Abdominal Pain in Children Flashcards by Annie Caldwell

Presentation of constipation

Infrequent passage of stool
Poor appetite
Lack of energy 
Irritable 
Pale
Black bags under eyes 
Abdominal pain / distention 
Withholding or straining 
Diarrhoea 
- overflow and liquid stool

How well did you know this?

Not at all

Perfectly

Causes of constipation

Poor diet
- insufficient fluids 
- excessive milk 
Potty training / School toilet 
Intercurrent illness 
Medication (opiates / Gaviscon)
FH
Psychological (secondary) 
Organic (RARE)
- anal stenosis 
- anterior anus

How well did you know this?

Not at all

Perfectly

What happens if you need to go and do not go?

Constipation

How well did you know this?

Not at all

Perfectly

Viscous cycle of constipation involves….

A large hard stool when young
Painful or caused an anal fissure
this leads to toddler withholding of stool to prevent pain

How well did you know this?

Not at all

Perfectly

What is a megarectum?

The stool stretches the rectum as there is so much hard stool stored

How well did you know this?

Not at all

Perfectly

Results of megarectum

UTIs
Wetting
Soiling

How well did you know this?

Not at all

Perfectly

Who particularly gets UTIs / wetting due to megarectum and why?

Girls as short urethra

How well did you know this?

Not at all

Perfectly

Why does soiling occur when have a megarectum?

Internal sphincter is held open by the stool and so can only rely on the external sphincter
Soft watery stool leaking around hard stool

How well did you know this?

Not at all

Perfectly

Why does stool get harder if it is not let out?

Bowel sucks out more and more water

How well did you know this?

Not at all

Perfectly

Treatment of constipation

Diet
- increased fibre
- increased fruit and veg 
- increased fluid 
- decreased milk 
Psychological 
- reduce adverse factors (make going to the toilet a pleasant experience)
- Soften stool and remove pain 
- Avoid punitive behaviour of parents 
- Reward good behaviour (praise, star charts)
Soften stool and stimulate defecation 
- drugs (osmotic laxatives, stimulant laxatives, isotonic laxatives)

How well did you know this?

Not at all

Perfectly

How can going to the toilet be made into a pleasant experience for children?

Correct height

Not cold

How well did you know this?

Not at all

Perfectly

How long is treatment for constipation given?

Under no longer required - enough to make them go

How well did you know this?

Not at all

Perfectly

Treatment of impaction

Empty impacted rectum and colon = movicol
Maintain regular stool passage
Slow weaning off treatment

How well did you know this?

Not at all

Perfectly

Investigations of impaction

Abdominal exam
- sometimes feel a suprapubic mass
Colonic marker study

How well did you know this?

Not at all

Perfectly

Symptoms of Crohn’s and UC

Diarrhoea (>UC)
Rectal bleeding (>UC)
Abdominal pain 
Fever
Weight loss (>C) as puts off eating
Growth failure (>C)
Arthritis
Mass (C)

How well did you know this?

Not at all

Perfectly

Pattern of inflammation in crohn’s

Can affect anywhere so the site of inflammation predicts the symptoms
Skip lesions
Long deep inflammation like snail tracks

How well did you know this?

Not at all

Perfectly

Particular features of UC

Bloody mucosal diarrhoea

Fluctuating

How well did you know this?

Not at all

Perfectly

Features of investigations for Crohn’s

Symptoms not strong esp in those who dont have diarrhoea

Abnormal bloods

How well did you know this?

Not at all

Perfectly

Features of investigations for UC

Dont always get abnormal bloods

Symptoms

How well did you know this?

Not at all

Perfectly

Lab tests for UC / chron’s

FBC 
- anaemia
- thrombocytosis
ESR
- raised 
Stool caprotectin 
Raised CRP
Low albumin 
No stool pathogens

How well did you know this?

Not at all

Perfectly

Investigations for UC / C

MRI 
Barium meal (< 5s)
Endoscopy

How well did you know this?

Not at all

Perfectly

Features of inflammation in UC

Not patchy
Continuous
Usually gets better as go round and check on endoscopy

How well did you know this?

Not at all

Perfectly

Aim of treatment for IBD in children

Induce and maintain remission
Correct nutritional deficiencies
Maintain normal growth and development

How well did you know this?

Not at all

Perfectly

Treatment of IBD

Anti inflammatorys 
Immunosuppressants
Biologics (infliximab)
Steroids (possibly)
Nutrition 
- immune modulation 
- nutritional supplementation 
Surgical

How well did you know this?

Not at all

Perfectly

What to ask in the history of abdominal pain?

``` Vomiting? - colour SOCRATES Bowel symptoms Urinary symptoms - dysuria WHERE Gynae / sexual history If teenagers Systemic features Vaccinations ```

How do you check for peritonism?

Get the child to jump

On abdo examination in children, what is done instead of rebound tenderness?

Percussion

What are the areas of the abdomen?

``` Right hypochondriac region Epigastric Left hypochondriac Right lumbar Umbilical Left lumbar Right illac fossa Hypogastrium Left iliac fossa ```

What investigations could be done for abdominal pain?

``` Urinalysis - microscopy - culture -BhCG possibly Stool culture - enteric pathogens - H pylori Bloods AXR / CXR AUSS MRI Colonoscopy / sigmoidoscopy ```

Causes of abdominal pain in infants

``` Colic CMPA Food intolerance Gastroenteritis Malrotation Intussception (PS) UTI Hernia (strangulation) Meckles diverticulum ```

Which cause of abdo pain in infants is an emergency?

