Abdominal pain (peds): Difference between revisions

Revision as of 08:49, 15 May 2011

Background

bilious emesis in a kid is a surgical emergency until proven otherwise

Visceral pain is dull & non-specific

Somatic pain is sharp & localized d/t peritoneal or diaphragm irritation

Guarding & TTP/rebound are most c/w surgical DZ in kids

Infants eat, sleep & poop, probs w/ these can be a bad sign

Epidemiology

Ten most common Dx in order:

AGE (26%)
Nonspecific AP (26%)
Viral Illness (6%)
Constipation (5%)
UTI (5%)
Pharyngitis (5%)
Appy (4%)
Asthma (2%)
OM (2%)
PNA (2%)

Also look for extra-abdominal (collagen dz, HSP, DKA, poison, IBD, CF, nephrotic syndrome)

DDx 1

Infancy
- gastroenteritis, intussusception, volvulus, incarcerated hernia, Hirschrung's dz, NEC, perforation, colic, pneumonia, pyloric stenosis
Childhood
- AGE, appy, pancreatitis, HSP, HUS, Incarcerated Hernia, constipation, UTI, pyelo, PNA, GAS phryngitis, ulcers, meckels, IBD
Adolescence
- same as before but add ectopic, PID, torsion (testicular, ovarian), IBD, biliary disease, nephrolithiasis

DDX 2

Infant

green vomit: bad sign

obstruction: volvulus, malrotation

abd pain also caused by trauma, intuss.(air enema is dx and tx), intestinal anomalies, incarcerated hernia, sickling syndromes, (acute intermittent porphyria), appy, milk allergy, wilms tumor, toxins (heavy metals), disaccharide deficiency.

2-5 years

viral, gastroenteritis, pnemonia, asthma, constipation, trauma, appy, sickling syndrome, UTI, meckel's diverticulum, HSP, nephrotic syndrome, intuss, IBD, HUS, DM, pancreatitis

order: amylase, LFT's

5-12 years

appy (CT c rectal contrast-very sens. + spec.), testicular torsion (or appendix testis torsion), functional abd pain, gastroenteritis, constipation, URI, CF, DM, torsion, renal calculi, Rheumatic fever

Adolescent

ectopic: get ßhCG, type + cross (rhogam), pelvic US--be sure well-hydrated for US for optimal imaging, PID, IBP, Rheumatic fever, abd abscess

Workup

UA, Upreg
Dehydration: electrolytes, renal fxn tests
Vomiting without diarrhea: LFTs, lipase, toxin screen
Fever: CBC, CRP
Diagnostic imaging
Role of abdominal xrays: only good if positive (ann emerg med-1992 rothrock et al)
50% of of patients with major disease had normal radiographs

Source

Gausche 11/03- By Lampe

7/2/09 PANI

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
+bilious emesis in a kid is a surgical emergency until proven otherwise
-Remember: bilious emesis in a kid is a surgical emergency until proven otherwise
 Visceral pain is dull & non-specific
@@ Line 11: / Line 10: @@
 Infants eat, sleep & poop, probs w/ these can be a bad sign
-== ==
 ==Epidemiology==
 Ten most common Dx in order:
+#AGE (26%)
+#Nonspecific AP (26%)
+#Viral Illness (6%)
+#Constipation (5%)
+#UTI (5%)
+#Pharyngitis (5%)
+#Appy (4%)
+#Asthma (2%)
+#OM (2%)
+#PNA (2%)
-AGE (26%)
+Also look for extra-abdominal (collagen dz, HSP, DKA, poison, IBD, CF, nephrotic syndrome)
-Nonspecific AP (26%)
-Viral Illness (6%)
-Constipation (5%)
-UTI (5%)
-Pharyngitis (5%)
-Appy (4%)
-Asthma (2%)
-OM (2%)
-PNA (2%)
-*Also look for extra-abdominal (collagen dz, HSP, DKA, poison, IBD, CF, nephrotic syndrome)
-== ==
 ==DDx 1==
 * Infancy
-* gastroenteritis, intussusception, volvulus, incarcerated hernia, Hirschrung's dz, NEC, perforation, colic, pneumonia, pyloric stenosis
+** gastroenteritis, intussusception, volvulus, incarcerated hernia, Hirschrung's dz, NEC, perforation, colic, pneumonia, pyloric stenosis
 * Childhood
-* AGE, appy, pancreatitis, HSP, HUS, Incarcerated Hernia, constipation, UTI, pyelo, PNA, GAS phryngitis, ulcers, meckels, IBD
+** AGE, appy, pancreatitis, HSP, HUS, Incarcerated Hernia, constipation, UTI, pyelo, PNA, GAS phryngitis, ulcers, meckels, IBD
 * Adolescence
-* same as before but add ectopic, PID, torsion (testicular, ovarian), IBD, biliary disease, nephrolithiasis
+** same as before but add ectopic, PID, torsion (testicular, ovarian), IBD, biliary disease, nephrolithiasis
-== ==
 ==DDX 2==
+===Infant===
-===Infant:===
 green vomit: bad sign
@@ Line 69: / Line 43: @@
 abd pain also caused by trauma, intuss.(air enema is dx and tx), intestinal anomalies, incarcerated hernia, sickling syndromes, (acute intermittent porphyria), appy, milk allergy, wilms tumor, toxins (heavy metals), disaccharide deficiency.
+===2-5 years===
-===2-5 years:===
 viral, gastroenteritis, pnemonia, asthma, constipation, trauma, appy, sickling syndrome, UTI, meckel's diverticulum, HSP, nephrotic syndrome, intuss, IBD, HUS, DM, pancreatitis
 order: amylase, LFT's
+===5-12 years===
-===5-12 years:===
 appy (CT c rectal contrast-very sens. + spec.), testicular torsion (or appendix testis torsion), functional abd pain, gastroenteritis, constipation, URI, CF, DM, torsion, renal calculi, Rheumatic fever
+===Adolescent===
-===Adolescent:===
 ectopic: get ßhCG, type + cross (rhogam), pelvic US--be sure well-hydrated for US for optimal imaging, PID, IBP, Rheumatic fever, abd abscess
 ==Workup==
+# UA, Upreg
+# Dehydration: electrolytes, renal fxn tests
-* UA, Upreg
+# Vomiting without diarrhea: LFTs, lipase, toxin screen
-* Dehydration: electrolytes, renal fxn tests
+# Fever: CBC, CRP
-* Vomiting without diarrhea: LFTs, lipase, toxin screen
+# Diagnostic imaging
-* Fever: CBC, CRP
+# Role of abdominal xrays: only good if positive (ann emerg med-1992 rothrock et al)
-* Diagnostic imaging
+# 50% of of patients with major disease had normal radiographs
-* Role of abdominal xrays: only good if positive (ann emerg med-1992 rothrock et al)
-* 50% of of patients with major disease had normal radiographs
 ==See Also==
 Peds:  Necrotizing Enterocolitis (NEC)
@@ Line 122: / Line 77: @@
 Peds:  Inguinal Hernia (Peds)
 ==Source==
 Gausche 11/03- By Lampe
 /2/09 PANI
 [[Category:Peds]]