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Acute Absominal Pain Flashcards

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1
Q

What is mittelshmertz?

A

Ovulation pain

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2
Q

Causes of abdo pain women

A

Ovarian cysts

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3
Q

What is HSP?

A

Vasculitis
Kidney and joints
Non blanching rash

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4
Q

What is intussusception?

A

Bowel goes into bowel
Pain in waves in abdomen
Obstruction of bowel - emergency
Fluid bolus
Volvulus ornmalrotatation

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5
Q

Neonatal presentation malrotatio

A

Abdo distension
No passage meconium
May present later

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6
Q

What is RAP?

A

Recurrent abdominal pain

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7
Q

How is RAP defined

A

> 3 episodes
Sufficiently severe to affect activities
Occur over period of >3 months
No known organic cause

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8
Q

Where are pain receptors mainly located in bowel?

A

Seroaa and mucosa
Bradykinin substance B

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9
Q

Why does referees pain happen?

A

Pain referred from dufferent organ that shares same dermatome

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10
Q

What determines where referred pain is from?

A

Dermatome that is in the area in

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11
Q

Where would pain be in the epigadtrium?

A

Liver
Pancreas
Biliary tree
Stomach

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12
Q

What could be affected if umbilical pain?

A

Distal all bowel
Caecum
Appendix
Proximal colon

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13
Q

What can be affected in suprapubic pain?

A

Distal large bowel
Bladder
Uterus and other female anatomy

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14
Q

Functional abdominal pain in children

A

Visceral hyper pain
Reduced threshold for pain
Impaired gastric relaxation
Dilated anal passage

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15
Q

Organic signs and symptoms

A

Less than 5 years
Constitutional problems
Vomiting
Nocturnal pain
Pain away from umbilicus, well localised
Urinary symptoms
Family H/o
Personal disease
Bloody stool

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16
Q

FAP signs and symptoms

A

Nonspecific
Periumbilical
Lack of SS organic Dian
Better on weekends or holidays
Distracts me
Ass with stress
Well otherwise
Normal growth
Normal examination
Perfectionist
Good vs poor school performers
Stress diversion
Coping mechanism
Difficult to manage
May not be acceptable to family

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17
Q

What does low albumin suggest?

A

Chronic disease

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18
Q

Managing functional pain

A

Education
Reassurance
Patient and family support
CAMHS
Restore normal activity and school attendance
Drugs have limits role
Paeds psychological support
Antispasmodics to help with pain - symptomatic management

Pain is real but

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19
Q

Better prognosis for FAP

A

Female
Less than 6 years old and 6 months duration

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20
Q

Most common age group for constipation

A

3-7 years old

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21
Q

What does long term constipation lead to

A

Loss of lower colonic tone

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22
Q

What does soil

A
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23
Q

Signs and symptoms of constipation

A

Abdominal pain
Rectal bleeding
Soiling
Stool withholding behaviour
Anorexia
Abdominal distension
Abdominal mass
Recurrent UTI

