Abdominal pain in children

Sausage like mass felt on abdominal exam is called what?

(Intussception) Dance sign

the following apply distinctly to children:

1. surgery should be performed within 24 hours of symptom onset, otherwise perforation is likely 2. the pain may be mild and discontinuous 3. the pain may be atypically located when the appendix is not located in the R iliac area serial examinations are useful

congenital megacolon; a condition that affects the large intestine and causes problems with passing stool; this condition is present at birth as a result of missing nerve cells in the muscles of the baby's colon

Hirschsprung's disease

_____ frequently begins in adolescence and can be a cause of acute or recurrent abd pain, especially when associated with growth failure

IBD

adolescence diarrhea growth failure diffuse abdominal tenderness often without rebound ESR elevated found on endoscopy

IBD

similar to FAP but also has change in frequency or form of stool and/or the pain is relieved by defecation abd pain/distention/bloating/gas

IBS

every child should have what tests before having surgery?

a blood glucose test and UA

test of choice to diagnose intussusception?

abdominal US, which will show "target sign" or "pseudo-kidney sign"

relieved by triptan medications

abdominal migraine

characteristically results from a combination of faulty toilet training and mental or emotional disturbances that result in a child's refusing to try to defecate; the administration of increasingly larger doses of laxatives fails to solve the problem permanently, and over time the child's rectum becomes filled with impacted feces and the colon becomes progressively enlarged; once the distended bowel has been emptied, the treatment for this disorder is primarily psychiatric and involves persuading the child to accept bowel training

acquired megacolon

red flags for chronic abd pain in children

age < 5yo nocturnal pain blood in stool change in bowel habits dysphagia arthritis family hx of IBD unexplained fever anemia persistent vomiting, esp bilious persistent diarrhea weight loss growth failure anorexia pain relieved by eating pain that prevents normal activity pain that disturbs sleep

treatment for intussusception

air contrast enema (is both diagnostic and treatment)

____ is uncommon in infants and children < 5yo, but the most common condition causing abd pain that requires surgery in this age group; because it is seldom considered, the diagnosis is often missed or delayed and a disproportionately high percentage of deaths occurs

appendicitis

coughing/percussion/hopping tenderness signs of peritonitis; fever, guarding, decreased peristalsis leukocytosis; US, CT scan child may lie still or on the left side with right thigh flexed

appendicitis

most common in children 5-15 peaks at 10-15 pain precedes anorexia and vomiting -the child has tenderness and guarding even in the absence of pain -increasing localized tenderness in the RLQ associated with rebound tenderness in RLQ is the most helpful finding favoring the diagnosis -pain begins gradually in the epigastrium or periumbilical area and progresses to constant RLQ pain -paralytic ileus may develop -atypical symptoms appear when the organ is unusually located

appendicitis

the second most common cause of acute abdominal pain in children

appendicitis

serial abdominal examinations and serial lab tests are very important when the diagnosis is unclear and the differential includes...

appendicitis and mesenteric adenitis

______ diarrhea affects the colon and manifests as lower abd pain and smaller amounts of bloody, mucoid diarrhea

bacterial

physical exam is esp important in children of what age because when they complain of abd pain it is usually organic in nature (with the exception of infantile colic)

children < 3 yo

constant, mid-epigastric, exacerbated by eating should also be considered in children with duodenal ulcers and recurrent abd pain

chronic gastritis caused by H pylori

children with congenital megacolon are prone to a serious infection called enterocolitis which can be life-threatening and requires immediate treatment

complications of Hirschsprung's disease

a firm stool may be palpated rectally studies include freq of BMs, fecal incontinence/encopresis, abd pain, stool consistency, painful defecation

constipation

peak incidence 5-12 yo recurrent, cramping RLQ pain occurring primarily after meals, esp if relieved by defecation; this diagnosis should only be accepted when an enema yields a large amount of feces and relieves pain

constipation

pain often generalized ketosis usually present polyuria, polydipsia, weight loss Kussmaul respirations, diffuse abd pain, sweet/fruity breath

diabetic ketoacidosis

in female adolescents with abdominal pain, these must all be considered

dysmenorrhea endometriosis PID ovarian cysts corpus luteal cysts Mullerian abnormalities

when vomiting preceded abd pain, an ____________ is suggested; when abdominal pain precedes vomiting, an ___________ is likely

extra-abdominal cause abdominal cause

if the pt has a hx of similar episodes and the current episode subsides in 24 hours, _________ is likely; until the diagnosis is clear, serial observations are essential; continued pain, tachycardia, anorexia, diarrhea, pain on movement, and esp rebound tenderness warn that the pain is not non-specific and that surgical intervention must be seriously considered; when the temp, blood count, ESR, UA, stool analysis for occult blood and ova and parasites are normal, _______ is most likely

functional abdominal pain

in Children 5-12 years the major dilemma involves _____, usually associated with psychological issues

