Paeds Abdo Flashcards
(17 cards)
Important local causes of abdo pain in a NEONATE:
NEC
Hirschsprungs
Volvulus
Intussusception
Hernia (incarc, strang)
Important local causes of abdo pain in INFANTS and CHILDREN:
Gastro
Mesenteric adenitis
Constipation
Pyloric stenosis
Meckel’s
Intussusception
Volvulus
UTI
Hernia (incarc, strang)
Appendicitis
Ovarian torsion
Testicular torsion
Important local causes of abdo pain in ADOLESCENTS:
Trauma
Constipation
Inflammatory bowel disease
Appendicitis
Renal calculi
Gallstones
UTI
Testicular torsion
Ovarian torsion
Ectopic pregnancy
PID
Important SYSTEMIC causes of abdo pain in paeds:
DKA
HSP
Sickle-cell
Cystic fibrosis (Enterocolitis)
Wilms
Toxin/OD
Sepsis
Psychosocial
Hirschprungs:
Congenital abscence of ganglia in distal colon- ie. no peristaslsis and functional obstruction
Males
Downs
Usually manifest within first weeks of life
–> Delayed meconium
–> abdo distension
Consider in childhood constipation/ FTT
Risk is ENTEROCOLITIS/ toxic megacolon.
DIAGNOSIS
- Barium enema
- Rectal biopsy
MANAGEMENT
Intusussception:
Typically ileocolic. Proximal into distal portion
<2 years (peak: 5-9mo)
CAUSES
- Idiopathic (90%)
–> Rotavirus vacc, viral illness, promotilities
- Lead point lesion more likely if older, or weird location:
–> Lymphoma, HSP, Meckel, adenopathy etc.
CLINICAL
- Sudden, severe, paroxysmal pain with pain-free intervals
- PR bleed
–> Only in 40%
–> Classic redcurrant jelly is a LATE sign
- Sausage-shaped mass on R
–> Bowel obstuction, wall ischaemia, perforation.
DIAGNOSIS
- Ultrasound
- Enema
TX
- Air (or contrast) enema
NOT if perforated.
Ultrasound diagnosis of intusussception:
- Target lesion
- ‘Cresent-in-a-doughnut’ sign
- ‘Pseudokidney’
- Other obstructive: eg. “whirling”
Meckel’s Diverticulum:
Small intestine
Rule of 2’s:
- 2% population
- <2yo
–> HALF apparent by then
–> Many not Sx until adulthood, if at all.
- 2cm wide, 2cm long
- 2 feet from ileocaecal valve
- 2 types ECTOPIC TISSUE
–> Gastric, pancreatic
Painless rectal bleeding
Obstruction
Colitis
Perforation
Intuss.
–> Resection if symptomatic
Midgut volvulus:
Due to congenital malrotation
Predisposes to small bowel wrapping around SMA –> Obstruction + ischaemia to SMA-supplied bowel segments.
Malrotation usually presents in first month of life AS VOVULUS, with bilious vomiting and abdo distension +- PR bleed.
In childhood, less dramatic.
Always consider in chronic GI complaints: Cyclical pain, cyclical vomiting, malabsorption
DIAGNOSIS
- Upper GI contrast series
–> ‘Corkscrew’ sign
‘Corkscrew’ sign of midgut volvulus
Pyloric stenosis:
Presents in first weeks of life (typically week 3)
Classically:
- Projectile, NON-BILIOUS vomiting +/- blood
- Palpable ‘olive’ in RIGHT UQ
- Visible peristalsis
- Dehydrated, hungry and low weight
IF OLIVE FELT, NO FURTHER WORK-UP REQUIRED.
Typical gas:
- HYPOCHLORAEMIC METABOLIC AKALOSIS
- +-HyPOkalaemia
DIAGNOSIS
- Ultrasound
Mx
- NBM
- Fluids
–> Resus, deficit, maint
–> Replace with FULL 0.9% saline (Cl), maint with usual HALF (neonate)
Myomectomy ONCE pH/ELECS/HYDRATION corrected.
Why is resuscitation of congenital diaphragmatic hernia so scary?
- Pulmonary hypoplasia
–> Low volumes
–> Less gas exchange surface - Pulmonary hypertension
Mesenteric adenitis
Any time incl. adolescence
Usually viral GI infections
If more unwell, possibly Yersinia
RLQ (appendicitis mimic)
Supportive only.
What is considered a ‘high risk’ ingested foreign body:
- > 2 x 6cm
- Sharp (in oesophagus)
- Button battery
- Multiple magnets
- Toxic substance
Button batteries and sharp objects less dangerous once past oesophagus
General approach to ingested FB in child:
Most can be left alone. If:
- Low risk object
- Low risk child
- Asymptomatic, eating, drinking
…..do nothing.
Return if red flags (pain, fever, bleed, food intol).
Consider XR if possible aspiration, or possible high-risk object. And radiopaque!.
Which ingested foreign bodies are ENT territory?
Above larynx. Ie. oropharynx.
BUTTON BATTERY ingestion:
Prehospital: Honey 2tsp, Q10min
Risk is oesophageal impaction
More likely >2cm
Will cause caustic erosion within 2 hours
–> Sucralfate
–> Endoscopy ASAP
Once into stomach, much lower risk.
Past pylorus? Can DC and allow to pass.
