Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

2H Pedia > MOD4 Abdominal pain > Flashcards

MOD4 Abdominal pain Flashcards

OUTLINE •Case Scenario •Types of Abdominal Pain •History: Clues to Ask About •Examination: Signs to Look For •Investigations •Management

1
Q

What are the clues?

A
  1. Persistent Crying
  2. Refusal of feeding
  3. Irritability
  4. Flexion of thighs on the abdomen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the types of abdominal pain?

A
  1. Visceral pain
  2. Somatic pain
  3. Reffered pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

– results when nerves within the gut
detect injury
- vague, dull, poorly localized
- slow in onset

A

VISCERAL PAIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

– overlying body structures are injured
- includes parietal peritoneum,
fascia, muscles, skin of the
abdominal wall

A

SOMATIC PAIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

– painful sensation in a body or region distant from the source of pain

A

REFERRED PAIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Intra-abdominal Causes

A

•GIT
•Liver and Gallbladder
•Pancreas
•Kidney and Urinary Tract
•Spleen
•Internal Genitalia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Extra-abdominal Causes

A
  • URT
  • Lungs
  • Heart
  • Nervous System
  • Hematologic
  • Metabolic
  • Functional/Psychogenic
  • Miscellaneous (eg. Poisoning)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the causes of acute abdominal pain?

A
  1. Mesenteric Adenitis
  2. Intussuception
  3. Diabetes
  4. Lower Lobe Pneumonia
  5. Peptic ulcer
  6. Renal Calculi
  7. GIT obstruction
  8. Gastroenteritis
  9. Constipation
  10. UTIs
  11. Henoch Schonlein Purpura
  12. Acute Appendicitis
  13. IBD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  • Recent Viral infection
  • No peritonism
  • Pain can mimic Appendicitis
A

Mesenteric Adenitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  • Intermitten screaming / colic
  • Shock/ pallorl
  • Recurrent jelly/ stool
  • Usually 3-24 months old
A

Intussupception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  • Signs of Pneumonia
  • Referred abdomina pain
A

Lower lobe pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  • Pain at night
  • relief with milk
  • helicobacter pylori
A

peptic ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  • hydronephrosis
A

Renal calculi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  • Bile-stained vomiting
  • abdominal distention
A

Intestinal obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  • vomiting and diarrhea
A

gastroenteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  • hard or infrequent stools
  • mass in left iliac fossa
  • faecal loading on x-ray
A

Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  • Dysuria, frequency
  • bedwetting
  • back pain
  • vomiting
  • evidentce of infection on urinalysis or microscopy
A

UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q
  • Purpuric rash on legs
  • Joint pain
A

Henoch-Schonlein purpura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  • Anorexia
  • pain central-> right iliac fossa
  • peritonism in right iliac fossa
  • tachycardia
A

acute appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  • blood/ mucus in stools
  • family history diarrhea
  • weight loss and poor growth
A

inflammatory bowel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

0-3 mo

Vomiting- Nonbilious

A

GERD reflux

Hypertrophic pyloric stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Vomiting- Bilious

