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Childs Health > Acute Absominal Pain > Flashcards

Acute Absominal Pain Flashcards

1
Q

What is mittelshmertz?

A

Ovulation pain

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2
Q

Causes of abdo pain women

A

Ovarian cysts

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3
Q

What is HSP?

A

Vasculitis
Kidney and joints
Non blanching rash

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4
Q

What is intussusception?

A

Bowel goes into bowel
Pain in waves in abdomen
Obstruction of bowel - emergency
Fluid bolus
Volvulus ornmalrotatation

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5
Q

Neonatal presentation malrotatio

A

Abdo distension
No passage meconium
May present later

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6
Q

What is RAP?

A

Recurrent abdominal pain

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7
Q

How is RAP defined

A

> 3 episodes
Sufficiently severe to affect activities
Occur over period of >3 months
No known organic cause

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8
Q

Where are pain receptors mainly located in bowel?

A

Seroaa and mucosa
Bradykinin substance B

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9
Q

Why does referees pain happen?

A

Pain referred from dufferent organ that shares same dermatome

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10
Q

What determines where referred pain is from?

A

Dermatome that is in the area in

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11
Q

Where would pain be in the epigadtrium?

A

Liver
Pancreas
Biliary tree
Stomach

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12
Q

What could be affected if umbilical pain?

A

Distal all bowel
Caecum
Appendix
Proximal colon

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13
Q

What can be affected in suprapubic pain?

A

Distal large bowel
Bladder
Uterus and other female anatomy

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14
Q

Functional abdominal pain in children

A

Visceral hyper pain
Reduced threshold for pain
Impaired gastric relaxation
Dilated anal passage

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15
Q

Organic signs and symptoms

A

Less than 5 years
Constitutional problems
Vomiting
Nocturnal pain
Pain away from umbilicus, well localised
Urinary symptoms
Family H/o
Personal disease
Bloody stool

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16
Q

FAP signs and symptoms

A

Nonspecific
Periumbilical
Lack of SS organic Dian
Better on weekends or holidays
Distracts me
Ass with stress
Well otherwise
Normal growth
Normal examination
Perfectionist
Good vs poor school performers
Stress diversion
Coping mechanism
Difficult to manage
May not be acceptable to family

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17
Q

What does low albumin suggest?

A

Chronic disease

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18
Q

Managing functional pain

A

Education
Reassurance
Patient and family support
CAMHS
Restore normal activity and school attendance
Drugs have limits role
Paeds psychological support
Antispasmodics to help with pain - symptomatic management

Pain is real but

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19
Q

Better prognosis for FAP

A

Female
Less than 6 years old and 6 months duration

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20
Q

Most common age group for constipation

A

3-7 years old

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21
Q

What does long term constipation lead to

A

Loss of lower colonic tone

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22
Q

What does soil

A
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23
Q

Signs and symptoms of constipation

A

Abdominal pain
Rectal bleeding
Soiling
Stool withholding behaviour
Anorexia
Abdominal distension
Abdominal mass
Recurrent UTI

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24
Q

Why get recurrent UTIs with constipation

A

Compression of bladder -> urinary stasis

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25
Q

5 Fs - abdominal mass

A

Foetus
Fluid
Faeces
Flatus
Fat

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26
Q

Why soiling after constipation

A

Loss of sensation in rectum due to continuous presence of stool
Internal anal sphincter is loose
Faecal imp action with overflow diarrhoea

27
Q

What looking for if no meconium in 24 hours

A

Meconium ileus
Hirschprungs disease
CF

28
Q

What is hirschprungs disease

A

Nerves in bowel absent

29
Q

What is criteria for functional constipation in children?

A

Rome IV

30
Q

Alarm features constipation

A

Meconium not for 48 hours
Constipation starting in first month
FH hirschprungs
Failure to thrive
Blood in stools
Bio lupus vomiting
Sever abdo distension
Anal abnormality
Spine abnormality
Decreased lower limb tone/power/reflex

31
Q

Differential diagnosis constipation organic

A

Neurological - hirschprungs, spinal cord dysplasia,
Obstructive - meconium ileus, anal ring stenosis
Endocrine/metabolic - coeliac disease, hypothyroidism, hypercalcemia, CMPA
Toxins - laxative/diuretic abuse, lead and iron poisonning, opiates

32
Q

What are the symptoms of lead poisoning and risks

A

Anaemia
Peeling paint old home

33
Q

Treatment constipation

A

Laxatives and compliance
Softeners then stimualnts after 2 weeks
PEG/movicol
Manual evacuations
Persistent rectal washouts
ACE. - anti grade colonic enema
Fluids and fibre in diet
Education nbehavioural therapy

34
Q

Why should you look out for in constipation?

