Abdominal pain Flashcards

Question

DDX for pain in Iliac fossa

Answer 1

``` mesenteric adenitis Gastroenteritis Constipation Urinary tract infection Hence-schonlein purpura Inflammatory bowel disease Ovarian pain Ectopic pregnancy Pyelonephritis ```

Answer 2

``` Appendicectomy Laparoscopically Excellent prognosis Perforation is commoner in children If peritonitis = severe illness and adhesions may lead to bowel obstruction. Other Resus IV Blood - G&H, cross hold, FBC, U&E, CRP, B Fluid bolus Antibiotics - cefuroxime, metronidazole Hx Reassess - ABC and vital signs Examination Reassess Ix - Abdo Xray - stones, SBO or servere constipation. Urinalysis +/- microscopy RBC/CRP/UE/BCs USS - Reassess surgery refer to paediatric surgery for Appendicectomy Laparoscopically ```

Answer 3

Enlarged lymphatic may form the leading edge of the intussusception. This is often following a viral infection. Adenovirus or rotavirus Very rarely due to pathological lesion such as polyp or lymphoma or complication of HSP.

Answer 4

AXR - rounded edge of intussusception against gas filled lumen of the distal bowel with signs of proximal bowel obstruction USS - Doughnut sign

Answer 5

Blood/mucus in stools Family Hx of diarrhoea Wt less and poor growth

Answer 6

Recent viral infection No peritonism or guarding Pain can mimic appendicitis

Answer 7

Pain at night Relief with milk Think Helicobacterpylori

Answer 8

Bile stained vomiting Abdominal distension Consider a volvulus

Answer 9

Hard or infrequent stools Mass in left iliac fossa Faecal loading on radiograph

Answer 10

``` Dysuria, frequency Bedwetting Back pain vomiting Evidence of infection on urinalysis or microscopy. ```

Answer 11

palpable purpuric rash on lower half of body (buttocks and extensor surfaces). disappears on pressure, due to signifying intradermal bleeding - Joint pain and Arthritis - Usually main compliant and most pain resolves in 24-48 hrs. +/-Swelling - eg scrotum, hands, feet and sacrum - can be very painful. Abdominal pain due to GI vasculitis risk of +/- intussusception. Blood in stool and acute abdomen If uncomplicated - resolves spontaneously 72 hr Complications - intussusception, blood stools, haematemesis, spontaneous bowel perforation, pancreatitis Renal +/- Glomerulonephritis haematuria (90%), Less common proteinuria, hypertension, nephrotic syndrome and rarely Renal failure Can present as abdominal pain or arthralgia before rash. Commonly 2-8 yrs Hx of URTI

Answer 12

Consult senior staff Steroids helpful in abdominal & joint pain - prednisolone 1mg/kg Look for complications e.g. Intussusception, Perforation, pancreatitis, stone, Admit if Cx presentation or severe pain from joint, abdomen or subcutaneous oedema. when DC follow up with GP for BP and urine Education - on need for follow up and rash being the last to go. Worsen in child is active.

Answer 13

Intussusception inflammatory bowel disease Henoch Schonlein purpura Some types of gastroenteritis.

Answer 14

``` Acute appendicitis Intussusception Ovarian cysts Volvulus Renal, ureteric and biliary stones ```

Answer 15

``` Gastroenteritis - common, colicky, V&D PID Ectopic UTI DKA Lower lobe pneumonia Henoch Schonlein purpura Anxiety Mesenteric adenitis ```

Answer 16

Diagnosis of exclusion | tx if simple analgesia

Answer 17

Hx where it is worse when it is worse Does the pain affect daily activities Constitutional symptoms - wt loss, anorexia, fever emotional, anxiety or daily problem Ex Growth - wt loss or fall off in growth indicated serious pathology GI - look for pallor, jaundice and clubbing Abdo - hepatomegaly, splenomegaly, enlarged kidneys or distended bladder. PR - not routine in children.

Answer 18

functional condition associated with recurrent abode pain and minor GI symptoms such as bloating and altered bowel habit e.g. ranging from pellets to unformed stools. Gas. Hx of colic as infant. Acute symptoms resolve with time but relapse occur. Red flags are change in symptoms e.g. wt loss, bleeding or anaemia

Answer 19

Reassurance Diet education Low FODMAP Smooth muscle relaxants eg mebeverine for spasms

Answer 20

