This document provides information about abdominal pain in children from the perspective of a pediatric resident. It outlines the resident's objectives of understanding causes of abdominal pain, developing a differential diagnosis, and formulating evaluation and management plans. Key challenges are that children have limited ability to communicate symptoms and parents may misinterpret complaints. The document further details types of abdominal pain, mechanisms of pain, approaches to diagnosis including history, exam findings, and testing. Differential diagnoses are provided for acute abdominal pain with distinctions between various potential causes.
For info log on to www.healthlibrary.com. Abdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar
Abdominal Pain in children occurs commonly. Sometimes it is nothing to do worry about but sometimes it can be life threatening. To identify and treat early is necessary in all children.
Acute abdomen in children
1/Why acute abdomen in children want to present ??!!!
2/Areal case discussion in dibba hospital .
3/Evaluation of acute abdominal pain clinically .
4/Intussusception
5/Cases .
6/Something missed in my topic . ?????
This document discusses abdominal pain in children, describing different types of abdominal pain including acute and chronic pain. It covers topics such as visceral pain resulting from internal organ injury, somatic pain from injury to external abdominal structures, and referred pain which occurs in distant areas from the source of pain. Specific conditions that can cause abdominal pain are also discussed such as appendicitis, intestinal obstruction, inflammatory bowel disease, lactose intolerance, and more. Key distinguishing features of different diseases are outlined to help evaluate the potential causes of a child's abdominal pain.
The document provides guidance on evaluating pediatric abdominal pain. It discusses taking a thorough history, including details of the pain and associated symptoms, as well as performing a physical exam. The history should explore timing, location, quality of pain, relieving/aggravating factors, bowel habits, past medical history, and more. The physical exam involves inspection, palpation, percussion, and auscultation of the abdomen as well as a digital rectal exam. Key points are determining if the pain is acute or chronic, whether the abdomen indicates something acute/surgical or benign, and looking for any red flag signs.
This document discusses the diagnosis and management of abdominal pain in pediatric patients through a series of case studies and discussions. It begins with an introduction on abdominal pain in children and objectives. It then presents 5 case studies of children presenting with abdominal pain and asks the reader to make a diagnosis. Following this, it discusses the causes, history, examination, investigations and management of abdominal pain in children at different ages. It provides details on recognizing red flag signs, systemic causes, and approaching the diagnosis of acute abdominal pain.
This document discusses the approach to evaluating abdominal pain in children. It outlines several potential causes of acute abdominal pain including appendicitis, intussusception, Henoch-Schönlein purpura, hepatitis, and infant colic. It also discusses recurrent or chronic causes such as Meckel's diverticulum, urolithiasis, testicular torsion, functional dyspepsia, and irritable bowel syndrome. The evaluation of abdominal pain involves considering the child's age, symptoms, physical exam findings, and potentially laboratory or imaging studies to identify serious conditions and determine the appropriate treatment.
This document provides information on acute abdominal pain in children, including:
1. It classifies abdominal pain by age group and lists common emergent and nonemergent causes for different age ranges from newborns to adolescents.
2. It describes important considerations for evaluating abdominal pain in children such as history, physical exam including genital exam, imaging options, and pain management.
3. It provides more detailed information on evaluating and managing some specific conditions that can cause abdominal pain in children like intussusception, appendicitis, constipation, and nonspecific viral syndromes.
This document discusses abdominal pain in pediatric patients. It separates causes into acute vs chronic and organic vs functional. Common acute organic causes include malrotation, intussusception, appendicitis, mesenteric lymphadenitis, and obstructive lesions. Chronic organic causes include IBD, hepatitis, pancreatitis, and urolithiasis. Functional abdominal pain is more common in older children and lacks clear pathology. A thorough history, examination, and testing is needed to identify potential organic causes of abdominal pain in pediatric patients.
For info log on to www.healthlibrary.com. Abdominal Pain in Children By Prof. Dr. Sushmita Bhatnagar
Abdominal Pain in children occurs commonly. Sometimes it is nothing to do worry about but sometimes it can be life threatening. To identify and treat early is necessary in all children.
Acute abdomen in children
1/Why acute abdomen in children want to present ??!!!
2/Areal case discussion in dibba hospital .
3/Evaluation of acute abdominal pain clinically .
4/Intussusception
5/Cases .
6/Something missed in my topic . ?????
This document discusses abdominal pain in children, describing different types of abdominal pain including acute and chronic pain. It covers topics such as visceral pain resulting from internal organ injury, somatic pain from injury to external abdominal structures, and referred pain which occurs in distant areas from the source of pain. Specific conditions that can cause abdominal pain are also discussed such as appendicitis, intestinal obstruction, inflammatory bowel disease, lactose intolerance, and more. Key distinguishing features of different diseases are outlined to help evaluate the potential causes of a child's abdominal pain.
