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Acute abdominal pain in children

Acute abdominal pain in children. Clinical features. Diagnosis. Labs Cbc not useful in undifferentiated abdominal pain Obtain glucose in altered child Urinalysis. imaging. Abdominal plain films intestinal obstruction (air fluid levels, dilated small/large bowel) perforation (free air)

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Acute abdominal pain in children

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  1. Acute abdominal pain in children

  2. Clinical features

  3. Diagnosis • Labs • Cbc not useful in undifferentiated abdominal pain • Obtain glucose in altered child • Urinalysis

  4. imaging • Abdominal plain films • intestinal obstruction (air fluid levels, dilated small/large bowel) • perforation (free air) • calcium-containing stones • Appendicolith • pneumatosis intestinalis (seen with NEC) • constipation (by degree of stool present)

  5. imaging • CT - appendicitis • US • Intussusception • ovarian pathology • testicular pathology • evaluation of the gallbladder for stones and inflammation • intrauterine pregnancy

  6. Pyloric stenosis • pyloric muscle hypertrophy that obstructs gastric outflow • Male, white race, first born, and a positive family history are risk factors • Presents during 2 and 8 weeks of life as nonbilious projectile vomiting • hyponatremic, hypokalemic, hypochloremic metabolic alkalosis • Diagnosed with ultrasound

  7. intussusception • portion of the alimentary tract telescopes into another segment • Obstruction of venous return, bowel ischemia, bloody stools • 6 – 18 month old with colicky abdominal pain • Plain films or US (best) • Air contrast enema both diagnostic and therapeutic

  8. Malrotation and volvulus • constant abdominal pain, bilious vomiting, abdominal distention, and irritability • Upper GI series: Bird’s beak appearance of duodenum • Tx: surgery

  9. appendicitis • Most common surgical emergency in children • Perforation rates approach 90% in children under 4 • vague, periumbilical pain that later localizes to the right side • Nausea, anorexia, and vomiting are seen in>80% of cases • Asking a child to hop is more sensitive than psoas, obturator or rovsing sign

  10. Diagnosis and treatment • Cbc is neither sensitive or specific • US or CT • Surgery • Unasyn for unperforated • Zosyn for perforated

  11. Necrotizing Enterocolitis • Intestinal necrosis in infants, most common premature • poor feeding, lethargy, abdominal distention, and tenderness • Leads to sepsis • Plain films are diagnostic • pneumatosis intestinalis (bubbles of air within the walls of the bowel) • NPO, IV fluids, antibiotics, and surgery

  12. Other causes • Non specific abdominal pain – number one • Colic • Gastroenteritis • Cholecystitis • Pancreatitis • Group A strep pharyngitis • constipation

  13. References • Tintinalli, Ch. 124

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