Acute Abdominal Pain

Question 1

Red flags in history to prompt further investigations

Answer 1

Age <5
Systemic symptoms - weight loss, recurrent oral ulcers, fever; dysphagia, vomiting (Haematemisis, bullious)
Nocturnal symptoms awakening a child from sleep
Persistent RU or RL abdominal pain
Dysuria / haematuria / flank pain
chronic NSAID use
FH IBD, coeliac, peptic ulcer

Question 2

Red flags on examination to prompt further investigation

Answer 2

Growth deceleration
Delayed puberty
Jaundice
Pallor
Rebound/guarding/organomegaly
Perianal disease
Blood in stool

Question 3

Red flags in investigations to prompt further investigations

Answer 3

Raised WCC
Raised inflammatory markers
Anaemia, hypoalbuminaemia

Question 4

Common causes of malaena in children?

Answer 4

Infective - bacterial diarrhoea eg. campylobacter, salmonella
IBD
Tearing from anal vein
Polyp
Intussusception - acutely unwell

Question 5

What is the initial screening marker for coeliac disease?

Answer 5

TTG antibody
(Use endomyseal antibody if patient has low IgA)

Question 6

How does intussusception present?

Answer 6

Severe, colicky abdominal pain

Pale, lethargic and unwell child
“Redcurrant jelly stool”

Right upper quadrant mass on palpation. This is described as “sausage-shaped”

Vomiting
Intestinal obstruction

Typical child in the exam will have had a viral upper respiratory tract infection preceding the illness