Abdominal pain

Question 1

Abdominal pain may caused by problems in the abdomen itself, or because of infection elsewhere such as a throat infection - why would this cause abdo pain?

Alternatively, it may be ass with other conditions e.g. migraine. May also be a symptom of stress e.g. issues at school or home.

Answer 1

is thought to cause the Peyer’s patches in the abdomen to swell (these are part of the body’s immune response)

Question 2

abdominal causes of abdominal pain?

Answer 2

Question 3

extra-abdominal causes of abdominal pain?

Answer 3

Question 4

rare but serious causes of abdominal pain?

Answer 4

Question 5

why is it important to look at the respiratory system properly when examining a child with abdominal pain?

Answer 5

lower lobe pneumonias can present as abdominal pain in kids

Question 6

how to assess how serious the abdominal pain is in children?

Answer 6

• most point to their umbilicus/ all over when asked to localise the pain, pointing elsewhere may suggest something more serious
• if patient is distatible, pain is less serious
• watch their face as you palpate then

Question 7

Intussusception is a condition which can affect all ages, but usually affects what age?

Answer 7

infants and toddlers

Question 8

what is intusseception?

Answer 8

caused by invagination of intestine into itself, like a telescope, leading to bowel obstruction.

Question 9

Intussusception can be associated with extra-abdominal infections (for example tonsillitis or an ear infection). Why would these lead to intussesception?

Answer 9

because these make lymph nodes (called Peyer’s patches) in the bowel wall swell, and this acts as a lead point for the bowel to fold on.

Question 10

intussesception presentation?

NB: It is important to recognise this life threatening condition.

Answer 10

• pain is characteristically colicky, and the child will settle in between bouts of this pain.
• A mass may be felt in the abdomen, usually on the right hand side.
• child will become dehydrated over time.

Question 11

Ix and management of intussesception?

Answer 11

• IV fluids
• send bloods, get USS
• radiologist, who may be able to reduce the intussusception with contrast liquid, or they may need a paediatric surgeon to operate.

Question 12

Any mass which isn’t obviously constipation must be taken seriously.

Cancer, for example ____ tumour and ____, occurs in children, and is often diagnosed late. _____ can present late with an appendix abscess.

Answer 12

Wilm’s

neuroblastoma

Appendicitis

Question 13

Vomiting bile means what?

Answer 13

that there is intestinal obstruction so is a very important symptom.

If parents say the vomit had a green colour, you need to be sure that there are no signs of obstruction before you attribute it to an empty stomach.

Question 14

Why is testicular torsion a surgical emergency?

Answer 14

Fertility in the testicle concerned may be lost within 4 - 6 hours of interrupted blood flow to the organ.

Requires prompt diagnosis and treatment to save the testicle.

Question 15

Testicular torsion age group?

Answer 15

more common >12s but need to be considered in any age group

Question 16

how does testicular torsion present?

Answer 16

• abdominal pain
• usually a history of testicular pain too but can present as just abdominal pain
• in a pre-verbal child: crying and unsettled.

In all of these circumstances you should always check the scrotum for signs of swelling, tenderness or discolouration.

Any suspicion > immediate referral to a paediatric surgical unit for examination and possible surgical exploration.

Question 17

Peritonitis - signs on examination?

Answer 17

• guarding
• dehydration
• sepsis

is caused by severe inflammation within the peritoneal cavity, surgery required

Question 18

commonest cause of peritonitis in childhood?

Answer 18

is a perforated appendix

Question 19

most likely cause of abdo pain in a child who is tender in the left iliac fossa, not guarding and is very well

Answer 19

constipation - will usually feel hard faeces on palpation

Question 20

why is it important to dip test the urine in all cases of abdominal pain?

Answer 20

look for

• UTI
• glucose and ketones in DKA
• just ketones - the child hasn’t been eating for a day or two, meaning the illness is more serious