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Emergency Medicine > Pediatric Abd > Flashcards

Pediatric Abd Flashcards

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1
Q

Abd pain is one of the most common reasons for a visit to the ED, are most causes benign or malignant?

A

Benign

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2
Q

What are some reassuring signs/sx of abd pain?

A

Frequent watery diarrhea
Normal appetite
Fever onset before pain
The “JUMP TEST”

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3
Q

Is fever an early or a late finding in appendicitis?

A

Late

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4
Q

Beware of vomiting (with/without) diarrhea, why?

A

without; could be head trauma, UTI, pregnancy, or SBO

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5
Q

If your patient is an adolescent female c/o abd pain, what should you always order?

A

urine pregnancy test

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6
Q

Where should you always examine in male patients with abd pain? Why?

A

the groin

Could be referred pain from epididymitis or testicular pain or penile discharge

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7
Q

What are some potential causes of referred abd pain? (hint: think chest or other infxn)

A

lower lobe PNA (can refer pain or mimic appendicitis) or GAS infxn (generalized achy abd pain)

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8
Q

If a pt has _______ they will usually present c/o vomiting with diarrhea

A

stomach virus

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9
Q

T/F Bilious emesis in a neonate is a surgical emergency until proven otherwise

A

True

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10
Q

If an infant pt presents with blood in the stool and is ill appearing, what condition may they be presenting with?

A

intussusception

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11
Q

Pain before vomiting is classic for what abd pain complaint/condition?

A

appendicitis

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12
Q

If a pt presents with focal involuntary guarding, what is this considered?

A

an abd emergency

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13
Q

Is intussusception an abd emergency?

A

yes

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14
Q

If a pt has a SBO or volvulus, they may present c/o ____ and ____ _____

A

vomiting and abd distension

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15
Q

If a pt presents with bilious vomiting, what color is it? What condition might this complaint indicate?

A

green; obstruction

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16
Q 
The following abd emergencies are common in what age group?
Malrotation w/ volvulus
Necrotizing Enterocolitis (NEC)
Intestinal atresias/stenosis
Hirschsprung disease (no stooling)
A

Neonates

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17
Q

If a pt presents with pyloric stenosis what type of vomiting will they have? What color? What age range is typical?

A

Projectile, non-bilious vomiting, 1-2 months old

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18
Q

If a pt presents with intussusception, how might their abd be described? What may they be doing with their legs? What is the typical age range?

A

Colicky abd pain, draw up legs, 6-10 months old

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19
Q

In adolescent females c/o abd pain, what abd emergencies are we concerned about?

A 
Ectopic pregnancy
Ovarian cyst/torsion
Appendicitis
STD/PID
Tubo ovarian abscess
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20
Q

In preschool age range patients c/o abd pain, what abd emergencies should be considered as causes?

A 
Appendicitis
Intussusception
Testicular/ovarian torsion
Incarcerated hernia
Non Accidental Trauma (NAT) w/blunt abdominal trauma
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21
Q

What medical condition is described as an “abnormal rotation of mesentery during embryonic development” where the cecum is in the mid-abdomen and is fixated to the right lateral wall by bands of peritoneum? What can this condition result in?

A

Intestinal Malrotation

Midgut suspended on narrow pedicle vs wide mesentery
Intestines can twist around the narrow pedicle resulting in volvulus

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22
Q

Can a pt with malrotation and volvulus have a normal PE?

A

Yes

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23
Q

What may be seen on XR of a pt with malrotation and volvulus?

A

Lack of distal bowel gas, without even distribution of gas throughout the belly

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24
Q

What is the diagnostic study of choice for a pt suspected to have malrotation and volvulus? What will be seen upon inspection of imaging result?

A

Upper GI series is study of choice

Trace contrast passes in corkscrew configuration and abnormal position of duodenum will be seen

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25
Q

What is the suggested management for a patient with malrotation and volvulus?

A 
IV fluid resuscitation
NG tube to intermittent suction
Call surgeon
Upper GI series
Laparotomy
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26
Q

A patient in opioid withdrawal may present with constricted pupils. Why may a pt with intussusception also present with constricted pupils?

A

Pt is in so much pain, causing endogenous release of opioid-withdrawal chemicals in the body

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27
Q

In a pt with intussusception, what signs may be seen on XR to help confirm your dx?

A

intestinal obstruction with distended loops of bowel, absence of colonic gas
May also see characteristic target sign and or crescent sign

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28
Q

On US, a very nearly 100% sensitive and specific test for intussusception, what may be seen?

A

Classic image is “bull’s eye” or “coiled spring” representing layers of intestine within the intestine

29
Q

What is the most common abd emergency in early childhood?

