Assessment most common GI complaint accurate description of pain and its characteristics vomiting before pain sug...
Assessment
- most common GI complaint
- accurate description of pain and its characteristics
- vomiting before pain suggests gastroenteritis
- vomiting after pain suggests a surgical condition
- physical examination: rebound tenderness, bowel sounds, rectal exam
- labs
- CBC and differential
- urinalysis to rule out UTI
Differential Diagnosis
- Gastroenteritis
- volvulus
- incarcerated hernia
- Henoch-Schonlein Purpura
- UTI
- sickle cell crisis
- appendicitis
- pneumonia
- ïntussusception
- DKA
- malrotation
- mesenteric adenitis
1. Appendicitis
- most common inflammatory bowel disorder from 5 years on
Clinical features
- low grade fever
- anorexia
- abdominal pain: periumbilical then ---->RLQ
- nausea, vomiting (after onset of pain)
- peritoneal signs
- generalized peritonitis is a common presentation in infants/young children
Treatment: surgical
Complications
- perforation
- abscess
- 90% idiopathic, children with CF at significantly at risk
- 50% between 3 -12 months, 75% before 2 years of age
- telescoping of segment of bowel into distal segment ----> ischemia and necrosis
- usual site: ileocecal junction
- lead point may be swollen Peyer's patches, Meckel's diverticulum, polyp, malignancy in older child
- sudden onset of recurrent, paroxysmal, severe periumbilical pain
- pain-free remissions
- later vomiting and rectal bleeding (“red currant jelly” stools)
- sausage-shaped mass often in upper to mid abdomen
- shock and dehydration
- classic triad of abdominal pain, palpable sausage-shaped mass and red currant jelly stools only in 10-15% of patients
Diagnosis and treatment
- air enema ----> see reverse "E" sign
- U/S
- reduction under hydrostatic pressure, air enema
- surgery rarely needed