A

Safeguarding

35
Q

What does bilious vomiting suggest?

A

Nil by mouth NG tube aspirate X-ray abdo and speak to surgeons
Consider sepsis as differential
Obstruction
Preterm necrotising enterocilitis
Term - congenital condition, eg malrotation or volvulus
Prev surgery adhesions cause bands

36
Q

Regurgitation vs re

A
37
Q

When does pyloric stenosis normally present?

A

2 weeks

38
Q

What causes telescoping of bowel

A

Intussecption

39
Q

How does intussception happen

A

Lymph nodes become inflammed form jump points -> bowel to bowel connections

40
Q

How does intussception happen

A

Lymph nodes become inflammed form jump points -> bowel to bowel connections

41
Q

Causes of vommitting

A

Infection
Obstruction
Brain

42
Q

Differnetials for vomit

A

Infection
Intestinal obstruction
GORD, oesophagitis
PUD
Food allergy and intolerance
Functional
Psychological
Iinduced illness
Metabolic
Renal
Neurological
Diverticulosis

43
Q

What is cyclical vomitting syndrome

A
44
Q

What is induced illness

A

Making themselves sick
Whats going on syndrome

44
Q

What is induced illness

A

Making themselves sick
Whats going on syndrome - mums created sick themselves/fabricated - safeguarding

45
Q

Typical signs of GORD

A

Excessive regurgitation/vmitting
Nausea
Irritability with feeds, araching back
Colic
Dysphagia, chest/epigastric
Excessive hiccups
Weight loss/faltering growth
Haematemesis/iron deficiency
ASpiration pneumonia
Oesophageal stricture

46
Q

Atypical symptoms and signs for GORD

A

Wheeze/intractable asthma
Cough/stridor
Cyanotic episodes
Generalised irritability
Sleep disturbanve
Breath holding, sandifer syndrome

47
Q

Investigations for GORD

A

Barium meal
Ph study
Upper GI endoscopy

48
Q

What are you looking for in barium meal?

A

Any structural abnormality in the gut

49
Q

What does pH study measure?

A

Reflux index - catheter/NG tube fixed at LOS for 24 hours measuring % of time where reflux index >4% (4-10 mild, >10 moderate, >20 severe)
Measuring severity of reflux

50
Q

Management of GORD

A

Explanation of natural history in babies
Review of feeding and feeding practise
Use of thickeners
Use of antiregurgiation milks

51
Q

Why can zantac medication be problematic?

A

Carcinogen

52
Q

When should domperidone not be used

A

If underlying heart condition
May increase life threatening cardiac events

53
Q

What is niseen fundoplication

A

Procedure for refractory GORD

54
Q

Treatment for refractory GORD

A

Nissen fundoplication
PEG tube

55
Q

IgE reaction time frame

A

2 minutes to 2 hours

56
Q

What can be donw to reduce risk of cows milk allwegy in babies

A

Bieng breast fed
Does not eliminate risk

57
Q

Presentation of cow milk allergy

A

GI - irritability, vomitting, food refusal, diarrhoea like stool, constipation. Blood and mucus in well baby
Skin
Respiratory - chronic cough or wheeziness

58
Q

Management of cow milk protein allergy

A

Clinical diagnosis
Cows milk free diet trial

59
Q

Steps of formula milk in cow milk protein allergies

A

Ubutramigen - cows milk proteins broken down a bit but not alot
Neocate - cows milk proteins completely broken down
Alpro soya

60
Q

How to test for milk allergy

A

Take away and reintroduce - if still problems then cows milk allergy

61
Q

How long dairy free if cows milk protein allergy as baby

A

til 1 year of age
Then slowly reintroduce milk based on milk ladder

62
Q

Pognosis for cows milk allergy

A

> 90% TOLERATN AT 6
50% at 1 year, >75% AT 3

63
Q

What need ot worry about with no dairy

A

Calcium and vitamin D supplements

Childs Health (82 decks)

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