03.04 Abdominal Pain in Infants, Children and Adolescents Flashcards
(103 cards)
1
Q
Step 1 in approach to diagnosis of acute abdominal pain
A
Establish emergent vs. non-emergent causes of abdominal pain
2
Q
Sudden or unremitting pain with no prior Hx
Less than 2 weeks
A
Acute pain
3
Q
More than 2 weeks
Persistent or current
A
Chronic
4
Q
S/sx associated with the cause of an acute abdominal pain
A
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
Q
Vomiting that precedes a colicky type of abdominal pain suggests problem of _____
A
AGE
6
Q
Vomiting that occurs after the onset of pain is suggestive of _______
A
Surgical condition
7
Q
Red flag symptoms for surgical consult
A
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
Q
Acute abdominal pain from a GI cause
A
Appendicitis Malrotation with volvulus Intussusception Intestinal adhesions Strangulated hernia Mesenteric vasculitis Cholelithiasis/cholecystitis Pancreatitis Henoch-Schonlein purpura
9
Q
Acute abdominal pain from a non-GI cause
A
Pyelonephritis Renal calculi Ureteropelvic junction obstruction Ovarian torsion or rupture of ovarian cyst Tubo-ovarian abscess Psoas abscess Ectopic pregnancy
10
Q
Step 2 of the approach to diagnosis of acute abdominal pain
A
Determine the possible origin of the pain
11
Q
Most helpful clues in Hx taking for determining the cause of acute abdominal pain
A
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
Q
Observation that the further away the pain is from the umbilicus, the greater the likelihood of an organic disease has held up well
A
Apley’s criteria
13
Q
Apley’s criteria
A
Location
14
Q
Rate on a scale of 1-5, 1-10 or pointing to a series of faces graded from smile to frown
A
Intensity
15
Q
Epigastric pain, LUQ
Back radiation
Constant, sharp, boring
A
Pancreatitis
16
Q
Periumbilical - lower abdomen
Back radiation
Alternating cramping and painless periods
A
Intestinal obstruction
17
Q
Periumbilical, then localized to RLQ
Back or pelvis radiation
Sharp, steady
A
Appendicitis
18
Q
Periumbilical to lower abdomen
No radiation
Cramping with painless periods
A
Intussusception
19
Q
Back pain (unilateral) Radiation to groin Sharp, intermittent, cramping
A
Urolithiasis
20
Q
Back pain, radiating to bladder
Dull to sharp
A
UTI
21
Q
Step 3 in the approach to diagnosis of acute abdominal pain
A
Clinical evaluation
22
Q
Fever in AGE
A
Pain follows vomiting
48-72 hours
Rotavirus
23
Q
Fever in UTI
A
Painful urination and tenderness in suprapubic area
24
Q
Triad for diagnosis pneumonia
A
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
31
Most common causes of vomiting in infancy
Ingestion of mother's blood in passing out and vomits this when given milk
Gastritis secondary to drugs
32
Vomiting similar to family members and friends
| Diarrhea
Food poisoning
33
Oral or pharyngeal burns
History of suicidal ideation
Tablets in vomitus
Toxin ingestion
34
History of NSAID intake
Epigastric tenderness
Blood in vomitus
Gastritis
| Peptic ulcer disease
35
Bilious vomiting + history of abdominal trauma
Duodenal hematoma
36
Causes splenomegaly
| Bleeding from esophageal varices
Portal hypertension
37
Colickly RUQ pain + fever + vomiting
Acute cholecystitis
38
Upper abdominal pain + history of drug intake
Erosive gastritis
39
Upper abdominal pain + tenesmus + severe vomiting
Pancreatitis
40
Epigastric tenderness + heartburn + eating meals
Peptic ulcer disease
41
One of the most common functional abdominal diseases showing periumbilical pain
Hx of constipation and soiling
Stool at rectal vault
Palpable sigmoid
Constipation
42
Periumbilical pain + fever + point tenderness
Acute appendicitis
43
Hx of chronic abdominal pain
Incongruent signs and symptoms
Normal screening tests
Functional abdominal pain
44
The most common cause of blood in the stools in infant would be ____
Lower abdomen pain
Anal fissure (treated with lubricant)
45
Second most common cause of blood in the stools is ____
| Lower abdomen pain
AGE
| Infectious diarrhea
46
Third most common cause of blood in the stools
Allergic proctocolitis
47
Lower abdomen pain
Hx of constipation and soiling