A

Malrotation and volvulus

Hirschsprung’s disease

Hernias

Meningitis or other sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

0- 3 mos

Abdominal mass

A

Renal or ovarian masses

Neuroblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

3 mos - 3 yr

Pain and lethargy

A

Intussusception

Wilm;s’ tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Older than 3 yr Pain- persistent and lateralized
appendicitis
26
Onset
Sudden or gradual, prior episode, associated with meals, history of injury Acute vs. Chronic
27
Nature
Sharp versus dull, colicky or constant, burning
28
Pain that interferes minimally with activity or Pain associated with a known benign cause, such as viral AGE
MILD
29
Pain that interferes with activity or Associated signs of bacterial infection (respiratory distress, UTI, Streptococcus pyogenes) A history of prior abdominal surgery or NEC
MODERATE
30
Signs of peritonitis or intestinal obstruction or intussusception or Alterations in mental status (delirium, confusion, lethargy) or Signs of moderate or severe dehydartion
SEVERE
31
Signs of sepsis or septic shock with altered mental status or Poor or peripheral perfusion, hypotension or Respiratory distress (adult respiratory distress syndrome)
VERY SEVERE
32
Location
Epigastric, periumbilical, generalized, right or left, upper or lower quadrant, change in location over time
33
Epigastric Pain
* Peptic Ulcer Disease * Hiatal hernia * Gastroesophageal Reflux * Esophagitis * Pancreatitis
34
Signs of Ulcer Disease
**Recurrent abdominal pain** –Often epigastric –Relieved by food or antacids –Awaken the patient from sleep **•Associated with** –Nausea –Vomiting –Hematemesis or melena
35
RUQ Pain
* Hepatitis * Liver abscess or tumor * Cholecystitis * Cholangitis
36
Mild Abdominal Pain: Diffuse, Periumbilical or Left sided
* Constipation * Mesenteric adenitis * Food poisoning * Muscle strain * Gastroenteritis * Psychogenic pain
37
Associated symptoms
* Dysuria, frequency (UTI) * Fever * Vomiting * Diarrhea * Rectal bleeding * Jaundice * Weight loss
38
Mild Abdominal Pain: Diffuse, Periumbilical or Left sided Precipitating Factors and Predisposing Conditions
* Constipation * Trauma * Medications * Menses * Pregnancy * Prior abdominal surgery * Inflammatory bowel disease
39
Extraintestinal Symptoms
Cough, dyspnea, dysuria, urinary frequency, flank pain
40
Course of symptoms
Worsening or improving, change in nature or location of pain
41
Physical Examination General
: growth and nutrition, appearance, degree of discomfort, body position
42
Signs of peritoneal irritation –Psoas sign –Obturator test
43
Psoas sign
(iliopsoas rigidity)
44
Obturator test
(pain with external thigh rotation)
45
Signs of intestinal obstruction
–abdominal distention –decreased bowel sounds –persistent vomiting
46
Signs of peritonitis
–rigidity of the abdominal muscles –rebound tenderness –decreased bowel sounds –abdominal distention –shock
47
Signs that suggest systemic disease or infection Jaundice
 Hepatitis
48
Signs that suggest systemic disease or infection Perianal lesions, weight loss, bloody stools
 IBD
49
Bloody stools with antibiotic use
 Pseudomembranous colitis
50
Bloody stools, hematuria, anemia, renal failure
 HUS
51
Bloody diarrhea, fever, no vomiting
 Bacterial enteritis
52
Palpable purpura, arthritis, hematuria
 HSP
53
Prolonged fever, conjunctivitis, mucosal lesions, rash
 Kawasaki disease
54
Vaginal discharge
 Pelvic inflammatory disease
55
Fever, weight loss, lymphadenopathy, hepatosplenomegaly
 Malignant neoplasm
56
Anemia
 Sickle cell disease
57
Cough, rales, decreased breath sounds
 Lower lobe pneumonia
58
Bruises, fractures, abdominal distention
 Non-accidental trauma
59
Cost-effective diagnostic technique •May identify **appendicitis, intussusception, gallbladder disorders, biliary tract disease, pelvic masses, and renal disorders** * Often **f*_ails to identify pelvic inflammatory disease, hepatitis, pancreatitis_*** * A **negative sonogram does not exclude appendicitis or abscess**
Ultrasonography
60
Abnormal Radiographic Findings Fecaliths
 Appendicitis
61
Abnormal Radiographic Findings Pneumatosis intestinalis
 NEC
62
Abnormal Radiographic Findings Free air
