Acute Abdoman

Question 1

Acute abdomen 3 main groups

Answer 1

1 as part of a generalized illness eg HSP mesenteric adenitis, DKA , HUS
2 abdominal pain. Appendicitis, ovarian, intasusseption, Mechels, small bowel obstruction
3 elsewhere. Eg pneumonia, torsion of tesicle, Pyleonephritis. Arthritis, disc it is

Question 2

What causes appendicitis

Answer 2

Luminal obstructions /lymphoid obstructions viral bacterial Fbc

Question 3

What clinical observations are important in the acute abdomen

Answer 3

Walking posture
Jumps on the spot / climbs on the bed
Resp rate effort ( exclude pneumonia)
Check testicles 
BSL 
Abdomen 
Deep muscle tenderness of abdomen
Guarding 
Hip movement 
Raisings sign LIF push and let go and the kids point to the RIF for pain

Question 4

Investigations

Answer 4

WCC can be Normal in acute appendicitis 
Urine MCS
Abdomen X-ray almost NEVER done
CTscan very good hardly used 
Laparoscopy

Question 5

Appendicitis in child <5years

Answer 5

Difficult historian
50 % perforated at time of the operation
Present with PUO generalized unwell
Difficult examination
Advanced signs
Child often needs vigorous resuscitation before surgery
High morbidity and mortality

Question 6

RIF pain in girls

Answer 6

Careful history to dd appendicitis and torsion of the ovary
Menstration history and sexual history
Past history
Torsion of the OVary has a history of sudden onset of pain that is constant
USS helpful in T of OVary can see the swollen ovary
Untwist and leave them and then review if there is a cyst that needs removing try to save the ovary

Question 7

Torsion of the testicle/ torsion of the undecended testicle

Answer 7

Always check the testicles. Then you wont miss it
Dd appendicitis
Peak time for torsion of Testicles is 12-14 years