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Paediatrics > Chronic Abdo Pain + Masses > Flashcards

Chronic Abdo Pain + Masses Flashcards

1
Q

GI Causes of Chronic Abdo Pain

A

most common

  • constipation
  • IBS
  • lactose intolerance

Other

  • esophagitis/gastritis
  • celiac
  • PUD
  • IBD
  • parasite
  • recurrent pancreatitis
  • hiatus hernia
  • choledochal cyst
  • malrotation
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2
Q

gynecologic/uro causes of chronic abdo pain

A 
dysmenorrhea
mittelschmerz
ovarian cyst
endometriosis
renal colic, uretopelvic junction obstruction
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3
Q

neurologic causes of chronic abdo pain

A

abdominal migraine

migraine

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4
Q

endocrine causes of chronic abdo pain

A

addisons disease

hyperparathyroidism

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5
Q

cardiovasc causes of chronic abdo pain

A

SMA syndrome

arrythmias

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6
Q

hematologic causes of chronic abdo pain

A

sickle cell disease
leukemia/lymphoma
prophyria
abdominal neoplasm (Wilm’s, neuroblastoma)

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7
Q

Other causes of Chronic abdo pain

A

Recurrent abdo pain of childhood
aerophagia
discitis

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8
Q

Encopresis definition

A

overflow incontinence of stool

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9
Q

Constipation Complications

A

encopresis, appetite suppression, recurrent UTI / incomplete voiding, self-esteem, missed school

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10
Q

Constipation etiology / ddx

A

functional (99%)

  • behaviour, diet, poor fluids
  • trigger: start cows milk, toilet training, school

organic

  • hypothyroidism, DM, hypercalcemia
  • hirschprung’s disease, spinal cord trauma
  • diabetes insipidus
  • CF
  • celiac disease
  • bowel obstruction
  • anal atresia, stenosis, displacement
  • chemotherapy, opioids
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11
Q

Hirschprung’s Disease Signs

A 
Delayed mec >48h
FTT
small stool
bilious vomiting
tight sphincter
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12
Q

Spinal cord abnormality signs

A

decreased lower reflexes
hypotonia
no anal wink

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13
Q

hypothyroidism signs

A

fatigue
FTT
cold intolerance
bradycardia

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14
Q

cystic fibrosis signs

A

diarrhea
FTT
fever
recurrent pneumonia

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15
Q

celiac signs

A

diarrhea or constipation after wheat

rash

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16
Q

Rome Criteria for Functional Constipation

A

4 years old, not meeting IBS criteria, with 2+:

  • <2 BM in toilet per week
  • 1+ fecal incontinence per week
  • retentive volition/ posturing
  • painful or hard BM
  • large fecal mass in abdomen
  • large diameter stool
17
Q

Constipation Treatment

A
  • education/behaviour: sit on toilet 10min 2x/d, praise, diary (may delay training until soft)
  • diet changes to increase fibre (no supplement), can try cow milk free if unresponsive
  • meds: PEG - larger dose to disimpact, them maintenance for months - years
18
Q

Functional Abdominal Pain Definition

A

3+ attacks of severe pain, 3+ years old, for at least 3 mo, without cause

lower abdo pain may be associated with altered bowel habits

19
Q

Functional abdo pain presentation

A
  • paroxysmal, varies in intensity, gradual onset
  • periumbilical
  • peptic sx (bloating, etc)
  • +/- headaches, dizziness, fatigue
  • interferes with activities
  • difficulty falling asleep but doesn’t wake from sleep
  • other somatic sx (limb pain)
  • psychologic stress at first episode
  • famHx: IBS, migraine, dyspepsia
20
Q

Red Flags for Abdo Pain (non-functional)

A
  • weight loss or growth decel
  • fever
  • joint pain / swelling
  • oral lesions, rash
  • rectal bleeding
  • pain away from umbilicus
  • rebound tenderness
  • radiation to back, shoulders, legs
  • wakes from sleep regularly
  • severe N/V/D or encopresis
21
Q

Work-up for functional abdominal pain

A

usually none needed
could consider from hx:
- UA / culture, CBC, stool culture or occult blood
- no routine AXRs
- if <4 years or hx/px point to organic causes, do more tests

22
Q

treatment of functional abdominal pain

A 
affirm pain
address psychosocial
family therapy or CBT?
good f/u
no elimination diets, but could avoid food triggers
probiotics ?
23
Q

Abdominal Masses DDx

A

flank: MCD kidney, PCKD, hydronephrosis, renal vein thrombosis, neuroblastoma, wilm’s tumor, adrenal hemorrahage

RUQ: liver mass, choledochal cyst, intussusception

periumbilical: GI duplication, mesenteric cyst, omental cyst, urachal cust, meconium pseudocyst, pancreatic pseudocyst

low mid: hydrometrocolpos, ovarian cyst/tumor, sacroccygeal teratoma

RLQ mass: appendix abscess, lymphoma, ectopic kidney, ovarian or testicular mass

LLQ: ovary/test mass, fecal impaction

24
Q

Initial W/U for abdominal mass

A
  • CBC
  • catecholamine metabolites (VMA, HVA), urine or serum (neuroblastoma /w adrenal involvement)
  • skeletal survey - bone mets
  • abdo US
  • AXR if think bowel obstruction
  • abdo CT after US, can show calcifications + detail (don’t do if cyst)
25
Q

Neuroblastoma description

A

Neural crest cell tumor: adrenal medulla, abdominal paraspinal, thoracic, cervical, pelvic ganglia

26
Q

Neuroblastoma presentation

+ workup

A

median age 19mo, sometimes fam hx

abdo: mass, fever, weight loss
thoracic: resp distress
cervical/upper chest: horners
nerve root/spinal compression
paraneoplastic: HTN, secretory diarrhea, opsoclonus-myoclonus

tests:
Catecholamines + urinary mets if adrenal
US or MRI, then staging

27
Q

Neuroblastoma Treatment + Prognosis

A

Surgery +/- radiation, chemo, biologics, immunotherapy

prognosis extremely variable: depends on stage, ploidy, MYCN gene, age, etc

28
Q

Wilm’s Tumor Description

A

Nephroblastoma - primary renal neoplasm

29
Q

Wilm’s Tumor Presentation

A

Ages 2-5

80% = asymptomatic unilateral abdo mass

HTN
gross hematuria
abdo pain
vomiting
dyspnea - pulmonary mets
30
Q

risk factors for Wilm’s Tumor

A 
African American
Fam Hx
WAGR (wilms, aniridia, geniturinary tract anomaly, mental retardation)
denys-drash syndrome
beckwidth-wiedemann
31
Q

workup for ? wilm’s tumor

A

US, +/- CT

look for mets:

  • CXR
  • bone scan
  • chest CT
32
Q

Wilm’s Tumor Treatment

A
  • surgery
  • +/- chemo, rads, neoadjuvent chemo

precursor = nephrogenic rests, monitor contralat kidney

90% long term survival

Paediatrics (23 decks)

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