Abdominal Pain and Vomiting in Child

Question 1

Presentation of intussuception

Answer 1

• sudden onset vomiting, bouts of abdominal pain with calm periods in between episodes; fever
• vomiting becomes bilious as obstruction sets in
• may have “sausage” shaped mass on right side
• “currant jelly” stool, bloody stool mixed with mucous
• may proceed to bowel necrosis if left untreated

Question 2

Patient presenting with intususseption what to evaluate for before treating

Answer 2

PERFORATION with abdominal plain x-ray

if yes, THEN SURGERY REQUIRED

if no, then barium enema to relieve intussuseption

Question 3

Most common cause of GI obstruction in infants

Answer 3

hypertrophic pyloric stenosis

Question 4

• nonbilious PROJECTILE vomiting occuring immediately after meals
• may palpate olive shaped mass in RUQ

Answer 4

hypertrophic pyloric stenosis

identified via upper GI study. If “double track sign” is found, surgical referral needed

Question 5

Test of choice to dx malrotation

Answer 5

upper GI series

Question 6

Classic rotation of malrotation

Answer 6

• usually in child younger than 1 month
• abdominal pain, BILIOUS vomiting as obstruction sets in
• vascular compromise esp around superior mesenteric artery, leads to ischemia
• “beak sign” on upper GI series
• surgery definitve treatment

Question 7

`Which foreign bodies to require immediate intervention

Answer 7

flat disk/”buttons”, batteries in esophagus —> can cause perforation/obstruction

• sharp objects and magnets
• any object in esophagus has to be removed in less than 24 hours
• sharp/elongated objects that haven’t moved in 3 days

Question 8

abdominal pain and vomiting + salivation/lacrimation/diarrhea/cramps/seizures (cholinergic syndrome)

Answer 8

poisoning

Question 9

Ingestion of antihistamines or TCAs produce

Answer 9

dry skin, dry mucosae, urinary retention, decreased bowel signs (anticholinergic)

Question 10

Any infant with abdominal pain and bilious vomiting is _______ until proven otherwise

Answer 10

volvulus