Differential diagnosis of abdominal pain in childhood Flashcards
What are the differentials of abdominal pain
Infantile colic
Gastroenteritis
Appendicitis
Etiology Of infantile colic
Causes is us unknown however it can be due to gas , milk allergy or intolerance or baby unable to calm itself
Clinical features of infantile colic
Burping
Making a string fist while crying
Flushed face
Diagnosis of infantile colic
≥ 3 hours per day,
≥ 3 days per week,
for ≥ 3 weeks in an otherwise healthy infant <3 months
Cbc, imaging, stool sample analysis and culture to rule out other causes
Treatment for infantile colic
Probiotic Lactobacillus reuteri may reduce crying
Elimination of allergen agents
Sitting and better feeding techniques
When dues appendicitis occur
Children aged 10-17
Etiology Of appendicitis
Obstruction of the appendix - hard stools
Lymphoid hyperplasia
When obstruction occurs the bacteria there multiply
Clinical features of appendicitis
Acute abdominal pain which is periumbilical
Or epigastric
Then migrates to lower right quadrant and tenderness there at mcburney point 1/3 the distance from superior right iliac spine to umbilicus
Fever
Vomiting
Dysuria and hematurea may occur
Anorexia
Diagnosis of appendicitis
Ultrasound
Cbc - non compressible and thickened appendix
Ct
Urinanalysis to differentiate it from uti
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Paediatric appendicitis score
Symptoms Migration pain to right lower quadrant Anorexia Nausea vomiting Each one = 1 point (pt)
Physical
Right lower quadrant tenderness - 2pt
Right lower quadrant pain elicited in coughing and jumping and percussion-2pt
Temperature more than 38 degrees-1 pt
Lab
Leukocytosis-2pt
Pmn more than 75 percent -1pt
Likelihood of appendicitis is high when 7 or more points
What is the treatment
No antibiotics by mouth
IV isotonic fluid
Non perforated appendicitis - iv cefotaxime
If perforated- carbapenem
Piperacillin tazobactum
Laparoscopic appendectomy
Complication of appendicitis
with no intervention Necrosis and gangrene
Perforation will follow Leading to peritonitis