A

intussusception

30
Q

80% of intussusception cases occur in pts ___ y/o

A

<2 y/o

31
Q

____% of pts have viral illness symptoms before onset of intussusception

A

30%

32
Q

Viral infections can accentuate ____ tissue in intestines

A

lymphatic

33
Q

Hypertrophy of Peyer patches in terminal ileum can serve as ______ in pts with intussusception

A

lead point

34
Q

What are Peyer patches?

A

Small masses of lymphatictissue found throughout the ileum region of SI

35
Q

Where does intussusception most frequently occur?

A

ileocecal junction

36
Q

Children ____ y/o more likely to have pathologic lead point identified

A

> 5 y/o

37
Q

What is the classic triad of intussusception?

A

Classic triad of pain, palpable sausage shaped mass, currant jelly stools (occurs < 15% of the time)

38
Q

Blood in stools is a (late/early) finding that indicates what has happened?

A

Late; Ischemia of the intestines

39
Q

What is the most important intervention in the management of intussusception?

A

Resuscitate with IVF (NS bolus)

40
Q

If a pt with intussusception is vomiting frequently, how should you decompress the stomach?

A

If frequent vomiting, decompress stomach with NGT

41
Q

You should consider IV abx if you are concerned for what possible complication of intussusception?

A

Perforation

42
Q

After you have ruled out any possibility of perforation, what procedure can be performed to tx intussusception?

A

Air enema reduction

43
Q

Air enema reduction has a success rate of ___-___% in ileo-colic intussusception

A

75-90%

44
Q

What are potential complications of performing an air enema?

A

Prolonged symptoms (> 3 days)
Signs of peritonitis
Evidence of free air on plain XR

45
Q

When is surgery indicated in patients with intussusception?

A

When nonoperative reduction fails or is incomplete

46
Q

T/F Manual reduction is performed in most cases of surgical intussusception

A

True

47
Q

When should resection with primary anastomosis be performed?

A

Manual reduction fails
Concern for necrotic bowel
Lead point is identified

48
Q

Is recurrence of intussusception an indication for surgery?

A

No

49
Q

T/F Each recurrence of intussusception is handled as if it is the first episode, and the provider will attempt air enema again

A

True

50
Q

The recurrence rates of intussusception are as follows:
__-__% after non-operative reduction
__-__% after manual reduction
___% after resection

A

5-10%
1-3%
<1%

51
Q

What labs and imaging are recommended in the workup of a pt with suspected appendicitis?

A

None

Imaging is not necessary for classic presentation, but may be useful for equivocal presentations

52
Q

An inflamed appendix next to the bladder can cause WBC in urine, which would mimic what other condition/dx?

A

UTI

53
Q

What imaging studies should be considered in sexually active adolescent females prior to CT?

A

Consider pelvic US

54
Q

What are the advantages of US over CT?

A

Quick, easy, no radiation

55
Q

What are the disadvantages of US when compared to CT?

A

Operator dependent, difficulty to visualize in obese patients or if aberrant location, overlying gas

56
Q

How do you manage appendicitis in the ED?

A

Obtain IV access, administer IVF and IV pain medication and anti-emetics (odansetron in pediatric population)
and IV antibiotics (Zosyn if concern for perforation, otherwise Ancef)

57
Q

Elevated WBC with left shift could indicate what clinical condition?

A

appendicitis!

58
Q

A 16 y/o F pt presents to the ED c/o sudden onset of unilateral lower abdominal pain on the right side with associated N/V. She denies fever and dysuria. What do you suspect she has?

A

This is the classic presentation for ovarian torsion

59
Q

T/F Ovarian torsion can occur at any age

A

True

60
Q

Ovarian torsion accounts for up to ___% of all cases of abdominal pain in children

A

2.7%

61
Q

Approximately ___% women are pregnant when diagnosed w/ ovarian torsion

A

20%

62
Q

Ovarian torsion impairs _____ & ____ outflow from the ovary, while ____ inflow persists

A

Venous and lymphatic; arterial

63
Q

Ovarian torsion is most frequent during what stage in life?

A

Reproductive years

64
Q

On what side, right or left, does ovarian torsion most commonly present on?

A

R>L 3:2

65
Q

T/F Prolonged symptoms does not preclude possible ovarian salvage

A

T

66
Q

T/F Ovarian torsion may be intermittent

A

T

67
Q

Fever before pain is (more/less) likely surgical in nature

A

Less

68
Q

What are some potential red flags for children with abd pain?

A 
Bilious emesis
Vomiting w/ abdominal distention
Blood in stool of ill appearing infant
Pain before vomiting
Focal abdominal pain
Involuntary guarding

Emergency Medicine (20 decks)

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