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Flashcards in Abdo pain Deck (20):
1

DDx of Abdo pain: Infancy (< 2 years)
(Common, Less Common, Very Uncommon)

INFANCY ( <2 years)
Common
- Colic (< 3 mo)
- GERD
- Acute gastro
- Viral Syndromes

Less Common
- Trauma (possible child abuse)
- Intussusception
- Incarcerated hernia
- Sickling syndromes
- Milk protein allergy

Very Uncommon
- Appendicitis
- Volvulous
- Tumors (ex. Wilms' tumor)
- Toxin (heavy metal, lead)
- Malabsorptive syndromes

2

DDx of Abdo pain: Preschool (2-5 years)
(Common, Less Common, Very Uncommon)

PRESCHOOL (2-5 years)
Common
- Acute gastro
- UTI
- Trauma
- Appendicitis
- Pneumonia
- Asthma
- Sickling syndromes
- Viral syndromes
- Constipation

Less Common
- Meckel's diverticulum
- HSP
- Cystic Fibrosis
- Intussusception
- Nephrotic syndrome

Very Uncommon
- Incarcerated hernia
- Neoplasm
- Hemolytic Uremic Syndrome
- Rheumatic fever
- Myocarditis
- Pericarditis
- Hepatitis
- Inflammatory bowel disease
- Choledochal cyst
- Hemolytic anemia
- Diabetes
- Porphyria

3

DDx of Abdo pain: SCHOOL AGE (> 5 years)
(Common, Less Common, Very Uncommon)

SCHOOL AGE (> 5 years)
Common
- Acute gastro
- Trauma
- Appendicitis
- UTI
- Functional abdo pain
- Sickling syndromes
- Constipation
- Viral Syndromes

Less Common
- Pneumonia
- Asthma
- Cystic Fibrosis
- IBD
- Peptic Ulcer disease
- Cholecystitis
- Pancreatitis
- Diabetes
- Collagen vascular disease
- Testicular torsion

Very Uncommon
- Rheumatic fever
- Toxin
- Renal calculi
- Ovarian torsion
- Meconium ileus (cystic fibrosis)
- Intussuception

4

DDx of Abdo pain: ADOLESCENT
(Common, Less Common, Very Uncommon)

ADOLESCENT
Common
- Acute gastro
- Gastritis
- Colitis
- GERD
- Trauma
- Constipation
- Appendicits
- Pelvic Inflammatory disease
- UTI
- Pneumonia
- Asthma
- Viral Syndromes
- Dysmenorrhea
- Epididymitis
- Lactose intolerance
- Sickling syndromes
- Mittleschmertz

Less Common
- Ectopic pregnancy
- Testicular torsion
- Ovarian torsion
- Renal Calculi
- Peptic Ulcer disease
- Hepatitis
- Cholecystitis
- Pancreatic disease
- Meconium ileus (Cystic fibrosis)
- Collagen vascular disease
- IBD
- Toxin

Very Uncommon
- Rheumatic fever
- Tumor
- Abdominal abcess

5

Life threatening causes of abdominal pain

Appendicitis
Intussusception
Incarcerated hernia
Trauma (accidental or inflicted)
Tumors
Sepsis
Malrotation/Volvulus
Ectopic pregnancy
DKA
Intra-abdominal abscess (pelvic, inflammatory disease, IBD)
HUS
Intestinal obstruction
Pancreatitis
Megacolon
Metabolic acidosis / Inborn error of metabolism
Aortic aneurysm
Toxic ingestion (lead, iron, aspirin)

6

Extra-intestinal causes of abdo pain

Pneumonia
Scrotal pathology - testicular torsion, epipdidymitis
Strep pharyngitis
Diabtetes mellitus
Sickle cell disease with vasoocclusive crisises

7

2 most common causes of acute abdominal emergencies in kids

Appendicitis - most common
Intussusception

8

What are the clinical features of appendicitis?

Periumbilical pain initially
then the onset of vomiting
Associated with low grade fever, N/V, anorexia
then RLQ deveops

Abdo pain before vomiting helps differentiate between acute gastro (vomiting - pain)

9

Conflicting signs making diagnosis of appendicitis challenging

Atypical locations of pain
- flank pain (appendix in the lateral gutter)
- hypogastric pain (appendix on the left)
- pelvic pain and deep pain (retrocecal appendix)
Diarrhea
- from direct sigmoid irritation
Pyruia or dysuria
- from bladder/ureteral irritation

10

US and CT test Sn/Sp

US - Sn 90% Sp 97%
CT - Sn 97% Sp 97%

CT needs IV contrast - not PO
MRI - Sn 100%, Sp 96%, PPV 88%, NPV 100%

11

Risk factors for appendiceal perforation

Young children
Atypical presentation
Present early in their clinical course

12

Classic triad for intussusception

Abdo pain
Currant jelly stools
Abdo mass on palpation

Intestinal obstruction -- venous congestion -- arterial insufficiency

13

Features of Intussusception

Kids 3 mo to 3 years
Intermittent colicky pain
Legs drawn up while crying
Vomiting
Sausage shaped abdo mass
Lethargy or altered LOC
Bloody stools - late

14

Imaging for Intussusception

XR - may show absence of air in RLQ/RUQ or soft tissue density - lack sensitivity - cannot rule out
US - Sn 98-100% Sp 88-100%
Contrast enema - standard of care - often air enema is used more - safer, cheaper, more effective

15

Features of abdo FBs that are reassuring that they will pass spontaneously

Move beyond the GE junction
< 5 cm in length
not sharp (not needles)
Kid is Asmxtc

16

Why are button battery FBs so conerning?

Because they can become lodged against mucosa in the nose or esophagus and have the potential to cause necrosis, perforation, and life-threatening GI bleed

17

Why are magnet FBs concerning?

Because the attraction across the bowel wall can lead to necrosis leading to obstruction
Always important to get 2 views on XR - two attached magnets can look like 1 on a single view

18

Name the features of Fitz-Hugh-Curtis Syndrome

RUQ abdominal pain
Low grade fever
Young female
Sexually active

Often in 5-10% of patients with chlamydial or gonococcal pelvic inflammatory disease

None of the following:
N/V/D
Dysuria
Vaginal disharge
No cervical motion/adnexal tenderness
No jaundice

Definitive diagnosis - only made laparoscopically
Sometimes cervical cultures can be negative
Liver enzymes may be up
Tx - Antibiotics

19

Describe the management of an acute abdomen?

Airway
Breathing
Circulation
IV access
Fluid resuscitation with 20cc/kg NS
Lab studies - CBC, Lytes, Glucose, Liver enzymes,
Broad spectrum antibiotics
Surgical consult

20

Describe the features and types of functional abdominal pain

Types: General functional abdo pain, IBS, abdominal migraines

Features:
Episodic pain
Periumbilical
Rarely occurs during sleep
Rarely associated with eating or activities
No systemic illness - fever, N/V/D, rash, joint pain
Normal growth and development
Normal exam except periumbilical tenderness
No signs of peritonitis