Pediatrics - Abdominal Flashcards
Writhing for a POC suggests
Obstruction, ie colic or intussusception
0-3 months, give 6 emergent reasons for abdominal pain
Necrotizing enterocolitis Volvulus Hirschsprung's disease Incarcerated hernia Testicular Torsion Nonaccidental trauma
0-3 months, give 3 nonemergent reasons for abdominal pain
Constipation
Acute gastroenteritis
Colic
3 months to 3 years, give 5 reasons for emergent abdominal pain
Intussusception Volvulus Testicular torsion Appendicitis Vaso-occlusive crisis
3 months to 3 years, give 4 reasons for nonemergent abdominal pain
UTI
Constipation
Henoch-Shonlein purpura
Acute gastroenteritis
3 years to adolescence, give 11 emergent reasons for abdominal pain
Appendicitis Pancreatitis Vaso-occlusive crisis Ectopic pregnancy DKA Ovarian Torsion Testicular Torsion UTI Tumor PNA Cholecystitis
3 years to adolescence, give 10 nonemergent reasons for abdominal pain
Pregnancy Henoch-Shonlein purpura Acute gastroenteritis IBD Renal stones Ovarian cyst Constipation Nonspecific viral syndrome PUD/gastritis Strep pharyngitis
Intermittent, paroxysmal abd pain in 0-3 months suggests
Intussusception
Gastroenteritis
Colic
Constant abdominal pain in 0-3 months suggests
Midgut rotation with volvulus
Necrotizing enterocolotis
Most common surgical emergency age 3-15 years
Appendicitis
Dx that mimics appendicitis but includes upper respiratory sxs
Mesenteric adenitis
First step in evaluating any ill-appearing child or in cases of persistent vomiting or poor oral intake
Bedside glucose
Pathognomonic signs of necrotizing enterocolitis
penumatosis intestinalis (air in bowel wall) portal venous gas *Normal abd xray does not rule out
Use of ampicillin in necrotizing enterocolitis
Cover gram +
Use of gentamicin or cefotaxime in necrotizing enterocolitis
Cover gram -
Use of metronidazole or clindamycin in necrotizing enterocolitis
Cover anaerobes
Infant with abrupt onset of bilious vomiting, constant pain, abdominal distention;
dx?
Volvulus
Imaging signs of volvulus
Corkscrew bowl, bird’s beak contrast cutogg in duodenum
Common location for intussusception
Ileum into colon
Diagnosis of intussusception is made by
Immediate air contrast enema
* If free air, skip this step and go straight to surgical consult
U/S findings in intussusception
Target appearance of bowel within bowel
Useful way to assess peritoneal signs in children
Walk, cough, jump
Appendiceal U/S findings
Max diameter > 6mm Wall thickness >or= 3mm Lack of compressibility Hyperemia on color Doppler U/S Surrounding edema or fat stranding Appendicolith
Appendicitis meds for nonperforated appendix
Cefoxitin
Ampicillin/sulbactam (Unasyn)
Appendicitis meds for perforated appendix
Piperacillin/tazobactam (Zosyn)
Triad of palpable purpuric rash, abdominal pain, arthritis;
dx?
HSP
GI bleeding in 50-75% of cases
Most significant long-term consequence of HSP
Renal: Hematuria/edema/proteinuria
Mgmt of incarcerated hernia
Manually reduce
Admit
Acute pancreatitis in children is defined by:
Lipase or amylase >3x normal or imaging
Complications of acute pancreatitis in children
Intra-abdominal third spacing
Shock
Multiorgan system failure
*Treat aggressively with NS or LR
Common reasons for cholelithiasis in kids
TPN
SCD
Diagnostics in peds cholecystitis
Lipase
LFTs
US
*Tests can be normal, does not rule out
Charcot’s triad is:
Cholangitis: RUQ pain, fever, jaundice
Medical emergency
Abx for peds cholecystitis
Ampicillin + gentamicin + clindamycin
