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Emergency medicine > Abdominal Pain in Children > Flashcards

Abdominal Pain in Children Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

reassuring signs and symptoms:

A
  • frequent watery diarrhea
  • normal appetite
  • fever onset before pain
  • the jump test
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2
Q

abdominal pain pearls:

A
  • 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
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3
Q

warning signs:

A
  • bilious vomiting
  • vomiting and abdominal distention
  • pain before vomiting
  • blood in stool or ill appearing infant
  • focal abdominal pain
  • involuntary guarding
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4
Q

abdominal emergencies in neonates:

A
  • malrotation w/ volvulus necrotising entrocollitis
  • intestinal artesian/stenosis
  • hirschsprung disease
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5
Q

abdominal emergency 1-2 months:

A

-pyloric stenosis

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6
Q

abdominal emergency 6-10 months:

A

-intussusception

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7
Q

abdominal emergency pre-school and school age:

A
  • appendicitis
  • intussusception
  • testicular/ovarian torsion
  • incarcerated hernia
  • NAT with blunt abdominal trauma
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8
Q

abdominal adolescent females:

A
  • ectopic pregnancy
  • ovarian cyst/torsion
  • appendicitis
  • STD/PID
  • tuboovarian abscess
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9
Q

intestinal malrotation:

A

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

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10
Q

malrotartion hallmark:

A

bilious emesis

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11
Q

malrotation imagining:

A

corkscrew

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12
Q

malrotatiion management:

A 
IV fluid resuscitation
NG tube to intermittent suction
Call your surgeon
Upper GI series
Laparotomy
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13
Q

ill appearing child =

A 
Cardiac monitor
Pulse ox
Oxygen if needed
IV access
IVF
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14
Q

intussusception imagining:

A

bulls eye sign

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15
Q

most common abdominal emergency in early childhood:

A

intussusception

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16
Q

intussusception peak case age

A

5-9 months

17
Q

intussusception in children most commonly occurs where?

A

near ileocecal junction

18
Q

potential lead points:

A
  • small bowel lymphoma
  • meckel diverticulum
  • duplication cysts
  • polyps
  • vascular malformations
  • parasites
19
Q

intussusception clinical presentation:

A
  • 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
20
Q

intussusception management:

A
  • 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
21
Q

intussusception tx:

A
  • air enema or water-soluble contrast enema
  • study of choice in typical presentation
  • surgery if enema fails
22
Q

contraindications of air enema:

A
  • prolonged symptoms
  • signs of peritonitis
  • evidence of free air on plain x-ray
23
Q

is intussusception recurrence an indication for surgery?

A

no

24
Q

appendicitis lab tests:

A
  • unreliable

- misdiagnosed UTIs

25
Q

appendicitis management:

A
  • IV access
  • IVF
  • IV pain medication and anti-emetics
  • IV antibiotics
  • call surgery
26
Q

appendicitis events:

A

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

27
Q

appendicitis tx:

A
  • IVF
  • IV morphine and zofran
  • labs
28
Q

ovarian torsion:

A
  • all ages
  • more during reproductive years
  • 2.7% of ab pain cases
  • increased during pregnancy
29
Q

ovarian torsion presentation:

A
  • non-specific
  • Classic: sudden onset, unilateral ab pain, right side over left, N/V
  • fever and dysuria is less common
30
Q

ovarian torsion tx:

A
  • pain control
  • IVF
  • US w/ doppler
  • emergent operation
  • prolonged symptoms does not preclude possible ovarian salvage
  • may have intermittent torsion
31
Q

Pearls:

A

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

32
Q

dont forgets:

A
  • check groin
  • preg test in females and pelvic exam
  • beware of vomiting without diarrhea
  • imaginig/ labs should not delay surgical consult
33
Q

red flags:

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

Emergency medicine (10 decks)

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