absent right psoas shadow
- Intraperitoneal gas indicating perforation
- Abnormal caecal gas or small bowel dilatation
11
Q
Trauma
A
- Traumatic pancreatitis is a common ‘handlebar’ injury
- Splenic injuries are also common
12
Q
Malrotation volvulus
A
- Present with abdominal pain, drawing up of legs comiting ‘bile’, diarrhoea/constipation, rectal bleeding, failure to thrive, tachypnoea, abdominal distension and tachycardia
- AXR is useful and sigmoidoscopy is used to check for volvulus
- Treat with IV fluids to manage dehydration and surgery to cure volvulus
13
Q
Pyloric stenosis
A
- Age of onset 2-6 weeks
- M:F = 5:1
- Rapidly progressive projectile vomiting without bile, soon after feeds, no bile
- Hungry baby with acute weight loss, dehudration, hypochloraemic, hypokalaemic metabolic acidosis
- Diagnosis by test feed (visible peristalsis and palpable pylorus muscle ‘olive’ in RUQ) or by US
- Management is correct electrolyte imbalance with IV fluids prior to surgery
14
Q
Necrotising enterocolitis
A
- Acute inflammatory disease occuring in the intestines of premature infants - can lead to necrosis of bowel
- Abdominal distension, blood in stool, feeding intolerance, vomiting (often bilious) and pyrexia
- Often managed conservatively by stopping feeds and IV fluids and antibiotics but some need surgical intervention
15
Q
Atresia of the intestine
A
- Most common in small intestine (jejunum and ileum)
- 30% of infants with it in the duodenum also have down syndrome
17
Q
Acute scrotal problems
A
