Child Health 1

Question 1

What is the most common surgical cause of abdominal pain in children?

Answer 1

Appendicitis

Question 2

What should you always check in children with acute abdominal pain/

Answer 2

Testes

Hernial orifices

Hip joints

Question 3

How can the causes of acute abdominal pain be considered in children?

Answer 3

Intra-abdominal (medical or surgical)

Extra- Abdominal

Question 4

under what age is appendicitis very uncommon?

Answer 4

under 3

Question 5

What are the symptoms of acute appendicitis?

Answer 5

Symptoms:

1. Anorexia
2. Vomiting (profuse may indicate peritonitis)
3. Abdominal pain - initially central and colicky (appendicular midgut colic) then localizing to the right iliac fossa (from localized peritoneal inflammation).
   May also be vague.

Question 6

What are the signs of acute appendicitis?

Answer 6

1. Fever
2. Abdominal pain aggravated by movement - .e.g. walking, coughing, jumping, bumps on the road during a car journey - N.B. asking the child to hop on one foot will be refused.
3. Persistent tenderness with guarding in the RIF (Mcburney’s point)

• A retrocaecal appendix localized guarding may be absent
• A pelvic appendix may give few abdominal signs. (suprapubic pain and urinary frequency +/- haematuria and leukocytes. +/- rectal irritation.

Question 7

Where is Mcburney’s point~?

Answer 7

2/3rds the way along a line drawn from the umbilicus to the anterior superior iliac spine.

Question 8

How often shoulder those with suspected appendicitis be reviewed?

Answer 8

Every few hours

Question 9

What makes appendicitis complicated?

Answer 9

Abcess

mass

perforation

Question 10

What is conservative Rx for acute appendicitis?

NAME

Answer 10

IV ABX

Co-amoxiclav 1.2g IV single dose

or

mild pen allergic

Cefuroxime 1.5g + Metronidazole

or
severe pen allergic

Gentamicin + metronidazole

Question 11

What is “non-specific” abdominal pain?

Answer 11

pain that resolved in 24-48 hours - often accompanied by UTRI with cervical lymphadenopathy.

Question 12

What is intussusception?

When does it commonly present?

Answer 12

The invagination/telescoping of proximal bowel (intussusceptum) into the lumen of a distal segment (intussuscipiens).

A lead point may be an enlarged lymph node (Peyer’s patch)

It commonly involves the ileum passing into the caecum.

It is the most common cause of intestinal obstruction in infants after the neonatal period between 3 months to 2 years (9 months).

Question 13

What conditions may cause intussusception?

Answer 13

idiopathic in infants

Luminal polys

malignant tumours

lipomata

Meckel’s diverticulum

Henoch-Schonlein Purpura

Enteric duplication cyst

Question 14

What is a complication of intussusception?

Answer 14

Stretching and constriction of the mesentery resulting in venous obstruction, causing engorgement and bleeding from the bowel mucosa, fluid loss, and subsequently bowel perforation.

Arterial compromise can result in ischaemia and necrosis.

Question 15

How does intussusception present?

Answer 15

• Males are affected more than females
• paroxysmal, severe colicky pain with pallor.
• There is recovery between episodes of the pain
• but the child becomes increasingly lethargic.
• vomiting, which may be bilious.
• sausage shaped mass often palpable
• passage of redcurrent jelly stool comprised of blood-stained mucus - a characteristic late sign.
• abdominal distension and shock

Question 16

What is the approach to pain management

Answer 16

1. Recognising
2. Responding
3. Reassessing

Question 17

What sign in children can indicate they are in pain?

Answer 17

Being extremely quiet

Question 18

What tool can be used in children over 3 to assess pain?

Answer 18

Wong Baker Faces scale.