Abdominal Pain in Children

Question 1

reassuring signs and symptoms:

Answer 1

• frequent watery diarrhea
• normal appetite
• fever onset before pain
• the jump test

Question 2

abdominal pain pearls:

Answer 2

• always check groin in males
• dont forget urine pregnancy test in adolescent females and pelvic if sexually active
• beware of vomiting without diarrhea
• consider: lower lobe pneumonia, GAS pharyngitis

Question 3

warning signs:

Answer 3

• bilious vomiting
• vomiting and abdominal distention
• pain before vomiting
• blood in stool or ill appearing infant
• focal abdominal pain
• involuntary guarding

Question 4

abdominal emergencies in neonates:

Answer 4

• malrotation w/ volvulus necrotising entrocollitis
• intestinal artesian/stenosis
• hirschsprung disease

Question 5

abdominal emergency 1-2 months:

Answer 5

-pyloric stenosis

Question 6

abdominal emergency 6-10 months:

Answer 6

-intussusception

Question 7

abdominal emergency pre-school and school age:

Answer 7

• appendicitis
• intussusception
• testicular/ovarian torsion
• incarcerated hernia
• NAT with blunt abdominal trauma

Question 8

abdominal adolescent females:

Answer 8

• ectopic pregnancy
• ovarian cyst/torsion
• appendicitis
• STD/PID
• tuboovarian abscess

Question 9

intestinal malrotation:

Answer 9

Abnormal rotation of mesentery during embryonic development
Cecum in mid-abdomen and fixated to R lateral wall by bands of peritoneum
Midgut suspended on narrow pedicle vs wide mesentery
Intestines can twist around the narrow pedicle resulting in volvulus

Question 10

malrotartion hallmark:

Answer 10

bilious emesis

Question 11

malrotation imagining:

Answer 11

corkscrew

Question 12

malrotatiion management:

Answer 12

IV fluid resuscitation
NG tube to intermittent suction
Call your surgeon
Upper GI series
Laparotomy

Question 13

ill appearing child =

Answer 13

Cardiac monitor
Pulse ox
Oxygen if needed
IV access
IVF

Question 14

intussusception imagining:

Answer 14

bulls eye sign

Question 15

most common abdominal emergency in early childhood:

Answer 15

intussusception

Question 16

intussusception peak case age

Answer 16

5-9 months

Question 17

intussusception in children most commonly occurs where?

Answer 17

near ileocecal junction

Question 18

potential lead points:

Answer 18

• small bowel lymphoma
• meckel diverticulum
• duplication cysts
• polyps
• vascular malformations
• parasites

Question 19

intussusception clinical presentation:

Answer 19

• sudden onset of intermittent, severe, cramps abdominal pain
• legs drawn up towards abdomen
• 20 min intervals
• more frequent and severe over time
• normal in-between episodes or lethargic
• • classic triad of pain, palpable sausage shaped mass, currant jelly stools

Question 20

intussusception management:

Answer 20

• ABC’s
• Resuscitate with IVF (NS bolus)
• if vomiting decompress stomach with NGT
• consider IV antibiotics if concern for perforation
• notify surgery early
• abdominal X-rays to exclude perf
• air enema reduction

Question 21

intussusception tx:

Answer 21

• air enema or water-soluble contrast enema
• study of choice in typical presentation
• surgery if enema fails

Question 22

contraindications of air enema:

Answer 22

• prolonged symptoms
• signs of peritonitis
• evidence of free air on plain x-ray

Question 23

is intussusception recurrence an indication for surgery?

Answer 23

no

Question 24

appendicitis lab tests:

Answer 24

• unreliable

- misdiagnosed UTIs

Question 25

appendicitis management:

Answer 25

- IV access - IVF - IV pain medication and anti-emetics - IV antibiotics - call surgery

Question 26

appendicitis events:

Answer 26

Right-sided lower abdominal pain for one day Pain sharp, non-radiating, fairly sudden onset Initially 10/10 in intensity Subsequently decreased to 3/10 Similar pain three times within the past month that spontaneously resolved NB, NB emesis multiple times within past 12hrs No fever, no diarrhea LMP 2 weeks ago Not sexually active

Question 27

appendicitis tx:

Answer 27

- IVF - IV morphine and zofran - labs

Question 28

ovarian torsion:

Answer 28

- all ages - more during reproductive years - 2.7% of ab pain cases - increased during pregnancy

Question 29

ovarian torsion presentation:

Answer 29

- non-specific - Classic: sudden onset, unilateral ab pain, right side over left, N/V - fever and dysuria is less common

Question 30

ovarian torsion tx:

Answer 30

- pain control - IVF - US w/ doppler - emergent operation - prolonged symptoms does not preclude possible ovarian salvage - may have intermittent torsion

Question 31

Pearls:

Answer 31

Fever before pain is less likely surgical in nature (mesenteric adenitis) Copious diarrhea often reassuring Consider referred pain (RLL pneumonia, GAS) Urinalysis is your friend The “JUMP TEST” Benign conditions improve over time while signs and symptoms in abdominal emergencies worsen over time Close follow-up and clear return precautions are extremely important

Question 32

dont forgets:

Answer 32

- check groin - preg test in females and pelvic exam - beware of vomiting without diarrhea - imaginig/ labs should not delay surgical consult

Question 33

red flags:

Answer 33

- bilious emesis - vomiting + abdominal distention - bloody stools in ill appearing - pain before vomiting - focal ab pain - involuntary guarding