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Paeds > Abdominal Pain in Children > Flashcards

Abdominal Pain in Children Flashcards

1
Q

Presentation of constipation

A 
Infrequent passage of stool
Poor appetite
Lack of energy 
Irritable 
Pale
Black bags under eyes 
Abdominal pain / distention 
Withholding or straining 
Diarrhoea 
- overflow and liquid stool
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2
Q

Causes of constipation

A 
Poor diet
- insufficient fluids 
- excessive milk 
Potty training / School toilet 
Intercurrent illness 
Medication (opiates / Gaviscon)
FH
Psychological (secondary) 
Organic (RARE)
- anal stenosis 
- anterior anus
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3
Q

What happens if you need to go and do not go?

A

Constipation

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4
Q

Viscous cycle of constipation involves….

A

A large hard stool when young
Painful or caused an anal fissure
this leads to toddler withholding of stool to prevent pain

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5
Q

What is a megarectum?

A

The stool stretches the rectum as there is so much hard stool stored

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6
Q

Results of megarectum

A

UTIs
Wetting
Soiling

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7
Q

Who particularly gets UTIs / wetting due to megarectum and why?

A

Girls as short urethra

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8
Q

Why does soiling occur when have a megarectum?

A

Internal sphincter is held open by the stool and so can only rely on the external sphincter
Soft watery stool leaking around hard stool

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9
Q

Why does stool get harder if it is not let out?

A

Bowel sucks out more and more water

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10
Q

Treatment of constipation

A 
Diet
- increased fibre
- increased fruit and veg 
- increased fluid 
- decreased milk 
Psychological 
- reduce adverse factors (make going to the toilet a pleasant experience)
- Soften stool and remove pain 
- Avoid punitive behaviour of parents 
- Reward good behaviour (praise, star charts)
Soften stool and stimulate defecation 
- drugs (osmotic laxatives, stimulant laxatives, isotonic laxatives)
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11
Q

How can going to the toilet be made into a pleasant experience for children?

A

Correct height

Not cold

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12
Q

How long is treatment for constipation given?

A

Under no longer required - enough to make them go

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13
Q

Treatment of impaction

A

Empty impacted rectum and colon = movicol
Maintain regular stool passage
Slow weaning off treatment

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14
Q

Investigations of impaction

A

Abdominal exam
- sometimes feel a suprapubic mass
Colonic marker study

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15
Q

Symptoms of Crohn’s and UC

A 
Diarrhoea (>UC)
Rectal bleeding (>UC)
Abdominal pain 
Fever
Weight loss (>C) as puts off eating
Growth failure (>C)
Arthritis
Mass (C)
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16
Q

Pattern of inflammation in crohn’s

A

Can affect anywhere so the site of inflammation predicts the symptoms
Skip lesions
Long deep inflammation like snail tracks

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17
Q

Particular features of UC

A

Bloody mucosal diarrhoea

Fluctuating

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18
Q

Features of investigations for Crohn’s

A

Symptoms not strong esp in those who dont have diarrhoea

Abnormal bloods

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19
Q

Features of investigations for UC

A

Dont always get abnormal bloods

Symptoms

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20
Q

Lab tests for UC / chron’s

A 
FBC 
- anaemia
- thrombocytosis
ESR
- raised 
Stool caprotectin 
Raised CRP
Low albumin 
No stool pathogens
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21
Q

Investigations for UC / C

A 
MRI 
Barium meal (< 5s)
Endoscopy
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22
Q

Features of inflammation in UC

A

Not patchy
Continuous
Usually gets better as go round and check on endoscopy

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23
Q

Aim of treatment for IBD in children

A

Induce and maintain remission
Correct nutritional deficiencies
Maintain normal growth and development

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24
Q

Treatment of IBD

A 
Anti inflammatorys 
Immunosuppressants
Biologics (infliximab)
Steroids (possibly)
Nutrition 
- immune modulation 
- nutritional supplementation 
Surgical
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25
Q

What to ask in the history of abdominal pain?

A 
Vomiting? - colour
SOCRATES
Bowel symptoms
Urinary symptoms - dysuria WHERE
Gynae / sexual history If teenagers
Systemic features
Vaccinations
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26
Q

How do you check for peritonism?

A

Get the child to jump

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27
Q

On abdo examination in children, what is done instead of rebound tenderness?

A

Percussion

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28
Q

What are the areas of the abdomen?

A 
Right hypochondriac region 
Epigastric
Left hypochondriac
Right lumbar
Umbilical 
Left lumbar 
Right illac fossa
Hypogastrium 
Left iliac fossa
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29
Q

What investigations could be done for abdominal pain?

A 
Urinalysis
- microscopy
- culture 
-BhCG possibly 
Stool culture
- enteric pathogens
- H pylori 
Bloods 
AXR / CXR
AUSS
MRI
Colonoscopy / sigmoidoscopy
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30
Q

Causes of abdominal pain in infants

A 
Colic
CMPA
Food intolerance 
Gastroenteritis
Malrotation 
Intussception (PS)
UTI
Hernia (strangulation)
Meckles diverticulum
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31
Q

Which cause of abdo pain in infants is an emergency?

A

Malrotation

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32
Q

Causes of abdo pain in a child

A 
Pancreatitis (uncommon)
Appendicitis 
IBS
Meckles diverticulum 
Gastroenteritis 
UTI
IBD
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33
Q

Causes of abdomen pain in adolescence

A 
Menstruation 
IBS
IBD
Ovarian 
- torsion 
- cyst 
Appendicitis
34
Q

What is intussception?

