Intussusception power point (3)

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Intussusception power point (3)

  1. 1.  9 month old white male T: 99.4 P 110 RR 30 BP: 90/60 presents with his Gen: normal appearing . NAD HEENT: PERRL, NCAT, mother. She states that oropharynx clear he was playing earlier CV: RRR, no m/r/g today when suddenly he Pulm: CTAB began screaming in Abdomen: sausage-shaped mass pain, followed by an in RUQ, NT, ND episode of calmness. Ext: 2+ pulses, No c/c/e This has recurred multiple times over the past few hours.
  2. 2. 1- Crescent Sign: intussusception lead point into gas filled lumen2- Target Sign: Mass in RUQ forms shape of target, sometimes just appears as a mass.3- Absent RUQ bowel gas4- Signs of small bowel obstruction
  3. 3.  IV & IV fluids If H&P convincing for Intussusception:  Air Contrast Enema  Notify Surgery prior to study due to risk of perforation  This can be both diagnostic and curative If H&P is not convincing but still in differential  Ultrasound 1st then Air contrast enema if indicated  This is done as a less invasive method to look for intussusception and other causes of abdominal pain. Admit to hospital  Recurrence rate of intussusception is 5-10%
  4. 4.  Most common intestinal obstruction between 3 months and 6 years of age “Currant Jelly Stool” is a late manifestation that is only present in 50% of cases ; (75% have heme-positive stool)  Should raise concern for intussusception if present but should have no bearing on decision if absent. Air contrast enema is both diagnostic and curative  Air is preferred over contrast b/c if perforation occurs no barium introduced into peritoneum
  5. 5.  In Left image, Note the outline of bowel telescoping proximally.
  6. 6.  King, Lonnie. Pediatrics, Intussusception. http://emedicine.medscape.com/article/802424- overview Tintanelli’s Emergency Medicine: A Comprehensive Study Guide. Chapter Chapter 127 Pediatric Abdominal Emergencies Wahba, Mark. The Pediatric Abdomen: Intussusception. www.remergs.com. Oct 9, 2003 http://www.nlm.nih.gov/medlineplus/ency/imagepag es/1172.htm

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