Peds Abdominal Pain

Question 1

Fever onset before abdominal pain or at same time of pain suggests..?

Answer 1

Most likely viral infection such as UTI

Question 2

2 common appendicitis mimickers

Answer 2

Lower pneumonia

Messenger is adenitis

Question 3

If complaining of abdominal pain what is a bad sign..

Answer 3

Vomiting without diarrhea

Think obstruction or head injury

Question 4

6 abdominal warning signs

Answer 4

Bilious vomiting 
Vomiting with distension
Pain prior to vomit 
I'll looking infant with bloody stool
Focal abdominal pain 
Involuntary gaurding

Question 5

Pain and vomiting :
If pain before think—
If pain is after think:

Answer 5

Before: appendicitis

After think gastroenteritis

Question 6

4 neonate emergencies

Answer 6

Malrotation with volvulus
NEC
Intestinal atresias or stenosis
Hirschprung disease

Question 7

1-2 mo

Emergency

Answer 7

Pyloric stenosis

Question 8

6-10mo emergency

Answer 8

Intussusception

Question 9

School age

Answer 9

Appendicitis
Testicular or ovarian torsion
Incarcerated hernia can occur any age
NAT with blunt trauma (any age)

Question 10

Bilious Emesis is

Answer 10

Surgical emergency till proven otherwise

Some sort of obstruction or intestinal malrotation

Question 11

Hallmark of intestinal makes rotation

Answer 11

Bilious emesis .. emergency! Bowel necrosis in hours!!

Question 12

Study of choice intestinal malrotation

Answer 12

Upper go series X-ray

Trace contrast will show corkscrew configuration

Question 13

Most common abdominal emergency in early childhood

Answer 13

Intussception

Question 14

Average age for intussception

Answer 14

5-9mo ..80% cases under 2 yrs old

Question 15

What is clue in general assessment and bc for intussception?

Answer 15

Or will look sick with hx of nonbilious vomiting

Also 30% have had hx of a viral infection

Question 16

Why concerned if kid over 5 has intussception?

Answer 16

May have other things that triggered it.. 
meckle diverticulum 
Duplication cysts
Polyps 
Vascular malformations 
Parasites

Question 17

What medical conditions can predispose to intussception?

Answer 17

CF HSP IBD PURTZ JEFHERS

Or iatrogenic post op.. from adhesions about 2 wks after laparotomy

Question 18

Target sign or crescent sign on X-ray could be..

Answer 18

Intussception

Question 19

Where is intussception most common to occur in bowel?

Answer 19

Ileiocecal junction

Question 20

Intussception triad

Answer 20

Pain palpable sausage shaped mass and currant jelly stools!

May have pinpoint pupils

Question 21

How will intussception show up on ultrasound?

Answer 21

Bulls eye appearance

Question 22

6 steps manage intussception

Answer 22

ABC 
NS IVF bolus 
NGT decompression if lots vomit 
If perforation concern.. abx 
Notify surgeon 
Abdominal X-ray with left lay decubitus

Question 23

When do u do air enema?

Answer 23

After X-ray of abdomen ro perforation

Question 24

If concerned with bowel perforation or there is a lead point or manual reduction fails.. try

Answer 24

Resection with primary anastomoses

Question 25

Recurrent intussception indicates surgery??

Answer 25

No

Question 26

Misdiagnosed uti can be due to..

Answer 26

Appendicitis by bladder get WBC in urine

Question 27

What if abx use for appendicitis

Answer 27

Zoysn or ancef

Piperacillin with taxobactam
Or cephazolin

Question 28

If suspect ovarian torsion order a ..

Answer 28

Stat ultrasound

Question 29

Red flag.. when you have severe abdominal pain but no diarrhea and or fever..

Answer 29

It’s not just gastroenteritis

Question 30

On ultrasound of ovary where should you see blood flow?

Answer 30

To the center of the ovary

Question 31

Risk of ovarian torsion increases with ..

Answer 31

Pregnancy