 Perforation
63
Obstructive patterns
 Mechanical and Functional
64
Abnormal Radiographic Findings
•Fecaliths  Appendicitis •Pneumatosis intestinalis  NEC •Free air  Perforation •Obstructive patterns  Mechanical and Functional •Air in an abscess •Abdominal mass •Abdominal calcifications •Renal stones •Pneumonia
65
•Radiates to the back or RUQ **•May be associated with –Ascites** –Abdominal distention –Peritoneal signs * Associated with vomiting * Elevated **serum amylase and lipase or radioimmune assay** of pancreatic trypsinogen
Pancreatitis
66
What is the mgt of pancreatitis?
Management: –Gastric suction –IVF –Bed rest –Adequate pain management –Oxygen –TPN –Antibiotics –Surgery
67
Fever, vomiting, pain over Mc Burney point, and signs of peritoneal irritation
Appendicitis
68
In diagnosing appendicitis, the Absence of fever and vomiting suggests an \_\_\_\_\_\_\_\_\_\_\_\_\_\_
alternative diagnosis
69
In the DRE: appendicitis is palpable where?
tender RLQ mass
70
Can Diarrhea and pyuria occur in appendicitis?
YES
71
Can leukocytosis occur in appendicitis?
Leukocytosis – common but nonspecific
72
What can precipitate appendicitis?
Can be precipitated by **fecaliths or parasitic infections**
73
Perforation most likely if treatment delayed more than \_\_\_\_\_\_\_\_\_\_\_\_\_
36 hours or if patient \< 8 years old
74
Ultrasonography sensitivity for appendicitis is
75-93%
75
Intermittent crampy abdominal pain * Associated with vomiting, abdominal distention, or bloody stools •Epigastric sausage-shaped mass * May cause alteration in mental status that suggests CNS disease
Intussuception
76
Intussusception commonly occurs in what age group?
Most commonly occurs in 4-24 months of age
77
Mostly in idiopathic intussusception occurs
Idiopathic – –75% of ileocolic intussusception –More likely in children \< 5 •Proximal bowel telescopes into distal
78
Causes of intussusception
•Leading point –Hyperplasia of Peyer patches in terminal ileum –Structural**: small bowel lymphoma**, **Meckel diverticulum** –Systemic: cystic fibrosis, Henoch-Schönlein, Crohn disease
79
What are the structural causes of intussuception?
–Structural**: small bowel lymphoma, Meckel diverticulum**
80
What are the systemic cause of intussusception?
–Systemic: cystic fibrosis, Henoch-Schönlein, Crohn disease
81
Epidemiology of intussusception male female ratio
•Male:female – 3:2
82
Epidemiology of Intussuception age
•Age – –3 months to 6 years with 80% \< age 2
83
Epidemiology of Intussuception peak of age is
–Peak at 6-12 months
84
Most common site of Intussusception?
•Most common - ileocolic
85
What are the clinical manifestation of Intussusception?
Clinical manifestations •Intermittent, severe, crampy abdominal pain **with loud cry and in curled up position** •Vomiting **•Appear normal between attack** •***_Currant-jelly stool_***
86
What are the laboratory procedures done?
Laboratory Procedures **•Chemistry** – dehydration, electrolyte imbalance **•CBC** – infection **•X-ray**: plain film & contrast or air enema •Ultrasound **•CT scan – only if other tests are negative**
87
When UTZ is done in a suspected intussusception, what can be seen?
Could detect **ileoileal intussusception**
88
What is the management in intussuscepion?
**Management** **•Air or contrast reduction** –Air is better than barium reduction – less perforation \<1% –Not very successful if symptoms \> 24 – 48 hours or with bowel obstruction –Successful rate – 75-90% with ileocolic intussusception **•Surgery** –Persistent filling defects –Failed nonoperative reduction –Prolonged intussusception
89
In the mgt of intussusception using •Air or contrast reduction –Air is better than barium reduction in ?
– less perforation \<1%
90
When is air contrast reduction not successful?
–Not very successful if symptoms **\> 24 – 48 hours or with bowel obstruction**
91
When is air reduciton successful?
–Successful rate – **75-90% with ileocolic intussusception**
92
When is surgery indicated in intussusception?
Surgery **–Persistent filling defects –Failed nonoperative reduction –Prolonged intussusception**
93
What is the problem in intestinal malrotation?