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24
Q

Why get recurrent UTIs with constipation

A

Compression of bladder -> urinary stasis

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25
5 Fs - abdominal mass
Foetus Fluid Faeces Flatus Fat
26
Why soiling after constipation
Loss of sensation in rectum due to continuous presence of stool Internal anal sphincter is loose Faecal imp action with overflow diarrhoea
27
What looking for if no meconium in 24 hours
Meconium ileus Hirschprungs disease CF
28
What is hirschprungs disease
Nerves in bowel absent
29
What is criteria for functional constipation in children?
Rome IV
30
Alarm features constipation
Meconium not for 48 hours Constipation starting in first month FH hirschprungs Failure to thrive Blood in stools Bio lupus vomiting Sever abdo distension Anal abnormality Spine abnormality Decreased lower limb tone/power/reflex
31
Differential diagnosis constipation organic
Neurological - hirschprungs, spinal cord dysplasia, Obstructive - meconium ileus, anal ring stenosis Endocrine/metabolic - coeliac disease, hypothyroidism, hypercalcemia, CMPA Toxins - laxative/diuretic abuse, lead and iron poisonning, opiates
32
What are the symptoms of lead poisoning and risks
Anaemia Peeling paint old home
33
Treatment constipation
Laxatives and compliance Softeners then stimualnts after 2 weeks PEG/movicol Manual evacuations Persistent rectal washouts ACE. - anti grade colonic enema Fluids and fibre in diet Education nbehavioural therapy
34
Why should you look out for in constipation?
Safeguarding
35
What does bilious vomiting suggest?
Nil by mouth NG tube aspirate X-ray abdo and speak to surgeons Consider sepsis as differential Obstruction Preterm necrotising enterocilitis Term - congenital condition, eg malrotation or volvulus Prev surgery adhesions cause bands
36
Regurgitation vs re
37
When does pyloric stenosis normally present?
2 weeks
38
What causes telescoping of bowel
Intussecption
39
How does intussception happen
Lymph nodes become inflammed form jump points -> bowel to bowel connections
40
How does intussception happen
Lymph nodes become inflammed form jump points -> bowel to bowel connections
41
Causes of vommitting
Infection Obstruction Brain
42
Differnetials for vomit
Infection Intestinal obstruction GORD, oesophagitis PUD Food allergy and intolerance Functional Psychological Iinduced illness Metabolic Renal Neurological Diverticulosis
43
What is cyclical vomitting syndrome
44
What is induced illness
Making themselves sick Whats going on syndrome
44
What is induced illness
Making themselves sick Whats going on syndrome - mums created sick themselves/fabricated - safeguarding
45
Typical signs of GORD
Excessive regurgitation/vmitting Nausea Irritability with feeds, araching back Colic Dysphagia, chest/epigastric Excessive hiccups Weight loss/faltering growth Haematemesis/iron deficiency ASpiration pneumonia Oesophageal stricture
46
Atypical symptoms and signs for GORD
Wheeze/intractable asthma Cough/stridor Cyanotic episodes Generalised irritability Sleep disturbanve Breath holding, sandifer syndrome
47
Investigations for GORD
Barium meal Ph study Upper GI endoscopy
48
What are you looking for in barium meal?
Any structural abnormality in the gut
49
What does pH study measure?
Reflux index - catheter/NG tube fixed at LOS for 24 hours measuring % of time where reflux index >4% (4-10 mild, >10 moderate, >20 severe) Measuring severity of reflux
50
Management of GORD
Explanation of natural history in babies Review of feeding and feeding practise Use of thickeners Use of antiregurgiation milks
51
Why can zantac medication be problematic?
Carcinogen
52
When should domperidone not be used
If underlying heart condition May increase life threatening cardiac events
53
What is niseen fundoplication
Procedure for refractory GORD
54
Treatment for refractory GORD
Nissen fundoplication PEG tube
55
IgE reaction time frame
2 minutes to 2 hours
56
What can be donw to reduce risk of cows milk allwegy in babies
Bieng breast fed Does not eliminate risk
57
Presentation of cow milk allergy
GI - irritability, vomitting, food refusal, diarrhoea like stool, constipation. Blood and mucus in well baby Skin Respiratory - chronic cough or wheeziness
58
Management of cow milk protein allergy
Clinical diagnosis Cows milk free diet trial
59
Steps of formula milk in cow milk protein allergies
Ubutramigen - cows milk proteins broken down a bit but not alot Neocate - cows milk proteins completely broken down Alpro soya
60
How to test for milk allergy
Take away and reintroduce - if still problems then cows milk allergy
61
How long dairy free if cows milk protein allergy as baby
til 1 year of age Then slowly reintroduce milk based on milk ladder
62
Pognosis for cows milk allergy
>90% TOLERATN AT 6 50% at 1 year, >75% AT 3
63
What need ot worry about with no dairy
Calcium and vitamin D supplements

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