The document provides guidance on evaluating pediatric abdominal pain. It discusses taking a thorough history, including details of the pain and associated symptoms, as well as performing a physical exam. The history should explore timing, location, quality of pain, relieving/aggravating factors, bowel habits, past medical history, and more. The physical exam involves inspection, palpation, percussion, and auscultation of the abdomen as well as a digital rectal exam. Key points are determining if the pain is acute or chronic, whether the abdomen indicates something acute/surgical or benign, and looking for any red flag signs.
This document discusses the diagnosis and management of abdominal pain in pediatric patients through a series of case studies and discussions. It begins with an introduction on abdominal pain in children and objectives. It then presents 5 case studies of children presenting with abdominal pain and asks the reader to make a diagnosis. Following this, it discusses the causes, history, examination, investigations and management of abdominal pain in children at different ages. It provides details on recognizing red flag signs, systemic causes, and approaching the diagnosis of acute abdominal pain.
This document discusses the approach to evaluating abdominal pain in children. It outlines several potential causes of acute abdominal pain including appendicitis, intussusception, Henoch-Schönlein purpura, hepatitis, and infant colic. It also discusses recurrent or chronic causes such as Meckel's diverticulum, urolithiasis, testicular torsion, functional dyspepsia, and irritable bowel syndrome. The evaluation of abdominal pain involves considering the child's age, symptoms, physical exam findings, and potentially laboratory or imaging studies to identify serious conditions and determine the appropriate treatment.
This document provides information on acute abdominal pain in children, including:
1. It classifies abdominal pain by age group and lists common emergent and nonemergent causes for different age ranges from newborns to adolescents.
2. It describes important considerations for evaluating abdominal pain in children such as history, physical exam including genital exam, imaging options, and pain management.
3. It provides more detailed information on evaluating and managing some specific conditions that can cause abdominal pain in children like intussusception, appendicitis, constipation, and nonspecific viral syndromes.
This document discusses abdominal pain in pediatric patients. It separates causes into acute vs chronic and organic vs functional. Common acute organic causes include malrotation, intussusception, appendicitis, mesenteric lymphadenitis, and obstructive lesions. Chronic organic causes include IBD, hepatitis, pancreatitis, and urolithiasis. Functional abdominal pain is more common in older children and lacks clear pathology. A thorough history, examination, and testing is needed to identify potential organic causes of abdominal pain in pediatric patients.
This panel session discusses various causes and management of recurrent abdominal pain (RAP) in children. Common causes include functional causes (70-75%), psychogenic causes (12-15%), and organic causes (10-15%). The document provides guidance on evaluating a child with constipation, discussing the importance of obtaining a thorough history. It also reviews common and rare organic causes of abdominal pain in children and discusses approaches to investigating and managing a child with suspected functional abdominal pain.
This document discusses acute abdominal pain in children, covering several topics:
- The pathophysiology of abdominal pain, which can be visceral, parietal, or referred pain.
- The most common causes of acute abdominal pain in children, including gastroenteritis, appendicitis, constipation, and others.
- Factors like age and sex that influence the differential diagnosis. Appendicitis is more common in older children and adolescents, while gastroenteritis is more common in younger children.
This document provides an overview of common causes of abdominal pain in infants and children. It discusses physiological and pathological causes of crying in infants and outlines common and rare etiologies of acute and chronic abdominal pain in both infants and older children. Specific conditions like infantile colic, constipation, functional abdominal pain syndrome, acute mesenteric adenitis, gastritis, giardiasis and acute pancreatitis are described in terms of their clinical features and management. The document promotes the 6th edition of the Textbook of Paediatrics published in Pakistan as a comprehensive resource on pediatric diseases and child health.
Abdominal pain is a common complaint in pediatrics and can be caused by benign or life-threatening issues. A thorough history and physical exam is important to identify concerning red flags and determine if the pain is acute surgical, visceral, referred, or chronic/recurrent in nature. Based on the location and characteristics of the pain, appropriate lab tests, imaging, and procedures should be considered to arrive at an accurate diagnosis and guide management. Common etiologies include appendicitis, gastroenteritis, constipation, and functional abdominal pain.
acute abdominal pain in pediatrics. include background and approach also there are three cases included, intussusception, Hirschsprung's disease and DKA.
This document discusses the approach to recurrent abdominal pain in children. It defines acute, subacute, and chronic abdominal pain and discusses recurrent abdominal pain. The most common causes of abdominal pain seen in emergency departments are also summarized. A full history and physical exam are important for evaluating abdominal pain, and diagnostic testing should be guided by symptoms and exam findings. Home care and lifestyle advice are usually sufficient for recurrent abdominal pain in children without concerning alarm symptoms.
