03.04 Abdominal Pain in Infants, Children and Adolescents Flashcards Preview

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Flashcards in 03.04 Abdominal Pain in Infants, Children and Adolescents Deck (103)
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1

Step 1 in approach to diagnosis of acute abdominal pain

Establish emergent vs. non-emergent causes of abdominal pain

2

Sudden or unremitting pain with no prior Hx
Less than 2 weeks

Acute pain

3

More than 2 weeks
Persistent or current

Chronic

4

S/sx associated with the cause of an acute abdominal pain

Intestinal inflammation (diarrhea, fever and fatigue, blood in the stool, LOA)
Perforation (severe, abdominal distention, fever, nausea and vomiiting)
Hemorrhage (weakness, lightheadedness, shortness of breath)
Obstruction (bilious vomiting, electrolyte imbalance, borborygmi and ileus)
Peritoneal irritation (fever and chills, LOA, abdominal bloating, nausea and vomiting)

5

Vomiting that precedes a colicky type of abdominal pain suggests problem of _____

AGE

6

Vomiting that occurs after the onset of pain is suggestive of _______

Surgical condition

7

Red flag symptoms for surgical consult

Progressive signs of deterioration (restlessness, confusion, weakness, dizziness, tachycardia, hypotension-late sign)
Bile-stained or feculent vomitus
Involuntary abdominal guarding
Rebound abdominal tenderness
Marked abdominal distention
Signs of acute fluid or blood loss
Significant abdominal trauma
No obvious etiology

8

Acute abdominal pain from a GI cause

Appendicitis
Malrotation with volvulus
Intussusception
Intestinal adhesions
Strangulated hernia
Mesenteric vasculitis
Cholelithiasis/cholecystitis
Pancreatitis
Henoch-Schonlein purpura

9

Acute abdominal pain from a non-GI cause

Pyelonephritis
Renal calculi
Ureteropelvic junction obstruction
Ovarian torsion or rupture of ovarian cyst
Tubo-ovarian abscess
Psoas abscess
Ectopic pregnancy

10

Step 2 of the approach to diagnosis of acute abdominal pain

Determine the possible origin of the pain

11

Most helpful clues in Hx taking for determining the cause of acute abdominal pain

Age (infancy - abdominal colic, 2-5 years - AGE, mesenteric lymphadenitis, acute appendicitis, school age or teenage - Mittelschmerz phenomenon, peptic disease or recurrent intussusception from Meckel's diverticulum, polyp
Pain history, location, timing, character, duration, radiation

12

Observation that the further away the pain is from the umbilicus, the greater the likelihood of an organic disease has held up well

Apley's criteria

13

Apley's criteria

Location

14

Rate on a scale of 1-5, 1-10 or pointing to a series of faces graded from smile to frown

Intensity

15

Epigastric pain, LUQ
Back radiation
Constant, sharp, boring

Pancreatitis

16

Periumbilical - lower abdomen
Back radiation
Alternating cramping and painless periods

Intestinal obstruction

17

Periumbilical, then localized to RLQ
Back or pelvis radiation
Sharp, steady

Appendicitis

18

Periumbilical to lower abdomen
No radiation
Cramping with painless periods

Intussusception

19

Back pain (unilateral)
Radiation to groin
Sharp, intermittent, cramping

Urolithiasis

20

Back pain, radiating to bladder
Dull to sharp

UTI

21

Step 3 in the approach to diagnosis of acute abdominal pain

Clinical evaluation

22

Fever in AGE

Pain follows vomiting
48-72 hours
Rotavirus

23

Fever in UTI

Painful urination and tenderness in suprapubic area

24

Triad for diagnosis pneumonia

Fever
Tachypnea
Cough

25

Abdominal pain in pneumonia

Referred pain

26

Fever + throat pain + abdominal pain

Acute tonsillopharyngitis

27

Post-surgery fever + abdominal pain

Intraabdominal abscess

28

Fever + vomiting + prominent lymph nodes on CT scan

Mesenteric lymphadenitis

29

Fever + bloody diarrhea + tenesmus + abdominal pain + vomiting

Shigella dysentery

30

Bilious vomiting, abdominal distention and hypoactive sounds

Intestinal obstruction