Abdominal Pain in Children Flashcards
reassuring signs and symptoms:
- frequent watery diarrhea
- normal appetite
- fever onset before pain
- the jump test
abdominal pain pearls:
- 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
warning signs:
- bilious vomiting
- vomiting and abdominal distention
- pain before vomiting
- blood in stool or ill appearing infant
- focal abdominal pain
- involuntary guarding
abdominal emergencies in neonates:
- malrotation w/ volvulus necrotising entrocollitis
- intestinal artesian/stenosis
- hirschsprung disease
abdominal emergency 1-2 months:
-pyloric stenosis
abdominal emergency 6-10 months:
-intussusception
abdominal emergency pre-school and school age:
- appendicitis
- intussusception
- testicular/ovarian torsion
- incarcerated hernia
- NAT with blunt abdominal trauma
abdominal adolescent females:
- ectopic pregnancy
- ovarian cyst/torsion
- appendicitis
- STD/PID
- tuboovarian abscess
intestinal malrotation:
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
malrotartion hallmark:
bilious emesis
malrotation imagining:
corkscrew
malrotatiion management:
IV fluid resuscitation NG tube to intermittent suction Call your surgeon Upper GI series Laparotomy
ill appearing child =
Cardiac monitor Pulse ox Oxygen if needed IV access IVF
intussusception imagining:
bulls eye sign
most common abdominal emergency in early childhood:
intussusception
intussusception peak case age
5-9 months
intussusception in children most commonly occurs where?
near ileocecal junction
potential lead points:
- small bowel lymphoma
- meckel diverticulum
- duplication cysts
- polyps
- vascular malformations
- parasites
intussusception clinical presentation:
- 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
intussusception management:
- 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
intussusception tx:
- air enema or water-soluble contrast enema
- study of choice in typical presentation
- surgery if enema fails
contraindications of air enema:
- prolonged symptoms
- signs of peritonitis
- evidence of free air on plain x-ray
is intussusception recurrence an indication for surgery?
no
appendicitis lab tests:
- unreliable
- misdiagnosed UTIs
appendicitis management:
- IV access
- IVF
- IV pain medication and anti-emetics
- IV antibiotics
- call surgery
appendicitis events:
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
appendicitis tx:
- IVF
- IV morphine and zofran
- labs
ovarian torsion:
- all ages
- more during reproductive years
- 2.7% of ab pain cases
- increased during pregnancy
ovarian torsion presentation:
- non-specific
- Classic: sudden onset, unilateral ab pain, right side over left, N/V
- fever and dysuria is less common
ovarian torsion tx:
- pain control
- IVF
- US w/ doppler
- emergent operation
- prolonged symptoms does not preclude possible ovarian salvage
- may have intermittent torsion
Pearls:
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
dont forgets:
- check groin
- preg test in females and pelvic exam
- beware of vomiting without diarrhea
- imaginig/ labs should not delay surgical consult
red flags:
- bilious emesis
- vomiting + abdominal distention
- bloody stools in ill appearing
- pain before vomiting
- focal ab pain
- involuntary guarding
