Peds Abdominal Pain Flashcards
Fever onset before abdominal pain or at same time of pain suggests..?
Most likely viral infection such as UTI
2 common appendicitis mimickers
Lower pneumonia
Messenger is adenitis
If complaining of abdominal pain what is a bad sign..
Vomiting without diarrhea
Think obstruction or head injury
6 abdominal warning signs
Bilious vomiting Vomiting with distension Pain prior to vomit I'll looking infant with bloody stool Focal abdominal pain Involuntary gaurding
Pain and vomiting :
If pain before think—
If pain is after think:
Before: appendicitis
After think gastroenteritis
4 neonate emergencies
Malrotation with volvulus
NEC
Intestinal atresias or stenosis
Hirschprung disease
1-2 mo
Emergency
Pyloric stenosis
6-10mo emergency
Intussusception
School age
Appendicitis
Testicular or ovarian torsion
Incarcerated hernia can occur any age
NAT with blunt trauma (any age)
Bilious Emesis is
Surgical emergency till proven otherwise
Some sort of obstruction or intestinal malrotation
Hallmark of intestinal makes rotation
Bilious emesis .. emergency! Bowel necrosis in hours!!
Study of choice intestinal malrotation
Upper go series X-ray
Trace contrast will show corkscrew configuration
Most common abdominal emergency in early childhood
Intussception
Average age for intussception
5-9mo ..80% cases under 2 yrs old
What is clue in general assessment and bc for intussception?
Or will look sick with hx of nonbilious vomiting
Also 30% have had hx of a viral infection
Why concerned if kid over 5 has intussception?
May have other things that triggered it.. meckle diverticulum Duplication cysts Polyps Vascular malformations Parasites
What medical conditions can predispose to intussception?
CF HSP IBD PURTZ JEFHERS
Or iatrogenic post op.. from adhesions about 2 wks after laparotomy
Target sign or crescent sign on X-ray could be..
Intussception
Where is intussception most common to occur in bowel?
Ileiocecal junction
Intussception triad
Pain palpable sausage shaped mass and currant jelly stools!
May have pinpoint pupils
How will intussception show up on ultrasound?
Bulls eye appearance
6 steps manage intussception
ABC NS IVF bolus NGT decompression if lots vomit If perforation concern.. abx Notify surgeon Abdominal X-ray with left lay decubitus
When do u do air enema?
After X-ray of abdomen ro perforation
If concerned with bowel perforation or there is a lead point or manual reduction fails.. try
Resection with primary anastomoses