This document provides guidance on examining pediatric patients in the emergency department. It emphasizes taking a thorough history from parents and children, performing physical exams at the child's level, using distraction techniques, and focusing on vital signs and observation. Common pediatric surgical and non-surgical abdominal conditions are discussed, along with their presentations and appropriate diagnostic approaches. Rectal exams and laboratory tests are noted to have limited diagnostic value for many conditions. The importance of thorough evaluation and follow-up prior to discharge is also stressed.
This document provides definitions and diagnostic guidelines for recurrent abdominal pain (RAP) in children. It defines RAP as paroxysmal abdominal pain occurring between ages 4-16 years, affecting activities for at least 3 months. New definitions classify it as chronic abdominal pain without evidence of organic disease. RAP is a description, not a diagnosis, and can include various functional gastrointestinal disorders. Prevalence is reported as 10-15% of children. A thorough history and physical exam are important to identify alarm signals requiring further testing and to diagnose functional abdominal pain when organic causes are ruled out. Treatment involves reassurance, diet modification, pharmacotherapy like anticholinergics or TCAs, and psychological therapies like CBT.
This document discusses various types of abdominal pain in children, including acute organic pain, chronic organic pain, and functional or inorganic pain such as recurrent abdominal pain. It notes that a large percentage of abdominal pains in children are functional in nature, with no identifiable organic cause. The document advises that for cases of suspected functional pain, a thorough history, physical examination, and follow-up are sufficient and investigations like ultrasound or endoscopy are generally not needed if no alarm symptoms are present. The case discussed involved a child with recurrent epigastric pain and tenderness who was found to have irritable bowel syndrome from a poor diet, which resolved with diet modification and medication.
Neonatal necrotizing enterocolitis
NEC is the most common life-threatening emergency of the gastrointestinal tract in the newborn period. The disease is characterized by various degrees of mucosal or transmural necrosis of the intestine. The cause of NEC remains unclear but is most likely multifactorial. The incidence of NEC is 1-5% of infants in neonatal intensive care units (NICUs). Both incidence and case fatality rates increase with decreasing birthweight and gestational age. Because very small, ill preterm infants are particularly susceptible to NEC, a rising incidence may reflect improved survival of this high-risk group of patients.
Clinical Manifestations
Infants with NEC have a variety of signs and symptoms and may have an insidious or sudden catastrophic onset (Table 96-1). The onset of NEC is usually in the 2nd or 3rd week of life but can be as late as 3 mo in VLBW infants. Age of onset is inversely related to gestational age. The 1st signs of impending disease may be nonspecific, including lethargy and temperature instability, or related to gastrointestinal pathology, such as abdominal distention and gastric retention. Obvious bloody stools are seen in 25% of patients. Because of nonspecific signs, sepsis may be suspected before NEC. The spectrum of illness is broad, ranging from mild disease with only guaiac-positive stools to severe illness with bowel perforation, peritonitis, systemic inflammatory response syndrome, shock, and death. Progression may be rapid, but it is unusual for the disease to progress from mild to severe after 72 hr.
Diagnosis
A very high index of suspicion in treating preterm at-risk infants is crucial. Plain abdominal radiographs are essential to make a diagnosis of NEC. The finding of pneumatosis intestinalis (air in the bowel wall) confirms the clinical suspicion of NEC and is diagnostic; 50-75% of patients have pneumatosis when treatment is started (Fig. 96-4). Portal venous gas is a sign of severe disease, and pneumoperitoneum indicates a perforation (Figs. 96-4 and 96-5). Hepatic ultrasonography may detect portal venous gas despite normal abdominal roentgenograms .
GEMC - Gastrointestinal Bleeding in the Pediatric PatientOpen.Michigan
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document summarizes key information about inflammatory bowel disease (IBD) in children, including:
1) IBD comprises ulcerative colitis and Crohn's disease, which have distinct but overlapping characteristics. The peak incidence is in adolescents and young adults between 15-30 years of age.
2) Diagnosis involves clinical suspicion based on symptoms, exclusion of other illnesses, differentiation of UC vs Crohn's based on endoscopy and imaging, and identification of extraintestinal manifestations. Laboratory tests like fecal calprotectin can help distinguish IBD from non-inflammatory diarrhea.
3) Treatment depends on disease severity and location, ranging from 5-ASA for mild disease to immunosuppressants, bi
This document provides an overview of the clinical approach and differential diagnosis of acute abdominal pain. It discusses the three types of abdominal pain and lists important factors to consider during evaluation such as associated symptoms. Common and uncommon potential causes of abdominal pain are outlined. For selected differential diagnoses, examples of relevant history, physical exam findings, working diagnoses, and recommended investigations are provided. The goal is to guide clinicians in appropriately evaluating and diagnosing the source of a patient's acute abdominal pain.
