Acute Absominal Pain Flashcards
What is mittelshmertz?
Ovulation pain
Causes of abdo pain women
Ovarian cysts
What is HSP?
Vasculitis
Kidney and joints
Non blanching rash
What is intussusception?
Bowel goes into bowel
Pain in waves in abdomen
Obstruction of bowel - emergency
Fluid bolus
Volvulus ornmalrotatation
Neonatal presentation malrotatio
Abdo distension
No passage meconium
May present later
What is RAP?
Recurrent abdominal pain
How is RAP defined
> 3 episodes
Sufficiently severe to affect activities
Occur over period of >3 months
No known organic cause
Where are pain receptors mainly located in bowel?
Seroaa and mucosa
Bradykinin substance B
Why does referees pain happen?
Pain referred from dufferent organ that shares same dermatome
What determines where referred pain is from?
Dermatome that is in the area in
Where would pain be in the epigadtrium?
Liver
Pancreas
Biliary tree
Stomach
What could be affected if umbilical pain?
Distal all bowel
Caecum
Appendix
Proximal colon
What can be affected in suprapubic pain?
Distal large bowel
Bladder
Uterus and other female anatomy
Functional abdominal pain in children
Visceral hyper pain
Reduced threshold for pain
Impaired gastric relaxation
Dilated anal passage
Organic signs and symptoms
Less than 5 years
Constitutional problems
Vomiting
Nocturnal pain
Pain away from umbilicus, well localised
Urinary symptoms
Family H/o
Personal disease
Bloody stool
FAP signs and symptoms
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
What does low albumin suggest?
Chronic disease
Managing functional pain
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
Better prognosis for FAP
Female
Less than 6 years old and 6 months duration
Most common age group for constipation
3-7 years old
What does long term constipation lead to
Loss of lower colonic tone
What does soil
Signs and symptoms of constipation
Abdominal pain
Rectal bleeding
Soiling
Stool withholding behaviour
Anorexia
Abdominal distension
Abdominal mass
Recurrent UTI
Why get recurrent UTIs with constipation
Compression of bladder -> urinary stasis
5 Fs - abdominal mass
Foetus
Fluid
Faeces
Flatus
Fat
Why soiling after constipation
Loss of sensation in rectum due to continuous presence of stool
Internal anal sphincter is loose
Faecal imp action with overflow diarrhoea
What looking for if no meconium in 24 hours
Meconium ileus
Hirschprungs disease
CF
What is hirschprungs disease
Nerves in bowel absent
What is criteria for functional constipation in children?
Rome IV
Alarm features constipation
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
Differential diagnosis constipation organic
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
What are the symptoms of lead poisoning and risks
Anaemia
Peeling paint old home
Treatment constipation
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
Why should you look out for in constipation?
Safeguarding
What does bilious vomiting suggest?
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
Regurgitation vs re
When does pyloric stenosis normally present?
2 weeks
What causes telescoping of bowel
Intussecption
How does intussception happen
Lymph nodes become inflammed form jump points -> bowel to bowel connections
How does intussception happen
Lymph nodes become inflammed form jump points -> bowel to bowel connections
Causes of vommitting
Infection
Obstruction
Brain
Differnetials for vomit
Infection
Intestinal obstruction
GORD, oesophagitis
PUD
Food allergy and intolerance
Functional
Psychological
Iinduced illness
Metabolic
Renal
Neurological
Diverticulosis
What is cyclical vomitting syndrome
What is induced illness
Making themselves sick
Whats going on syndrome
What is induced illness
Making themselves sick
Whats going on syndrome - mums created sick themselves/fabricated - safeguarding
Typical signs of GORD
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
Atypical symptoms and signs for GORD
Wheeze/intractable asthma
Cough/stridor
Cyanotic episodes
Generalised irritability
Sleep disturbanve
Breath holding, sandifer syndrome
Investigations for GORD
Barium meal
Ph study
Upper GI endoscopy
What are you looking for in barium meal?
Any structural abnormality in the gut
What does pH study measure?
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
Management of GORD
Explanation of natural history in babies
Review of feeding and feeding practise
Use of thickeners
Use of antiregurgiation milks
Why can zantac medication be problematic?
Carcinogen
When should domperidone not be used
If underlying heart condition
May increase life threatening cardiac events
What is niseen fundoplication
Procedure for refractory GORD
Treatment for refractory GORD
Nissen fundoplication
PEG tube
IgE reaction time frame
2 minutes to 2 hours
What can be donw to reduce risk of cows milk allwegy in babies
Bieng breast fed
Does not eliminate risk
Presentation of cow milk allergy
GI - irritability, vomitting, food refusal, diarrhoea like stool, constipation. Blood and mucus in well baby
Skin
Respiratory - chronic cough or wheeziness
Management of cow milk protein allergy
Clinical diagnosis
Cows milk free diet trial
Steps of formula milk in cow milk protein allergies
Ubutramigen - cows milk proteins broken down a bit but not alot
Neocate - cows milk proteins completely broken down
Alpro soya
How to test for milk allergy
Take away and reintroduce - if still problems then cows milk allergy
How long dairy free if cows milk protein allergy as baby
til 1 year of age
Then slowly reintroduce milk based on milk ladder
Pognosis for cows milk allergy
> 90% TOLERATN AT 6
50% at 1 year, >75% AT 3
What need ot worry about with no dairy
Calcium and vitamin D supplements