``` epigastric pain Relieved by food May be family hx ALARM Symptoms: A – anorexia L – loss of weight A – anemia R – recent onset/ progressive symptoms M – melaena/ haematemesis S – swallowing difficulty ```

Answer 21

``` Ix - stool examination for helicobacter antigen, Hydrogen breath test or endoscopy H2 receptor eg ranitidine PPI eg ezomerprazole Helicobactor pylori - PPI - Ezomerprazole - ABx - Amoxicillin, clarithroycin ```

Answer 22

``` Idiopathic - Fluid depletion - low fibre diet - lack of mobility & exercise Gastrointestinal - Hirschsprung's disease - anal disease - infection, stenosis, ectopic, fissure, hypertonic sphincter) - Bowel obstruction - food hypersensitivity - Coeliac disease Non-gastrointestinal - Hypothyroidism - Hypercalcaemia - Neurological disease e.g. spinal disease - Chronic dehydration eg diabetes insipidus - Drugs e.g. opiate and anticholinergics - sexual abuse ```

Answer 23

Infrequent stool

Answer 24

Short term - soften retained stool e.g. movicol - Colonic stimulant eg Senna. Continue until bowel pattern regular and then decrease Long term - Soften retained stool for at least a week - Oral colonic stimulant eg senna - if failure then try oral bowel evacuation preparation, enema, manual evacuation under general sedation Maintenance tx - Increase dietary fibre and fluid - Regular bulk laxative - Reg colonic stimulant - Persist with medication for at least 6 months. - Behaviour management - establish toilet routine - Assessment by a clinical psychologist and therapist if there is a degree of family discord

Answer 25

in newborn period with delayed passage of meconium and abdominal distention. If only small segment then may present later with constipation and FTT. Commoner in boys then girl Dx by barium enema and then rectal biopsy Mx resection of abnormal section of bowel.

Answer 26

Diet - not drinking enough fluid or high fibre foods Holding of stools - e.g. not liking public toilet Change in routine - e.g. holiday, moving house, or school or even changing of formula Lack of exercise Genetic Medication eg codeine, cough medicine, some anticonvulsants, antihistamines.

Answer 27

Non organic - periodic pain with intervening good health, often periumbilical, may be related to school hours Organic pain- pain occurring at night, wt loss, reduced appetite, lack of energy, recurrent fever, organ-specific symptoms e.g. change in bowel habit, polyuria, menstrual problems, vomiting, occult or frank bleeding Ill appearance, growth failure, swollen joint.

Answer 28

``` Alvarado score uses the Acromin MANTRELS Migration of pain 1 Anorexia 1 Nausea 1 Tenderness in RLQ 2 Rebound pain 1 Elevated temperature 1 Leucocytosis 2 Shift of WBC count to the left 1 Score 1-4 D/C (30%) Score 5-6 Observation/admission (66%) Score 7-10 Surgery 93% ```

Answer 29

heartburn, difficult feeding with crying Painful swallowing haematemesis

Answer 30

``` 90% Escherichia coli - important recurrence UTI - 40% - very common Rarely - 10% Staph Saprophyticus Proteus Klebs Entero Ureaplasma - rare ```

