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ACUTE ABDOMINAL PAIN

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Assessment

  1. most common GI complaint
  2. accurate description of pain and its characteristics
  3. vomiting before pain suggests gastroenteritis
  4. vomiting after pain suggests a surgical condition
  5. physical examination: rebound tenderness, bowel sounds, rectal exam
  6. labs
    • CBC and differential
    • urinalysis to rule out UTI




    Differential Diagnosis
    1. Gastroenteritis             
    2. volvulus
    3. incarcerated hernia     
    4. Henoch-Schonlein Purpura
    5. UTI                    
    6. sickle cell crisis
    7. appendicitis               
    8. pneumonia
    9. ïntussusception           
    10. DKA
    11. malrotation 
    12. mesenteric adenitis

    1. Appendicitis

    • most common inflammatory bowel disorder from 5 years on

    Clinical features
    1. low grade fever
    2. anorexia
    3. abdominal pain: periumbilical then ---->RLQ
    4. nausea, vomiting (after onset of pain)
    5. peritoneal signs
    6. generalized peritonitis is a common presentation in infants/young children

    Treatment: surgical

    Complications
    • perforation
    • abscess
    2. Intussusception 

    1. 90% idiopathic, children with CF at significantly at risk
    2. 50% between 3 -12 months, 75% before 2 years of age
    3. telescoping of segment of bowel into distal segment ----> ischemia and necrosis
    4. usual site: ileocecal junction 
    5. lead point may be swollen Peyer's patches, Meckel's diverticulum, polyp, malignancy in older child
    Clinical features
    1. sudden onset of recurrent, paroxysmal, severe periumbilical pain
    2. pain-free remissions
    3. later vomiting and rectal bleeding (“red currant jelly” stools)
    4. sausage-shaped mass often in upper to mid abdomen
    5. shock and dehydration
    6. classic triad of abdominal pain, palpable sausage-shaped mass and red currant jelly stools only in 10-15% of patients

    Diagnosis and treatment
    1. air enema ----> see reverse "E" sign
    2. U/S
    3. reduction under hydrostatic pressure, air enema
    4. surgery rarely needed
    ACUTE ABDOMINAL PAIN ACUTE ABDOMINAL PAIN Reviewed by Radiology Madeeasy on August 27, 2010 Rating: 5
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