Infant colic, appendicitis & obstruction Flashcards
What is infant colic?
- Occurs in first few months of life in 40% of babies.
- Paroxysmal, inconsolable crying or screaming
- Drawing up of knees, excessive flatus several times a day (in evening especially)
- Benign condition - can be frustrating and worrying for parents
- Can precipitate non-accidental injury/abuse in infants
- Support and reassurance
- If severe and persistent - could be cows milk protein allergy or GORD - 2 week trial of hydrolysate formula followed by a trial of anti-reflux treatment.
Appendicitis in children - epidemiology?
- (MOST COMMON CAUSE of abdominal pain in childhood requiring surgical intervention)
- Very uncommon in children under 3 years old
- Perforation rates are high in <5 years old
Clinical presentation of appendicitis?
1) Anorexia
2) Vomiting
3) Abdominal pain - initially central and colicky, but then localising to the right iliac fossa due to local peritoneal inflammation. Persistent tenderness with guarding. Aggravated by movement.
4) Low grade fever - 37.2-38 degrees
5) Retrocaecal appendix - local guarding may be absent
6) Pelvic appendix - few abdominal signs present
7) Perforation is more rapid in pre-school children as their omentum is less well developed and fails to surround appendix.
Ddx of appendicitis?
In pre-school children faecolith (hard stool) shows up on X-ray.
Diagnosis of appendicitis?
- In pre-school children diagnosis is more difficult.
- Neutrophilia may be present.
- WBC and organisms in urine if inflamed appendix is near bladder
- Ultrasound may support diagnosis, assess complications and exclude other pathology.
- No consistent test.
Treatment of appendicitis?
- Appendicectomy
- If severe/complicated due to abscess, mass or perforation then fluid resuscitation and IV antibiotics - IV Cefoxitin before surgery.
What is intussusception?
Invagination of proximal bowel into a distal segment - most commonly in the ileo-caecal region.
Epidemiology of intussusception? Risk factors?
Commonest cause of intestinal obstruction in infants after the neonatal period - peak age of onset between 3 months and 2 years. More common in boys.
RF: Male, meckel diverticulum or polyp.
Clinical presentation of intussusception?
1) Paroxysmal, severe colicky pain and pallor
2) During episodes of pain child becomes pale and draws up legs - initially recovers between painful episodes but eventually becomes lethargic.
3) May refuse feeds
4) May vomit - may be bile stained depending on site of intussusception.
5) RED CURRENT JELLY STOOL (blood stained mucus) - characteristic but occurs late-stage
6) Sausage shaped mass in RUQ palpable
7) Abdominal distention and shock
Differential diagnosis of intussusception?
1) Gastroenteritis
2) Appendicitis
Diagnosis of intussusception?
1) Ultrasound (minimally invasive, no X-ray) - may show target-like mass
2) Abdominal X-ray (avoid if possible) - Distended small bowel and absence of gas in distal colon or rectum
Treatment of intussusception?
1) IV fluid resuscitation
2) Reduction via air enema (with paeds surgeon present in case of perforation)
3) Surgery if air reduction unsuccessful
Complication of intussusception?
Stretching and constriction of mesentery resulting in venous obstruction -> bleeding -> fluid loss -> bowel perforation -> peritonitis -> gut necrosis
What is Meckel’s diverticulum? Epidemiology?
Congenital diverticulum (sac) of the small intestine - remnant of the vitellointestinal duct/omphalomesenteric duct which contains ectopic ileal, gastric or pancreatic mucosa.
Rule of 2s: 2% of population, 2 feet from ileocaecal valve,, 2 inches long.
Pathophys of Meckel’s diverticulum?
Ectopic ileal, gastric or pancreatic mucosa secretes enzymes causing ulceration and bleeding. It can lead to intussusception or volvulus where loop of intestine twists around itself.