**•Mesentery is not fixed properly** so that **midtransverse colo**n may **be twisted around a narrow base** and **occlude the arterial** **blood supply, causing a volvulus**
94
How do neonates present with intestinal malrotation?
•Neonates present with **bilious vomiting** and **other signs of small bowel obstruction** **•Assess for associated anomalies such as cardiac defects**
95
Pyloric Stenosis Causes
Unknown Associations Abnormal muscle innervations **Erythromycin use in neonates** hypergastrinemia
96
What drug is associated with Pyloric Stenosis?
Erythromycin
97
What is the epidemiology of pyloric stenosis?
Prevelance – 3/1000 More common in white northern European descents **Male:female = 4:1 to 6:1** **( MORE IN MALES)**
98
What is the age onset of pyloric stenosis?
Age – 1 week – 5 months **but usually 3 to 6 weeks**
99
WHat is the Clinical presentation of pyloric stenosis?
•Abdominal pain •Nonbilious vomiting after feeding and with **91% having projectile emesis** –Hungry after feeding –Weight loss –Progressive symptoms • Jaundice 5% of affected patients Indirect hyperbilirubinemia due to **decreased level of glucuronyl transferase**
100
What is the PE in pyloric stenosis?
•Abdominal distension **•Olive mass** – RUQ, after feeding
101
What are the lab procedures done in pyloric stenosis?
Laboratory Procedures •Chemistry •Plain abdominal x-ray •Ultrasound •UGI
102
What is the abdominal xray finding in pyloric stenosis?
Abdominal x-ray **Increased gastric air or fluid suggestive gastric outlet obstruction**
103
What is this finding?
Increased gastric air or fluid suggestive gastric outlet obstruction
104
What is found in the UTZ of pyloric stenosis?
Ultrasound **Shoulder sign - indentation of pylorus into the stomach**
105
UGI **•String sign •Pyloric spasm may mimic the string sign**
106
What is seen in the UGI of Pyloric stenosis?
UGI **•String sign** •Pyloric spasm may mimic the string sign
107
what exactly is the difference? Why is pyloric stenosis non-bilious but duodenal atresia bilious? Where does it exactly occur that's making the difference?
Bile duct drains into second part of duodenum via ampulla of Vater. So, obstruction proximal to 2nd part of duodenum will have non-bilious vomiting and obstruction distal to it will have bilious vomiting.
108
What is the mgt in pyloric stenosis?
Management: **•Medical resuscitation first** –IVF hydration with potassium –Correction of alkalosis because of postoperative apnea associated with general anesthesia **•Pyloromyotomy** **•Endoscopically-guided balloon dilation** – surgery is contraindicated or incomplete pyloromyotomy
109
What is the first thing that yolou should do in pyloric stenosis?
Management: **•Medical resuscitation first** –IVF hydration **with potassium** –**Correction of alkalosis** because of postoperative apnea associated with general anesthesia
110
What is the clinical presentation of Volvulus
Clinical presentation **•Bilious emesis •Abdominal distension**
111
What are the procedures done for volvulus?
Procedures * *• UGI**- duodenum not crossing the midline * *• Barium ene**ma – malposition of cecum
112
* Suggested by a **positive history or associated bruises or fractures** * Causes traumatic pancreatitis, intramural duodenal hamaturia, and lacerations of the liver, spleen or bladder
Abdominal Trauma
113
* Signs of a**cute abdomen** * When right ovary involved  **similar to acute appendicitis** * *•Ultrasonography** * *•Early diagnosis and surgery** are necessary to save the ovary and fallopian tube
Acute Ovarian Torsion
114
* Often considered a benign disease * Major cause of morbidity and mortality
Gastroenteritis
115
\_\_\_\_\_\_\_\_\_\_\_ **remain the most common cause** of acute gastroenteritis in children:
viruses
116
What virus remains to be the most common cause of gastroenteritis in children?
Rotavirus
117
How will you differentiate if the cause of gastroenteritis is bacterial; or viral in stool exam?
Watery – viral gastroenteritis •Bloody or mucoid - bacterial
118
* one of the most common pediatric infections * **first-time symptomatic UT**I: highest in boys and girls during the **first year of life** * history and clinical course of a UTI vary with the patient's age and the specific diagnosis. -**No one specific sign or symptom**