Answer 31

``` Obstructed urinary system Pelviureteric obstruction Urinary stones Posterior urethral valves 0 in boys with poor urinary stream) Duplex kidney with obstructed pole Horse shoe kidney Organism - E.coli most of the time Gram -ve - E.coli, Klebsiella, proteus, enterobacter, pseudomonas Gram +ve - S.saprophyticus, enterococcus ```

Answer 32

Non modifiable - female, caucasian, previous UTIs, FmHx Modifiable - Urinary tract abnormalities (vesicoureteral reflux, neurogenic bladder catheterisation, uncircumcised males, labial adhesions, sexually active, constipation, toilet training Increase chance of spread to kidney in

Answer 33

Distal system - Dysuria, Low grade fever, frequency, urgency, Pyelonephritis. Flank pain, high fever, Paediatrics Hx often non-specific e.g. fever, irritability, poor feeding and vomiting, failure to thrive, septic May have loin or abdominal pain, frequency and dysuria but are often absent in younger patients varies from children looking well to appearing very unwell. NICE 3 months Preverbal - Most common - Fever Less common - Abdominal pain, loin tenderness, vomiting, poor feeding Least common - Lethargy, irritability, Haematuria, offensive urine, failure to thrive > 3 months Verbal - Most common - frequency, Dysuria Less common - Dysfunctional voiding, changes to continence, abdominal pain, loin tenderness Least common - Fever, Malaise, Vomiting, Haematuria, Offensive urine, cloudy urine. O/E Often normal other then fever May have Loin or supra-pubic tenderness Toxic vs non toxic, FTT, Jaundice, look for external genitalia abnormalities (Phimosis, labial adhesions), Lower back signs of occult myelodysplasia (eg hair tufts), which may be associated with neurogenic bladder. Old child - febrile, suprapubic and/or CVA tenderness, abdominal mass (enlarged bladder or kidney); may present with short stature, FTT or hypertension secondary to renal scarring from previously unrecognised or recurrent UTIs

Answer 34

Blood: Leukocytosis – neutrophilia Midstream clean catch Urine specimen* Dipstick: Leukocyte esterase (only in neutrophils) & nitrite +ve. Urine: pyuria, neutrophils, bacteria, cloudy MCS Urinanalysis - blood, nitrates, leucocytes esterase, screening test only. bHCG - confirm that they are not pregnant - changes treatment

Answer 35

Clean catch - sterile around and give the parents a jar and ask them to watch and wait SPA - indications - Don’t have time to wait for a clean catch e.g. septic and need to give antibiotics in a child

Answer 36

If unwell or

Answer 37

``` Symptoms PolyUria polydipsia weight loss weakness Nausea vomiting leg cramps blurred vision abdominal pain Sign Kussmaul breathing (deep and laboured breathing), dehydration Hypotension - postural or supine Cold extremities/peripheral cyanosis tachycardia smell of acetone hypothermia confusion, drowsiness, coma ```

Answer 38

combination of hyperglycemia, metabolic acidosis, and ketonaemia BGL >/= 11.1 mol/L bed side Blood ketone >0.6 mol/L or urinanlysis vBG pH

Answer 39

1 degree of dehydration: None/mild (7%): poor perfusion, rapid pulse, reduced blood pressure e.g. shock 2 level of consciousness 3 Investigations: VGB, FBC, Blood glucose, urea, electrolytes, blood ketones. investigations for cause. if new diabetic: Insulin antibodies, GAD antibodies, coeliac seen (total IgA, anti gliadin Ab, tissue transglutaminase Ab) and TFT Urine - ketones and culture

Answer 40

``` DRSABCDEFG IV O2 cardiac monitor - signs of hyperkaleia (Peaked T waves, widened QRS) or hypokalemia (flattened or inverted T waves, ST depression, wide PR interval. Blood cultures if febrile Catheterise and fluid control Fluid requirements - if hypo perfusion - give 0.9% NS at 10ml/Kg initial fluid replacement - NS + potassium Insulin 0.1units/kg/hr - Glucose Nil by mouth ``` Ongoing monitoring and management - Strict fluid balance - Hourly observation - HR, BP, RR, GCS, neuro signs:pupillary responses, assess for change e.g. restlessness, irritability, headache. Hourly glucose and ketones recheck K+ within 1 hr of commencing insulin infusion VBG and lab glucose 2 hourly for initial 6 hrs and then 2-4 hourly there after. Serum U&E 2-4 hourly for initial 12-24hr 2-4 hourly temp nursed head up

Answer 41

Hyper/hyponatraeia Hypoglycaemia Cerebral oedema

Answer 42

``` 5S Site Size Shape Surface, Skin Consistency - hard, soft Young liver is 4-6cm big. Starts at 5th rib. ```

Abdominal pain Flashcards

(66 cards)