Abdominal Pain and Vomiting in Children

Question 1

A 1 month old previously well child presents with bile stained vomit. What could this indicate? How is it definitively diagnosed?

Answer 1

• Malrotation +/- volvulus
• Upper GI contrast studies: show location of DJ flexure (right of the midline in malrotation)

Question 2

A 10 week old baby (previously well) presents with forceful non-bilious vomiting after every meal. It is hungry again soon after each vomit and is becoming dehydrated. What needs to be ruled out here? What is the likely metabolic abnormality?

Answer 2

• Hypertrophic pyloric stenosis
• Diagnosed via US
• Hypochloraemic, hypokalaemic alkalosis

Question 3

A 6/12 infant presents with vomiting and spasmodic episodes of pallor, leg-indrawing and irritability, with following limpness. What needs to be ruled out here and how? How is it treated?

Answer 3

• Intussusception
• US - target sign
• Rehydration, air enema reduction
  
  • If complicated - laparotomy

Question 4

What are the presenting features of a child with appendicitis?

Answer 4

• Looks toxic (flushed, febrile, tachycardic), migratory pain, peritonism (localised guarding, tenderness and inflammatory signs)
• Anorexia, vomiting, also frequently present

Question 5

A child presents with abdominal pain and vomiting thought o be due to a surgical cause. What is important to correct before they go to theatre?

Answer 5

• Dehydration - replace at least half of deficit