Abdominal Pain in Children Flashcards
What common differentials should be considered in neonates with abdominal pain
Colic (self-limiting), Necrotising enterocolitis, Volvulus, Testicular torsion and CMPA (Cow’s milk protein allergy)
What common differentials should be considered in infants (1 month-2 years) with abdominal pain
Viral illness (self-limiting), Gastroenteritis (self-limiting), UTI, Constipation (self-limiting), Food allergy, intussusception and haemolytic uraemic syndrome
What common differentials should be considered in young children (2-5 years) with abdominal pain
Viral illness (self-limiting), Gastroenteritis (self-limiting), UTI, constipation (self-limiting), Appendicitis, Haemolytic uraemic syndrome, HSP and Foreign body ingestion.
What common differentials should be considered in older children (>5 years) with abdominal pain
Viral illness (self-limiting), gastroenteritis (self-limiting), UTI, Constipation (self-limiting), Appendicitis, primary bacterial peritonitis, lower lobe pneumonia, DKA, inflammatory bowel disease and abdominal migraine.
Does appendicitis occur in children <4yrs
Rare before age of 4 but perforation is high in this group so must be aware of it.
What are the risk factors for appendicitis?
<6 months of breast feeding Low dietary fibres Improved personal hygiene Smoking More common in Caucasians
What causes appendicitis?
Faecolith
Lymphoid hyperplasia
Impacted stool
Appendiceal or caecal tumour
How does appendicitis usually present?
Dull and poorly localised abdominal pain that starts in the umbilical region and then moves towards the RIF becoming well localised and sharp
Rebound tenderness + percussion pain at McBurney’s point 2/3rd between umbilicus + ASIS
Anorexia
Nausea and slight vomiting
Absence of cough
Fever and tachycardia
If child is well, can sit unsupported and hop it is unlikely to be appendicitis
Psoas sign – RIF pain with extension of the right hip (suggesting retrocaecal position)
What is Rovsing’s sign?
Rovsing’s sign – RIF pain on palpation of the LIF
What is Psoas sign?
Psoas sign – RIF pain with extension of the right hip (suggesting retrocaecal position)
How should suspected appendicitis be investigated?
FBC + CRP Urinalysis Transabdominal USS (younger patients) – dilated appendix, echogenic peri-appendiceal fat and target appearance CT scan (older patients) Pregnancy test
How is appendicitis managed?
Laparoscopic appendicectomy
Some evidence to suggest uncomplicated cases can be treated with antibiotics
How often to children normally open their bowels?
The frequency at which children open their bowels varies widely, but generally decreases with age from a mean of 3 times per day for infants under 6 months old to once a day after 3 years of age.
What causes constipation in children?
The vast majority of children have no identifiable cause which is termed idiopathic constipation. Other causes of constipation in children include: • Dehydration • Low-fibre diet • Medications: e.g. Opiates • Anal fissure • Over-enthusiastic potty training • Hypothyroidism • Hirschsprung's disease • Hypercalcaemia • Learning disabilities • Psychological issues and toilet training
How do you make a diagnosis of idiopathic constipation?
After making a diagnosis of constipation you must exclude secondary causes. If no red or amber flags are present, then a diagnosis of idiopathic constipation can be made.
