Pediatric Abdominal Pain (Surgical) - Dr. Reynolds

Intussusception:

• most common ileocolic
• Plain Films:
  

    -Crescent sign on plain film

    -Paucity of gas due to loss of gas in ascending colon

• Presentation

    -Classic triad colic abd pain, vomiting, currant jelly stool only in <25% cases.  

    -Age rage 5 mo - 3 yr but typically <1 yr

• U/S or air enema??

    -Longer duration of symptoms (>24 hrs), convincing radiograph: Lean toward enema first

    -Ideal U/S patient:  sens 98-100%, spec 88-100%

          -Must prep patient well for US with good pain control and anxiolysis

Bowel obstruction:

• Decompress bowel
  
• Treat nausea
• Hydrate
• Control pain
  
• Consult Surgery +/- CT Abd.

Appy:
2007 JAMA RCE - Does my patient have appendicitis

• MIMICS: Mesenteric adenitis, incarcerated hernia, ovarian cyst, ovarian torsion, ectopic, UTI, PID/TOA
• Rare in infants and toddlers  (<2yr) because appy wide open in infancy
• Clinical exam not sufficient to make diagnosis.  Of signs and sx, Fever highest LR with 3.4
  

• Alvarado score - Migration of pain, anorexia, N/V, RLQ tend (2 points), rebound pain, fever, WBC >10K, L shift. However unacceptable miss rate.
  

• CRP? If elevated >3, increased likelihood but poorly sensitive.

• U/S: Sens approaches 100%, need to be properly prepped with pain control/anxiolysis.  

• CT - Cross-sectional appy diameter >6mm

Chronic Abd Pain:

• Alarm symptoms: Involuntary weight loss, decreased linear growth, GI blood loss, significant vomiting, severe diarrhea, ongoing low grade fever, persistent RLQ or RUQ pain, family hx of IBD, hx trauma

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