Stool at rectal vault
Palpable sigmoid
Constipation
48
Lower abdomen pain
Blood in stools
Tenesmus
Fever
Colitis
49
History of sexual activity
Vaginal discharge
Rectal or vaginal tenderness
Lower abdomen pain
Pelvic inflammatory disease
50
Dysuria
Hematuria
Suprapubic tenderness
Lower abdomen pain
Cystitis
51
Diagnostic tests
Hema: CBC, blood smear and ESR
Urinalysis, stool exam
CXR, AXR, Scout film (volvulus), CT scan (appendix - fat stranding), US (to rule out choledochal cyst)
52
Severe constipation
Abdominal distention
Bilious emesis
Increased bowel sounds
Obstipation
53
Choledochal cysts triad
Abdominal pain
Jaundice
Abdominal mass
54
Long-lasting intermittent or constant abdominal pain that is functional or organic
Chronic abdominal pain
55
A disorder caused by a detectable physiological or structural change in an organ
Organic pain
56
ABdominal pain without demonstrable evidence of pathologic condition, e.g. anatomic, metabolic, infectious, etc
Functional dyspepsia, irritable bowel syndrome, abdominal migraine
Functional abdominal pain
57
Includes variable combination of age dependent, chronic or recurrent GI symptoms
Potentially debilitating group of disorders which can affect the quality of life of patient and family
Functional GI disorders
58
Pain for more than 2 weeks duration and a child must meet a certain criterion
Recurrent abdominal pain
59
Pain with poor relation to gut function and decreased activities of daily living
Functional abdominal pain
60
Pain that persists for greater than 6 months without evidence of physiologic events and also interferes with daily functioning
Functional abdominal pain syndrome
61
Functional dyspepsia, functional abdominal pain
Abdominal migraine
Irritable bowel syndrome
FGIDs
62
Acute persistent pain increasing in intensity
Sharply localized
Awakens at night
Further away
Fever, anorexia, vomiting, weight loss, anemia, elevated ESR
Organic
63
```
Less likely to change
Various locations
No effect in sleep
At umbilicus
Headache, dizziness, multiple system complaints
With psychological stress
```
Functional
64
FGIDs are best understood from a _______
Biophychosocial perspective
65
Criteria for childhood FGID
Rome III Criteria
66
FGIDs in neonates and toddlers may present with abdominal pain
Infant colic
Infant dyschezia
Functional constipation
67
Unclear etiology
Part of the normal distribution of crying
Painful gut contractions, lactose intolerance, gas or parental misinterpretation of normal crying
Infant colic
68
Infant colic Dx criteria
All in infants 0-4 months of age: paroxysms of irritability, fussing or crying that start and stop with obvious cause, episodes lasting 3 or more hours a day, occurring at least 3 days per week for at least 1 week, no failure to thrive
69
Clinical evaluation of infant colic
```
Younger than 4-5 months
Crying with temporal features
No CNS abnormalities
No developmental deficiencies
Normal PE
Normal growth patterns
```
70
Treatment of infant colic
Non-analgesic, non-nutritive soothing maneuvers (rocking, patting)
Self-limiting
Milk intolerance or esophagitis (hyrolyzed protein formula)
71
Disorder of defecation
| Grunting baby syndrome
Infant dyschezia
72
Infant dyschezia Dx criteria
Both in younger than 6 months: at least 10 minutes of straining and crying before successful passage of stools
No other health problems
73
Failure to coordinate increased intaabdominal pressure with pelvic floor relaxation
Infant dyschezia
74
Clinical evaluation of infant dyschezia
Hx
PE (rectal exam)
Anthropometrics
75
Management of infant dyschezia
Avoid rectal stimulation and use of laxatives
76
Functional constipation Dx criteria
Must include 1 month of at least 2 of the following in infants up to 4 years of age
- = 2 defecations per week
- at least 1 episode per week of incontinence after acquisition of toileting skills
- Hx of excessive stool retention
- Hx of painful or hard bowel movements
- Presence of a large fecal mass in the rectum
- Hx of large-diameter stools that may obstruct the toilet
77
Functional constipation typically occurs in any of the three periods
