Acute Abdomen Paediatrics and other Emergencies

Question 1

What are sentinel signs that a child is unwell?

Answer 1

• feed refusal
• bile vomits
• colour (pallor, red, blue)
• tone (floppy?)
• temperature

Question 2

What makes abdominal pain less likely to be sinister?

Answer 2

closer to the umbilicus

Question 3

How qualities of the pain would you want to elicit from history and what additional features make it more likely to be serious?

Answer 3

• colic vs constant pain (constant ain more worrying)

- vomiting

Question 4

What investigations might you consider for a child with abdominal pain?

Answer 4

• urine (all)
• FBC (only if diagnostic doubt)
• electrolytes (only if very sick/very dry)
• X ray or US

Question 5

What is Murphy’s Triad of appendicitis?

Answer 5

• pain
• vomiting
• fever

Question 6

What are complications of appendicitis?

Answer 6

• abscess
• mass due to momentum wrapping around appendix
• peritonitis

Question 7

What are clues to diagnosis of appendicitis?

Answer 7

• moderate temperature, vomiting

- child looks unwell

Question 8

What are features of nonspecific abdominal pain?

Answer 8

• short duration
• central
• constant
• not made worse by movement
• no GIT disturbance
• no temperature
• site & severity of tenderness vary

Question 9

What is mesenteric adenitis?

Answer 9

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.

Question 10

How does mesenteric adenitis present?

Answer 10

• high temperature
• usually follow URTI
• child does not appear unwell

Question 11

How does pneumonia present?

Answer 11

• child is very sick
• usually right lower lobe
• no tummy signs
• usually worth doing x ray

Question 12

How would malrotation present?

Answer 12

3 day old baby with bilious vomiting

Question 13

How would you investigate malrotation?

Answer 13

upper GI contrast study ASAP

Question 14

How would you manage malrotation?

Answer 14

laparotomy ASAP

Question 15

What is intussusception and who gets it?

Answer 15

• when part of small bowel folds into other part of small bowel causing obstruction
• affects babies 6-12 months old exclusively

Question 16

How does intussusception present?

Answer 16

• 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

Question 17

How would you investigate intussusception?

Answer 17

US abdomen ‘target sign’

Question 18

How would intussusception be managed?

Answer 18

pneumostatic reduction (air enema)

Question 19

What is gastroschisis?

Answer 19

an abdominal wall defect where the gut is outside the body

Question 20

How is gastroschisis managed?

Answer 20

• cling film it and keep baby warm until surgery
• closure
• total parenteral nutrition

Question 21

What is exomphalos?

Answer 21

umbilical defect where abdominal contents are outside the body covered in peritoneum

Question 22

What is exomphalos associated with?

Answer 22

cardiac, chromosomal or genitourinary abnormalities

Question 23

How would exomphalos be managed?

Answer 23

primary (straight away) or delayed closure (down the line when other things are stabilised)

Question 24

What prognosis is there with exomphalos?

Answer 24

post natal mortality about 25%