Acute abdominal pain in childhood

Question 1

Define acute abdomen

Answer 1

new onset abdominal pain with signs consistent with likely surgical pathology

Question 2

Associated features to ask for in abdo pain hx

Answer 2

distension
appetite
vomiting
bowel habit
LUTS
LMP
fever
systemic upset
coryza/sore throat

Question 3

What should always be examined in a boy presenting with abdominal pain?

Answer 3

testicles –> rule out torsion

Question 4

Define colic

Answer 4

waves of smooth muscle contraction against an obstruction

(biliary colic is not colic as obstruction is only temporary)

Question 5

Abdominal pain investigations

Answer 5

urinalysis (incl pregnancy)
bloods
AXR
USS

Question 6

What causes the localisation of pain in appendicitis?

Answer 6

due to irritation of parietal peritoneum (visceral pain starts centrally)

Question 7

What word describes pain on palpation?

Answer 7

tenderness

Question 8

What colour is bilious vomiting?

Answer 8

green

Question 9

Where do the bile ducts drain to?

Answer 9

2nd part of duodenum

Question 10

What is the name of the opening to the bile ducts in the duodenum?

Answer 10

ampulla of vater

Question 11

When is it normal to feel the liver and spleen?

Answer 11

in babies (esp. <1 month)

Question 12

Causes of splenomegaly in children

Answer 12

EBV
sickle cell
leukaemia

Question 13

Child with bilious vomiting and no other symptoms - what conditions should you have a high suspicion for?

Answer 13

malrotation
volvulus

Question 14

What hip pathology can cause referred abdominal pain in children?

Answer 14

septic arthritis

Question 15

What can a small bowel obstruction in a baby be caused by?

Answer 15

inguinal hernia

Question 16

USS signs of appendicitis

Answer 16

appendix dilated >7mm
see wall of appendix

Question 17

Most common location of intussusception

Answer 17

terminal ileum telescoping into caecum

Question 18

Define appendicitis

Answer 18

acute inflammation of appendix caused by luminal obstruction and subsequent bacterial infection

Question 19

Classic intussusception presentation

Answer 19

colicky pain
pale
redcurrant jelly stool
sausage shaped mass

Question 20

How is intussusception diagnosed?

Answer 20

USS

Question 21

Intussusception management

Answer 21

air enema reduction
or theatre for reduction +/- bowel resection

Question 22

What is malrotation volvulus?

Answer 22

abnormality in embryological rotation of midgut

Question 23

Malrotation volvulus treatment

Answer 23

Ladd’s procedure
often involving the release of “Ladd’s bands” and repositioning the intestines