A

Telescoping of the bowel

35
Q

Presentation of intussception

A

Episodes of pain and drawing legs up
Sausage like mass
Redcurrent jelly stools (late sign)

36
Q

Investigations of intussception

A

AUSS

37
Q

Tx of intussception

A

Air enema
- 90% successful
Theatre 10%

38
Q

Risks of air enema

A

15% recurrence

Risk of perforation

39
Q

Pathology of intussception

A

Peristalsis when younger

Pathological if older

40
Q

What age normally gets intussception?

A

4 - 18 months

41
Q

Special signs of appendicitis

A

Press in LIF get pain in RIF
Internal rotation of the hip causing pain
Bring knee up causing pain

42
Q

Lifetime incidence of appendicitis

A

6 - 8%

43
Q

Pathology of appendicitis

A 
Blocked lumen leads to 
- swelling
- ischaemia
- necrosis 
Results in 
- perforation 
- abscess formation
44
Q

Pattern of the pain in appendicitis

A

Starts central

Moves to RIF

45
Q

What rule goes with Meckles diverticulum?

A

Rule of 2s

  • 2% of pop have it
  • 2% will become symptomatic
  • 2 ft from ileocaecal valve
  • 2cm long
46
Q

Definition of Meckles diverticulum

A

Congenital diverticulum of the small intestine

47
Q

Pathology of meckles diverticulum

A

Remnant of the omphalomesenteric duct and contains ectopic ileal, gastric or pancreatic mucosa

48
Q

Presentation of meckles diverticulum

A

Abdo pain mimicking appendicitis
Rectal bleeding
Intestinal obstruction
- intusseception

49
Q

Tx of meckles diverticulum

A

Removal if

  • narrow neck
  • symptomatic
50
Q

Definition of mesenteric adenitis

A

Inflammed lymph nodes within the mesentery after viral infection causing abdominal pain

51
Q

Treatment of mesenteric adenitis

A

No treatment

52
Q

What does the vomiting look like in gastroeneteritis?

A

Clear or foodstuffs

53
Q

Features of vomiting and diarrhoea in GE

A

Diarrhoea lasts 5 - 7 days, resolves by 2 weeks

Vomiting lasts 1 - 2 days, resolves by 3 days

54
Q

Causes of GE in children

A 
Rotavirus
Adenovirus
Enterovirus 
Norovirus 
E coli 
Shigella 
Salmonella
Campylobacter
Giardiasis 
Amoebiasis
55
Q

Which usually comes first in GE, the diarrhoea or the vomiting?

A

Vomiting

56
Q

Most common cause of GE in children

A

Rotavirus

57
Q

Fluid replacement in a child with no clinical dehydration

A

Continue breast feeding
Encourage fluid intake
Discourage fruit juices and carbonated drinks
Offer ORS if risk of dehydration

58
Q

What % dehydration is mild?

A

< 5%

59
Q

What % is moderate dehydration?

A

5 - 10%

60
Q

What can be seen in the nappy in under 1s in dehydration?

A

Urate crystals

- Look like orange crystals in the nappy

61
Q

Examples of High H20 content foods

A

Jellys

Yogurts

62
Q

Treatment of clinical dehydration

A 
Oral replacement therapy
- ORS 50ml/kg over 4 hours then maintenance often in small amounts 
Continue breast feeding
Consider ORS via NG tube 
If clinically deteriorate for IV fluids
63
Q

Management of clinical shock

A

Fluid bolus 20ml/kg
IVT - for maintenance and fluid deficient replacements
Add 100ml/kg for children initially shocked or 50ml/kg for children who were not initially shocked to maintenance fluids

64
Q

How do you work out maintenance fluids in children?

A

4, 2, 1 rule
4ml/kg 10kg
2ml/kg 10kg
1ml/kg / kg everything else

150ml/kg/day < 1s or sometimes pyloric stenosis

65
Q

What is the resus fluid in children?

A

20mls/kg 0.9% NaCl

10mls/kg if bleeding

66
Q

Types of fluid treatment

A

Replacement
Resuscitation
Maintenance

67
Q

How to work out replacement fluid for children?

A

ml for ml

68
Q

What are the maintenance fluids used in children?

A

0.9% NaCl
5% Dextrose
0.15% KCl

69
Q

Types of dehydration

A

Hypernatraemic
Hyponatraemic
Isotonic

70
Q

Who is especially at risk of hypoglycaemia and why?

A

< 5s

Dont have some reserves

71
Q

What does the stool look like in coeliac disease?

A

Mucous in it

72
Q

Treatment of hypernatraemic dehydration

A

Isotonic solution
Replace fluid deficit over 48 hours
Aim to reduce plasma Na less than 0.5mmol/l per hour

73
Q

What fluid replacement is done after rehydration?

A

ORS 5ml/kg for each large watery stool

74
Q

Red flags in GE

A 
Temperature
Tachypnoea
Altered consciousness state
Neck stiffness
Blood in stool 
Bilous vomiting 
Severe or localised abdominal pain 
Abdominal distension
75
Q

Who is at increased risk in GE?

A 
Children < 1 y/o
LBW infants
> 6 stools in 24 hours
> 3 vomits in 24 hours 
Children not tolerating supplementary fluids
Children with malnutrition
76
Q

Complications of GE

A 
Electrolyte imbalances
- Decreased Na
- decreased K
Hypoglycaemia
Metabolic acidosis
Seizures (febrile convulsions)
77
Q

If have D + V, what is the school exclusion advice?

A

48 hours after symptoms have settled

78
Q

Common complication after viral GE

A

Transient lactose intolerance

79
Q

What is a red flag for hirschprungs disease?

A

Passage of meconium after 48 HOURS

80
Q

Stools / diarrhoea containing undigested food typically point towards what diagnosis?

A

Toddlers diarrhoea

81
Q

If movicol isn’t working, what else can be done?

A

Add senna

Paeds (28 decks)

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