functional abdominal pain

weekly episodes of abd pain occurring over 2+ months common in children > 5yo usually central, non-radiating, rarely awakens children at night recurrent: 3+ episodes of central non-radiating pain in 3 months rarely associated with with diarrhea or vomiting often assoc with vague s/s such as HA and extremity pains, poor app no systemic signs (fever, leukocytosis) or localized abd findings usually has a psychosocial cause tend to be anxious or perfectionists high incidence of behavioral or personality disorders hx of colic timing of the 1st occ. of abd pain may help identify stress as the cause

functional abdominal pain

eating worsens mid-epigastric pain caused by drugs or H. pylori infection

gastritis

diffuse cramping abd pain that follows or coincides with the onset of D/N/V pain poorly localized no localizing physical signs are found diffuse and generalized hyperperistalsis low-grade fever; viral infection aggravates/precipitates

gastroenteritis

the most common cause of acute abdominal pain in children

gastroenteritis

growth failure can also indicate ________

gluten-sensitive enteropathy (celiac disease)

can be noted when an inflamed retroceccal appendix overlies the ureter or with urolithiasis

hematuria

occasionally an enlarged kidney is detected by palpation indicating ______ as the cause of abd pain

hydronephrosis

when otherwise healthy infants cry for >3h, >3d per week, for >3mos

infantile colic

bulge in the groin or presence of an undescended testicle lower quadrant pain abdominal distention

inguinal hernia

a walnut-sized mass/lump may be found either rectally or abdominally; when ____ is ileocecal (most common), a lump may be palpated in the RUQ or epigastrium

intussusception

kidney sign on abdominal US

intussusception

rectal exam classically reveals bloody mucus on the examining finger the "currant jelly" stool of dark blood is a late sign a barium enema both diagnoses and alleviates it; abd radiographs also used to diagnose

intussusception

signs of intestinal obstruction in infants (peaks at 6mos) sudden onset of severe, crampy, spasmodic pain that causes an infant to scream and draw up his legs; the spasmodic pain often recurs at intervals of 15-30 minutes; the child may be lethargic or sleeping between attacks rushes of high-pitched peristalsis a lead point is rarely found

intussusception

_______ is particularly helpful in children with recurrent RLQ pain and premenarchal girls with undiagnosed recurrent abd pain

laparoscopy

paroxysms of diffuse, crampy, abd pain alternating with constipation mild anemia hx of pica possible

lead poisoning

WBC usually not elevated temp may be high may follow viral gastroenteritis diffuse crampy abd pain with N/V/D gradually changes to constant RLQ pain; lymphocytosis child is not necessarily anorexic pain may be colicky in younger children, severe in older children child has tenderness and guarding ONLY when the pain is present preceding URI (pharyngitis, tonsillitis, otitis media)

mesenteric adenitis

diagnostic Rome criteria for functional abdominal pain

most be fulfilled for at least 2 months before diagnosis, must be met at least 4 times per month, and include all of the following: 1. episodic or continuous abd pain that does not occur solely during physiological events such as eating and menses 2. insufficient criteria for other functional GI disorders inc. IBS, functional dyspepsia, or abd migraine

- palpation of fecal material in the colon and tenderness over the course of the colon suggests _______

obstipation

a severe form of constipation where a person cannot pass stool or gas

obstipation

rushes of high-pitched peristalsis assoc with crampy pain

obstructive process

pain relieved by eating or antacids

peptic disease

shallow breathing absence of peristalsis low-grade fever with a disproportionate rise in pulse leukocytosis (but it may be absent in the first 24 hours)

peritonitis

most common in children age 1-4 another frequent cause of abdominal pain

poisoning

abd pain associated with tenderness on percussion in the CVA

pyelonephritis

it is critical to perform a ________ because pain in the RUQ may be due to a retroceccal appendix; this child may also limp and demonstrate a positive psoas and obturator sign

rectal exam

having a sibling with the disease being male having Down's syndrome, congenital heart disease, or other abnormalities present at birth

risk factors for Hirschsprung's disease

failure to have a bowel movement within 48 hours after birth swollen belly vomiting; may vomit a green or brown substance constipation or gas, might make a newborn fussy diarrhea failure to thrive fatigue

s/s of Hirschsprung's disease

severe abd pain associated with ileus

sickle cell crisis

recurrent episodes of severe abd pain suggest these disorders

sickle cell disease IBD cystic fibrosis constipation

treatment for congenital megacolon

surgery to bypass or remove the diseased part of the colon

when significant diarrhea is associated with abd pain a ____ is rare, but when abd distention is assoc with acidosis a ______ is more likely

surgical lesion surgical emergency

every black patient should have.....

their sickle cell status confirmed

true or false when chronic or recurrent abd pain is the chief complaint, no additional symptoms suggest organic disease, and a thorough H&P is negative, only simple diagnostic tests should be performed because complex and invasive studies rarely influence the outcome

true

severe, colicky pain radiates to groin or flank hematuria

urolithiasis

______ diarrhea of the small bowel often manifests as midabdominal cramping, pain, and large amounts of watery diarrhea

viral