Acute abdomen Flashcards
What are the medical red flags of an acute abdomen?
1) Septic appearance
2) Resp Sx
3) Generalised oedema, ?nephrotic syndrome
4) Dehydration
5) Purpuric rash (?sepsis if febrile, ?HSP if afebrile)
6) Jaundice
7) Polyuria/polydipsia (?DM)
What are the surgical red flags of an acute abdomen?
1) Peritoneal pain
2) Faecal vomiting
3) Recent Hx of abdominal trauma
4) Recent Hx of abdominal surgery
5) Irreducible hernia
6) Testicular torsion
What is a negative Prehn’s sign?
No relief of pain when the testicles are raised above the pubic symphysis - suggestive of testicular torsion
What is a positive Prehn’s sign?
Relief of pain when the testicles are raised above the pubic symphysis - more suggestive of epididymitis
What are the equivocal red flags that also require escalation?
1) Severe/increasing abdominal pain
2) Non-mobile due to pain, or gait change due to pain
3) Bilious (green) vomits
4) Red current jelly stool
5) Abdominal distension
6) Abdominal mass
What cause of abdominal pain specific to boys should be considered?
Testicular torsion
What causes of abdominal pain specific to girls should be considered?
1) Menarche
2) Mittelschmertz
3) Pregnancy
4) Ectopic pregnancy
5) PID
6) Ovarian torision
What are the differentials for acute abdominal pain in children?
1) Gastroenteritis
2) Infantile colic
3) Appendicitis
4) Mesenteric adenitis
5) Intussusception
6) Meckel’s diverticulum
7) Constipation
8) UTI
9) Testicular torsion
10 ) Irreducible hernia
11) HSP
12) Lower lobe pneumonia
13) DKA
14) Sickle cell crisis
15) Trauma
16) Psychogenic
17) Gynae
What question do you need to ask in ?gastroenteritis?
Recent travel?
Children with what pre-exisiting diagnoses are at increased risk of gallstones?
CF
Sickle cell disease
If a child has recently had an URTI, and is now presenting with abdominal pain, what might this suggest?
Mesenteric adenitis Pulmonary cause (referred pain)
Children with which pre-exisitng diagnoses are at increased risk of constipation?
Spina bifida
Cerebral palsy
(Non-mobile)
Where is McBurney’s point?
1/3rd along the line between the ASIS and umbilicus
What are the different signs that may be seen in appendicitis?
1) Dunphy’s
2) Rovsing’s
3) Rosenstein’s
4) Psoas
5) Obturator
6) Hamburger
7) Kocher’s
What is Dunphy’s sign?
Increased pain in the RLQ on coughing
What is Rovsing’s sign?
When palpation of the LLQ results in increased pain in the RLQ
What is Rosenstein’s sign?
Increased pain in the RLQ when the patient is being examined whilst lying on their L side
What is Psoas sign?
Pain on active flexion/passive extension of the R hip
What is Obturator sign?
Pain on internal rotation of the R hip
What is Hamburger sign?
Patient refuses to eat (anorexia is specific in 80%)
What is Kocher’s sign?
Pain starts in the umbilical region before migrating to the RLQ
What is a Meckel’s diverticulum a remnant of?
Vitellointestinal duct
How is Meckel’s diverticulum Dx?
Technetium scan - increased uptake
What is the most common location of intussusception?
Invagination of the ileum into the caecum through the ileocoecal valve
What is the first-line management of intussusception?
Rectal air insufflation (in the absence of peritonitic signs) - 75% success rate
What is the second-line management of intussusception?
Operative reduction - 25% success rate
