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Flashcards in Paeds: Acute abdo pain Deck (22):
1

Dx surgical

1. Intussusception or other I.O.
2. Peritonitis
3. Trauma
4. Meckel’s Diverticulum
5. Acute Appendicitis
6. Malrotation
7. Inguinal hernia
Pancreatitis

2

Dx MEdical

1. Gynaecological in pubertal females
2. Sickle cell disease
3. Non-specific abdo pain
4. Mesenterc adenitis
5. Hepatitis
6. Constipation
7. Toxin e.g. lead
8. IBD
9. Henoch-Schonlein purpura
10. UTI, acute phylonephritis, hydronephrosis, renal calculus
11. Gastroenteritis
DKA

3

Extra-abdominal

1. URTI
2. Lower lobe pneumonia – referred pain
3. Hip and spine
Peritonitis in patients with ascites from nephritic syndrome

4

Intussusception: Definition

‘ Invagination of proximal bowel into a distal segment’

5

Intussusception: Epi

Commonest cause of Intestinal obstruction in infants after neonatal period.
Occurs between 2/12 and 2 yoa

6

Intussusception: Pathophysiology

Ileum passing o caecum/colon through ileo-caecal valve.

7

Intussusception: S&S

- Paroxysmal, severe colicky pain
- Draws up legs
- Pallor in episodes pain
- Abdo distension
- Sausage-shaped mass (often palpable)
Redcurrent jelly stool (blood-stained mucus)

8

Intussusception:
Diagnosis

AXR

9

Intussusception: Treatment

- I.V. volume expansion (often pooling of fluid in gut which may cause hypovolaemic shock)
- Rectal air insufflation
Operative reduction

10

Intussusception:
Complications

Shock

11

Meckels Diverticulum:
Definition

Ileal remnant of the vitellointestinal duct – Contains ectopic gastric mucosa or pancreatic tissue

12

Meckels Diverticulum:
S&S

Asymptomatic
Rectal bleeding

13

Meckels Diverticulum:
Other presentations

Intussussception
Diverticulutus
Volvulus around a band

14

Meckels Diverticulum:
Investigations

Technetium scan

15

Meckels Diverticulum:
Treatment

Surgical resection

16

Acute Appendicitis: Definition

Commonest cause of abdo pain in children

17

Acute Appendicitis: Symptoms

- Anorexia
- Vomiting
Abdo pain – central and colicky, then localizing to R.I.F

18

Acute Appendicitis: Signs

- Flushed face with oral foector
- Fever
- Abdo pain aggravated by movement
- Tenderness
Guarding in r.i.f

19

Acute Appendicitis: Note

- Retrocaecal appendix: localised guarding may be absent
Pelvic appendix: few abdo signs

20

Acute Appendicitis: Investigations

- FBC
Laparoscopy

21

Acute Appendicitis:
Treatment

Appendicectomy (if perforation give fluid resuscitation and i.v. prior to laparotomy)

22

Acute Appendicitis:
Complications

- Appendix mass
- Abscess
Perforation

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