- in infants with hard stools, often following dietary change
- in toddlers acquiring toilet skills and find defecation painful
- as school starts and children avoid defecation
78
PE of functional constipation
Incontinence, fecal soiling, palpating fecal mass, rectal exam
79
Tx of functional constipation
Family education
Avoid coercive toilet training tactics
Stool evacuation: mineral oil, lactulose, polyethylene glycol
Behavior modification
80
Developmental issue and not a disease
| Involuntary return of previously swallowed food or secretions into or out of the mouth
Infant regurgitation
81
Retrograde movement of gastric contents and out of stomach
GER
82
RF of infant regurgitation
Prematurity
Developmental delay
Congenital anomalities of the oropharynx, chest, lungs, CNS, heart GIT
Milk allergy
83
Infant regurgitation Dx criteria
Both in healthy 3 week to 12 months of age
- regurgitation of 2 or more times per day for 3 or more weeks
- no retching, hematemesis, aspiration, apnea, faillure to thrive, feeding or swallowing difficulties
84
Infant regurgitation s/sx that need further evaluation
```
Failure to thrive
Hematemesis
FOBT
Anemia
Food refusal
Swallowing difficulties
Persistence > 1 year of age
```
85
Management of infant regurgitation
Effective reassurance
Symptom relief
Improved maternal-child interaction
86
FGIDs in children and adolescents
```
Functional dyspepsia
Irritable bowel syndrome
Abdominal migraine
Childhood functional abdominal pain
Childhoold functional abdominal pain syndrome
Constipation and incontinence
```
87
Most common FGID in children and adolescents
Irritable bowel syndrome
88
Cyclic vomiting Dx criteria
All
- 2 or more periods of intense nausea and unremitting or retching lalsting hours to days
- return to usual state of health lasting weeks to months
89
Recurrent, stereotypic episodes of intense nausea and vomiting
Begins at the same time of the day
Prompt recovery
Cyclic vomiting
90
Tx for frequent, severe and prolonged episodes
Amitriptyline, pizotifen, cyproheptadine, phenobarbital, propanolol
Avoid food, emotional and physical stressors
91
Treatment during prodrome
Ondansetron to reduce nausea/vomiting
H2 blockers/PPI
Deep sedation: lorazepam
92
Treatment during attack
Sedation
| IVF, electrolytes, H2 blockers
93
Functional constipation Dx criteria
Must include 2 or more in a child with a developmental age of at least 4 years
- 2 or fewer defecations in the toilet per week
- at least 1 episode of fecal incontinence per week
- Hx of painful or hard bowel movements
- presence of a large mass in rectum
- Hx of large diameter stool that may obstruct the toilet
94
PE of functional dyspepsia
Exam of perineum and perianal area
| Rectal exam
95
Treatment of functional dyspepsia
Address myths and fears
Manage fecal impaction
Stool softeners preferred over laxative
Rewards for success in toilet training
96
Persistent or recurrent pain centered in upper abdomen
| Not relieved by defecation or associated with change in form or frequency of bowel action
Functional dyspepsia
97
Abdominal discomfort or pain associated in 25% of the time or more, with 2 or more of:
- improvement with defecation
- change in frequency of stool
- change in form or appearance of stool
Irritable bowel syndrome
98
Episodic or continuous abdominal pain
| Insufficient criteria for other functional GI disorders
Functional abdominal pain
99
Functional abdominal pain with one or more of the following:
- some loss of daily functioning
- additional somatic symptoms (headache, limb pain, sleep difficulty)
Functional abdominal pain syndrome
100
Paroxysmal episodes of intense periumbilical pain lasting 1 or more hours (2 or more times in the preceding 12 months)
Healthy in between for weeks or months
Interferes with normal activities
Abdominal migraine
101
Abdominal migraine pain is associated with 2 or more of:
```
Anorexia
Nausea
Vomiting
Headache
Photophobia
Pallor
```
102
RF of abdominal pain-related in FGID
Parental anxiety in the first year of life
| Family facotrs
103
Appears to be beneficial for abdominal migraine
Pizotifen