Malrotation

Causes of abdo pain in a child

``` Pancreatitis (uncommon) Appendicitis IBS Meckles diverticulum Gastroenteritis UTI IBD ```

Causes of abdomen pain in adolescence

``` Menstruation IBS IBD Ovarian - torsion - cyst Appendicitis ```

What is intussception?

Telescoping of the bowel

Presentation of intussception

Episodes of pain and drawing legs up Sausage like mass Redcurrent jelly stools (late sign)

Investigations of intussception

AUSS

Tx of intussception

Air enema - 90% successful Theatre 10%

Risks of air enema

15% recurrence | Risk of perforation

Pathology of intussception

Peristalsis when younger | Pathological if older

What age normally gets intussception?

4 - 18 months

Special signs of appendicitis

Press in LIF get pain in RIF Internal rotation of the hip causing pain Bring knee up causing pain

Lifetime incidence of appendicitis

6 - 8%

Pathology of appendicitis

``` Blocked lumen leads to - swelling - ischaemia - necrosis Results in - perforation - abscess formation ```

Pattern of the pain in appendicitis

Starts central | Moves to RIF

What rule goes with Meckles diverticulum?

Rule of 2s - 2% of pop have it - 2% will become symptomatic - 2 ft from ileocaecal valve - 2cm long

Definition of Meckles diverticulum

Congenital diverticulum of the small intestine

Pathology of meckles diverticulum

Remnant of the omphalomesenteric duct and contains ectopic ileal, gastric or pancreatic mucosa

Presentation of meckles diverticulum

Abdo pain mimicking appendicitis Rectal bleeding Intestinal obstruction - intusseception

Tx of meckles diverticulum

Removal if - narrow neck - symptomatic

Definition of mesenteric adenitis

Inflammed lymph nodes within the mesentery after viral infection causing abdominal pain

Treatment of mesenteric adenitis

No treatment

What does the vomiting look like in gastroeneteritis?

Clear or foodstuffs

Features of vomiting and diarrhoea in GE

Diarrhoea lasts 5 - 7 days, resolves by 2 weeks | Vomiting lasts 1 - 2 days, resolves by 3 days

Causes of GE in children

``` Rotavirus Adenovirus Enterovirus Norovirus E coli Shigella Salmonella Campylobacter Giardiasis Amoebiasis ```

Which usually comes first in GE, the diarrhoea or the vomiting?

Vomiting

Most common cause of GE in children

Rotavirus

Fluid replacement in a child with no clinical dehydration

Continue breast feeding Encourage fluid intake Discourage fruit juices and carbonated drinks Offer ORS if risk of dehydration

What % dehydration is mild?

< 5%

What % is moderate dehydration?

5 - 10%

What can be seen in the nappy in under 1s in dehydration?

Urate crystals | - Look like orange crystals in the nappy

Examples of High H20 content foods

Jellys | Yogurts

Treatment of clinical dehydration

``` Oral replacement therapy - ORS 50ml/kg over 4 hours then maintenance often in small amounts Continue breast feeding Consider ORS via NG tube If clinically deteriorate for IV fluids ```

Management of clinical shock

Fluid bolus 20ml/kg IVT - for maintenance and fluid deficient replacements Add 100ml/kg for children initially shocked or 50ml/kg for children who were not initially shocked to maintenance fluids

How do you work out maintenance fluids in children?

4, 2, 1 rule 4ml/kg 10kg 2ml/kg 10kg 1ml/kg / kg everything else 150ml/kg/day < 1s or sometimes pyloric stenosis

What is the resus fluid in children?

20mls/kg 0.9% NaCl | 10mls/kg if bleeding

Types of fluid treatment

Replacement Resuscitation Maintenance

How to work out replacement fluid for children?

ml for ml

What are the maintenance fluids used in children?

0.9% NaCl 5% Dextrose 0.15% KCl

Types of dehydration

Hypernatraemic Hyponatraemic Isotonic

Who is especially at risk of hypoglycaemia and why?

< 5s | Dont have some reserves

What does the stool look like in coeliac disease?

Mucous in it

Treatment of hypernatraemic dehydration

Isotonic solution Replace fluid deficit over 48 hours Aim to reduce plasma Na less than 0.5mmol/l per hour

What fluid replacement is done after rehydration?

ORS 5ml/kg for each large watery stool

Red flags in GE

``` Temperature Tachypnoea Altered consciousness state Neck stiffness Blood in stool Bilous vomiting Severe or localised abdominal pain Abdominal distension ```

Who is at increased risk in GE?

``` Children < 1 y/o LBW infants > 6 stools in 24 hours > 3 vomits in 24 hours Children not tolerating supplementary fluids Children with malnutrition ```

Complications of GE

``` Electrolyte imbalances - Decreased Na - decreased K Hypoglycaemia Metabolic acidosis Seizures (febrile convulsions) ```

If have D + V, what is the school exclusion advice?

48 hours after symptoms have settled

Common complication after viral GE

Transient lactose intolerance

What is a red flag for hirschprungs disease?

Passage of meconium after 48 HOURS

Stools / diarrhoea containing undigested food typically point towards what diagnosis?

Toddlers diarrhoea

If movicol isn't working, what else can be done?

Add senna

Abdominal Pain in Children Flashcards

(81 cards)