Gastro - abdominal pain

Question 1

acute appendicitis presentation

tests
treatment

Answer 1

anorexia, vomiting
central abdominal pain - worse on moving so they are very still (car journeys painful) - this then moves to McBurneys point
fever
guarding for McBurneys point

painkillers dont help
raised WCC, ultrasound may help

treatment is appendicectomy

Question 2

age at which appendicitis is more likely?

Answer 2

any age but usually over 3

Question 3

anorexia, vomiting
central abdominal pain - worse on moving so they are very still (car journeys painful) - this then moves to McBurneys point
fever
guarding for McBurneys point

what am i

Answer 3

acute appendicitis

Question 4

mesenteric adenitis

Answer 4

non specific pain, often with are just after a viral URTI
enlarged mesenteric lymph nodes
pain comes and goes, patient can move about
resolves in 24-48 hours

Question 5

intussusception - what is it

Answer 5

invagination of proximal into distal bowel

most common cause of intestinal obstruction

Question 6

intussusception - what age is most likely to get it

Answer 6

3 months - 2 years old

Question 7

intussusception - presentation

Answer 7

paroxysmal, severe colicky pain with pallor. kid brings up legs during it, may vomit
not feeding well
sausage shaped mass is palpable
redcurrent jelly stool

Question 8

intussusception suspected - what do you do?

Answer 8

X ray
fluid resus if shocked
rectal air insufflation
surgery if this doesnt work/peritonitis

Question 9

Meckel’s diverticulum - rule of 2’s

Answer 9

presents in 2year old (boy)
2% population
2inches long
2 feet from ileocaecal valve
2 types of ectopic tissue can be found there - gastric/pancreatic

Question 10

Meckel’s diverticulum - how does it present?

Answer 10

rectal bleeding - not bright red nor very dark
acute anaemia

can present as a complication: intussusception/volvulus/diverticulitis

technetium scan = test
surgery - treatment

Question 11

malrotation presentation
investigation
treatment

Answer 11

obstruction with bilious vomiting (dark green) in the first few days of life (or whenever)
can affect blood supply to bowel (abdominal pain/tenderness)
upper GI contrast study
surgery to correct volvulus

Question 12

abdominal migraine

Answer 12

headache with abdominal pain
midline pain
vomiting, pallor

Question 13

Irritable bowel syndrome

Answer 13

altered GI motility
^force of GI contractions ^sensation of them
may be after a GI infection

non specific pain
explosive, loose mucous stools
bloating
feeling of incomplete defecation
constipation on and off

Question 14

peptic ulcers/gastritis

Answer 14

H pylori
epigastric pain which wakes from sleep and radiates to the back
nausea
C13 breath test and biopsy
treat with triple therapy
1- omeprazole
2- amoxicillin
3 - metronidazole1/clarithromycin

Question 15

Non- GI causes of abdominal pain in a child

Answer 15

Gynae - dysmenorrhoea, ovarian cyst, pelvic inflammatory disease
GU - UTI, PUJ obstruction
GI+ - hepatitis, gallstones, pancreatitis
psychosocial - bullying, abuse, stress etc