Acute Abdomen Paediatrics and other Emergencies Flashcards
What are sentinel signs that a child is unwell?
- feed refusal
- bile vomits
- colour (pallor, red, blue)
- tone (floppy?)
- temperature
What makes abdominal pain less likely to be sinister?
closer to the umbilicus
How qualities of the pain would you want to elicit from history and what additional features make it more likely to be serious?
- colic vs constant pain (constant ain more worrying)
- vomiting
What investigations might you consider for a child with abdominal pain?
- urine (all)
- FBC (only if diagnostic doubt)
- electrolytes (only if very sick/very dry)
- X ray or US
What is Murphy’s Triad of appendicitis?
- pain
- vomiting
- fever
What are complications of appendicitis?
- abscess
- mass due to momentum wrapping around appendix
- peritonitis
What are clues to diagnosis of appendicitis?
- moderate temperature, vomiting
- child looks unwell
What are features of nonspecific abdominal pain?
- short duration
- central
- constant
- not made worse by movement
- no GIT disturbance
- no temperature
- site & severity of tenderness vary
What is mesenteric adenitis?
mild condition which causes temporary pain in the abdomen, mainly in children. It usually clears up without treatment. Mesenteric adenitis means inflamed (swollen) lymph glands in the abdomen, which cause abdominal pain.
How does mesenteric adenitis present?
- high temperature
- usually follow URTI
- child does not appear unwell
How does pneumonia present?
- child is very sick
- usually right lower lobe
- no tummy signs
- usually worth doing x ray
How would malrotation present?
3 day old baby with bilious vomiting
How would you investigate malrotation?
upper GI contrast study ASAP
How would you manage malrotation?
laparotomy ASAP
What is intussusception and who gets it?
- when part of small bowel folds into other part of small bowel causing obstruction
- affects babies 6-12 months old exclusively
How does intussusception present?
- may have had 3 day history of viral illness then intermittent colic and dying spells (get colicky pain and draw knees up and shout for a while then go white and floppy)
- bilious vomiting
- may have recurrent jelly stool
How would you investigate intussusception?
US abdomen ‘target sign’
How would intussusception be managed?
pneumostatic reduction (air enema)
What is gastroschisis?
an abdominal wall defect where the gut is outside the body
How is gastroschisis managed?
- cling film it and keep baby warm until surgery
- closure
- total parenteral nutrition
What is exomphalos?
umbilical defect where abdominal contents are outside the body covered in peritoneum
What is exomphalos associated with?
cardiac, chromosomal or genitourinary abnormalities
How would exomphalos be managed?
primary (straight away) or delayed closure (down the line when other things are stabilised)
What prognosis is there with exomphalos?
post natal mortality about 25%
