Acute Abdo Pain

Question 1

Differentiate between visceral and somatic pain

Answer 1

Visceral pain: Vague, dull, gradual in onset, poorly localised. Stimuli - variety of causes, can be overactive nerves.

Somatic pain: Overlying body structures are injured, well localised, sharp, rapid

Question 2

Differential for Acute abdominal pain in children arising from bowel

Answer 2

• Intussusception
• Malrotation with volvulus
• Paralytic ileus
• Incarcerated hernia
• Intestinal obstruction of variable etiology
• Toxic megacolon

Question 3

Differential for Acute abdominal pain in children arising from infection / inflammation

Answer 3

• Appendicitis
• Mesentericadenitis
• Intra-abdominal abscess
• Spontanoeus bacterial peritonitis (Nephrotic syndrome)
• UTI
• Pneumonia
• Typhlitis (neutropenic states)
• Hepatitis / Pancreatitis / cholecystitis / Gastritis

Question 4

Differential for Acute abdominal pain in children arising from genitals

Answer 4

• Testiculartorsion
• Ovarian cyst/torsion
• Ectopic pregnancy

Question 5

Differential for Acute abdominal pain in children arising from metabolic cause

Answer 5

Diabetic ketoacidosis

drug overdose

Question 6

Differential for Acute abdominal pain in children arising from haematology cause

Answer 6

Sickle cell crisis

Question 7

Differential for vomiting in infants

Answer 7

• Gastro-oesophageal reflux (disease)
• Pyloric stenosis
• Intestinal obstruction – malrotation
• Food intolerance / allergy
• Metabolic – organic acidaemia, galactosemia, urea cycle defect)

Question 8

Differential for vomiting in younger children

Answer 8

• Appendicitis
• Viral infections
• UTI/Braintumours

Question 9

Differential for vomiting in older children

Answer 9

• All of the same as for younger children (appendicitis, viral, UTI, brain tumours)
• Drug overdose
• Eating disorders
• Cyclical vomiting syndrome

Question 10

Faltering growth should be differentiated from:

Answer 10

• Distinguish from acute weight loss!
• Distinguish from short stature
• During infancy growth is nutritionally driven
• Think genetics

Question 11

Faltering growth causes

Answer 11

• Inadequate food offered: Too little, too less frequent, calorie deficient
• Inadequate intake: Organic pathology, Eating disorders
• Vomiting
• Malabsorption
• Increased requirements: CF, cardiac pathology
• Decreased utilisation: Chromosome abnormalities, metabolic disorders

Question 12

Clinical manifestations of Pyloric stenosis

Answer 12

• Projectile vomiting, soon after feed, milky, ‘hungry baby’, faltering growth
• o/e – malnourishment, dehydration, olive sized mass in upper abdomen, visible peristalsis

Question 13

Lab findings in Pyloric stenosis

Answer 13

Hypochloremic hypokalemic metabolic alkalosis, Raised urea, Jaundice

Question 14

Surgical causes of acute abdominal pain in children

Answer 14

Tracheo-oesophageal fistula
Foreign Body
Accidental Ingestions
Pyloric Stenosis
Intestinal Obstruction
Gastroschisis
Omphalocoele

Question 15

Three main types of Jaundice

Answer 15

Hepatocellular: infective, chronic, other

Obstructive: must, bile duct stenosis, gall stones in CF or haemoglobinopathies

Haemolytic: Spherocytosis, Haemoglobinopathies, Haemolytic Uraemic Syndrome