Urinary Tract Infection
119
Whats are the symptoms of UTI in neonates ( 0 to 2 months)
Jaundice fever failure to thrive poor feeding vomiting irritability
120
What are the symptoms of UTI in aged 2 mos to 2years old?
Poor feeding fever vomiting strong smelling urine abdominal pain irritability
121
Symptoms of UTI in childrean aged 2- 6 years old
Vomiting Abdominal pain FEver Storng-smelling urine Enuresis Urinary symptoms( Dysuria, urgency and frequency)
122
What is the criteria of UTI by AMerican Academy of Pediatrics
children **2-24 months** are the **presence of pyuria** and/or **bacteriuria** on urinalysis and of **at least 50,000 colony-forming units (CFU) per mL** of a **uropathogen from the quantitative culture** of a properly collected urine specimen
123
What are the most commonly isolated bactera in PHIL in urine specimen?
1. Escherichia coli 2. Klebsiella sp 3. Enterobacter sp
124
Urine specimen collection
A midstream, clean-catch specimen may be obtained from children who have urinary control
125
Suprapubic aspiration is the method of choice for obtaining urine from the following patients:
1. **Uncircumcised boys with a redundant or tight foreskin** 2. **–Girls with tight labial adhesions,** 3. –Children of either sex with **clinically significant periurethral irritation**
126
When does a culture of a urine specimen has a false-positive rate?
Culture of a urine specimen from a **sterile bag** attached to the **perineal area** has a **false-positive rate** **–a negative culture is strong evidence that UTI is absent**
127
What is the management of UTI
Most cases are treated on **OPD basis with appropriate antibiotic** •A Cochrane review concluded that children with **acute pyelonephritis can be treated** effectively with either **oral antibiotics or with 2-4 day**s of **IV therapy followed by oral therapy**
128
129
How to define chronic abdominal pain?
Defined as **three or more episodes of pain,** **severe enough to affect activities** occuring over a **period of three months.** -Affects about **10-15% of school-age children**
130
How to say if it is a recurrent abdominal pain ( RAP )
Commonly occuring in more than 1**0% of pre-school and school aged children** -In younger than 2 yo, associated with an **organic cause** -
131
RAP w/o organic cause is often called \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
“functional” abdominal pain
132
What are the differential diagnosis of recurrent abdominal pain?
NON-ORGANIC organic
133
What are the two possible causes of Non organic?
1. Functional abdominal pain 2. Irritable Bowel Syndrome
134
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ -pain almost daily -not associated with meals or relieved with defecation -Symptoms often **result from stress in school or in novel social situations**
Functional Abdominal pain
135
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_– characterized by **onset of pain at the time of a change in stool frequency or consistency** - a stool pattern **fluctuating between diarrhea and constipation** and **relief of pain with defecation** - Linked to gut motility - Linked with anxiety of imagined causes, disordered peer relationship
Irritable bowel syndrome
136
What are the organic causes?
Chronic pancreatitis •Gallstones •Peptic disease •Lactose intolerance •Fructose malabsorption •Inflammatory bowel disease •Congenital intestinal malformation •Parasitic infection •Abdominal migraine •Lead poisoning
137
Warning signs of Underlying Illness in Recurrent Abdominal Pain
* Vomiting * Abnormal screening laboratory study * Fever * Bilous emesis * Growth failure * Pain awakening child from sleep * Weight loss * Location away from periumbilical region * Blood in stool or emesis * Delayed puberty
138
SUGGESTED EVALUATION OF RECURRENT ABDOMINAL PAIN
Initial Evaluation Complete history and PE Ask about “warning signs” Deterrmine degree of functional impairment CBC,ESR Amylase Urinalysis Abdominal UTZ Trial of lactose free diet
139
What are the followup evaluation in RAP?
Follow-up Evaluation CT scan Upper GI series Endoscopy Colonoscopy
140

2H Pedia (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions