Murtagh - Abdominal pain cont. in children Flashcards
probability diagnosis of acute abdomen in children
infant colic
gastroenteritis (all ages)
mesenteric adenitis
serious causes not to be missed for acute abdomen in children
intussusception (peaks at 6-9 months)
acute appendicitis (mainly 5-15 years)
bowel obstruction/strangulated hernia
when is the most likely time for a child to have intussusception
peaks at 6-9 months
when is the most likely time for a child to have acute appendicitis
peaks at 5-15 years
pitfalls for acute abdomen in children
child abuse
constipation/faecal impaction
torsion of testes
lactose intolerance
peptic ulcer
infections: mumps, tonsillitis, pneumonia (especially right lower lobe), EBM, UTI
adnexal disorders in females e.g. ovarian
rare causes of acute abdomen in children
meckel’s diverticulitis
hence-schonlein purpura
sickle crisis
lead poisoning
seven masquarades checklist for acute abdomen in children
diabetes mellitus
drugs
UTI
Hx of infant colic
a well baby with regular, unexplained periods of inconsolable crying and fretfulness, usually in the late afternoon and evening
especially between 2 and 16 weeks of age
no cause for the abdominal pain can be found and it lasts for a period of at least 3 weeks
how common is infant colic
very common and occurs in one third of infants
clinical features of infant colic
baby between 2 and 16 weeks old
prolonged crying - at least 3 hours
occurrence at least three days per week
crying worst at around 10 weeks of age
crying during late afternoon and early evening
child flexing legs and clenching fists as if severe stomach ache
normal physical examination
management of infant colic
advise the parents:
- use gentleness (such as subdued lighting, soft music, speaking softly, quiet feeding times)
avoid quick movements that may startle the baby
make sure the baby is not hungry
if the baby is breastfed, express the watery fore milk before putting the baby to breast
provide demand feeding
make sure the baby is burped and give posture feeding
provide comfort from a dummy or pacifier
provide plenty of gentle physical contact
cuddle and carry the baby around
how to assist parents with baby with infant colic
a carrying device allows baby to be carried around at the time of crying
make sure the mother gets plenty of rest during this difficult period
do not worry about leaving a crying child for 10 minutes or so after 15 minutes of trying consolation
drugs fro infant colic
drugs are not generally recommended, but for severe problems some preparations can be helpful e.g. simethicone (infacol wind drops)
Hx of intussusception
child usually between 3 months and two years
sudden onset severe colicky pain, coming at intervals of about 15 minutes and lasting for 2-3 minutes
how quickly should intussusception be diagnosed
early diagnosis within 24 hours of onset is essential, as there is a significant rise in morbidity and mortality after this point
what causes intussusception in children
due to telescoping og segment of bowel into the adjoining distal segment resulting in intestinal obstruction
usually idiopathic but can have a pathological lead point (e.g. polyp, meckel’s diverticulum)
typical clinical features of intussusception
male babies > female
birth to school age usually 5-24 months
sudden onset acute pain with shrill cry
vomiting
lethargy
pallor with attacks
intestinal bleeding - redcurrant jelly
pain distribution and abdominal mass of intussusception
pale child with severe colic and vomiting is likely
intussusception
signs on examination of a child with intussusception
pale, anxious and unwell
sausage shaped mass in high upper quadrant anywhere between the line of colon and umbilicus, especially during attacks (difficult to feel)
signe de dance (i.e. emptiness in RIF to palpation)
alternating high pitched active bowel sounds with absent sounds
rectal examination may show blood or hard lump
what might be found on rectal examination of a child with intussusception
blood or hard lump
how do you diagnose a child with intussusception
ultrasound
oxygen or barium enema (with caution) is also used for diagnosis and treatment
treatment for a child with intussusception
hydrostatic reduction by air or oxygen from the ‘wall’ supply (preferred) or barium enema
surgical intervention may be necessary
how to tell acute gastroenteritis from intussusception
usually attacks of pain are of shorter duration for gastroenteritis
there is loose watery stool, fever and no abdominal mass
if doubtful, refer as possible intussusception
differential diagnosis for intussusception
acute gastroenteritis
impacted faeces can lead to spasms of colicky pain - usually an older child with a Hx of constipation
other causes of intestinal obstruction eg. irritable inguinal hernia, volvulus, intra-abdominal band
at what ages is acute appendicitis more likely in children
more common in children of school age (10-12 years) and in adolescence, and uncommon in children under 3 years of age
presentation of a child with acute appendicitis
vomiting in 80%
diarrhoea in 20%
usually only very slightly elevated temperate
how do you tell mesenteric adenitis and acute appendicitis apart in a child
sometimes indistinguishable
mesenteric adenitis has a more vague localisation of pain
rigidity is less of a feature in mesenteric adenitis
features of mesenteric adenitis vs. acute appendicitis in children
recurrent abdominal pain in children
three distinct episodes of pain over 3 or more months
very few cases are able to determine an organic cause
possible causes of recurrent abdominal pain in children
constiptaion
childhood migraine equivalent (pain with extreme pallor)
lactose intolerance (symptoms related to milk ingestion)
intestinal parasites (may disturb child about 60 minutes after falling asleep)