Delayed passage of meconium can be caused by several intestinal obstructions and diseases. It is suspected in full-term infants who do not pass meconium in the first 24 hours and in premature infants who delay passage for over a week. Diagnostic workup includes abdominal x-rays, ultrasound, and contrast studies to locate the obstruction. Management requires gastric decompression, fluid resuscitation to address dehydration, and monitoring of electrolytes and glucose levels which may become imbalanced. The cause is determined based on the presentation and imaging findings, and treatment involves surgery for structural issues or supportive care for medical conditions.
Gastrointestinal causes are the most common causes of abdominal pain not requiring surgery, such as gastroenteritis. Appendicitis is the most common cause of abdominal pain requiring surgery in patients under age 60. In older patients over age 60, biliary diseases and intestinal obstructions are more common surgical causes of abdominal pain. The location, characteristics, and progression of abdominal pain can provide clues to diagnose the underlying cause and determine appropriate treatment. A thorough history, physical exam, and testing are important for correctly diagnosing acute abdominal pain.
1) Acute abdominal pain in children is commonly caused by non-specific abdominal pain, acute appendicitis, constipation, or urinary tract infections. Other potential causes include intestinal obstruction, gastroenteritis, or tropical diseases.
2) Acute appendicitis presents with anorexia, vomiting, central abdominal pain shifting to the right lower quadrant, fever, localized tenderness, and guarding. Ultrasound can show a thickened, edematous appendix. Treatment is resuscitation, antibiotics, and appendicectomy.
3) Intussusception is when one portion of the gut invaginates into an adjacent segment, most commonly the ileum into the colon. It typically affects
This document discusses abdominal pain in pediatrics. It begins by defining pain and nociception, and noting key differences in infant and adult nociception. It then covers the types, causes, pathophysiology, and differential diagnosis of abdominal pain. Specific gastrointestinal, genitourinary, metabolic, and other causes are examined. Functional abdominal pain is discussed. Indications for surgical consultation and approaches to specific conditions like intussusception are outlined. Non-surgical causes and management strategies are also summarized.
This document provides an overview of pediatric gastroesophageal reflux disease (GERD). It discusses the physiology of gastric acid secretion and the regulation of acid production. It defines GER and GERD and notes that GER is common in infants while GERD occurs when reflux causes symptoms. Common symptoms of pediatric GERD are then outlined. The document reviews diagnostic approaches and the relationship between GERD and asthma. It provides guidelines on the medical management of GERD in children, including lifestyle modifications and drug treatments like H2 receptor antagonists. It concludes by discussing signs that suggest a non-GER cause of vomiting and signs of complicated GERD.
1. Choledochal cysts are abnormal dilations of the bile ducts that are more common in Asia and women.
2. They are classified into 5 types based on location and extent of dilation.
3. Presentation varies from jaundice and abdominal mass in children to pain and cholangitis in older patients.
4. Investigation involves ultrasound, CT, MRCP and cholangiography to determine type and rule out complications.
5. Treatment is complete excision of the cysts and biliary tree with Roux-en-Y hepaticojejunostomy, except for type III which can be managed endoscopically.
Describes the concept of a surgical abdomen, acute abdominal pain, emergency intervention and approach to management, including the controversial use of analgesic and antibiotics in emergency room.
This panel session discusses various causes and management of recurrent abdominal pain (RAP) in children. Common causes include functional causes (70-75%), psychogenic causes (12-15%), and organic causes (10-15%). The document provides guidance on evaluating a child with constipation, discussing the importance of obtaining a thorough history. It also reviews common and rare organic causes of abdominal pain in children and discusses approaches to investigating and managing a child with suspected functional abdominal pain.
This document discusses acute abdominal pain in children, covering several topics:
- The pathophysiology of abdominal pain, which can be visceral, parietal, or referred pain.
- The most common causes of acute abdominal pain in children, including gastroenteritis, appendicitis, constipation, and others.
- Factors like age and sex that influence the differential diagnosis. Appendicitis is more common in older children and adolescents, while gastroenteritis is more common in younger children.
This document provides an overview of common causes of abdominal pain in infants and children. It discusses physiological and pathological causes of crying in infants and outlines common and rare etiologies of acute and chronic abdominal pain in both infants and older children. Specific conditions like infantile colic, constipation, functional abdominal pain syndrome, acute mesenteric adenitis, gastritis, giardiasis and acute pancreatitis are described in terms of their clinical features and management. The document promotes the 6th edition of the Textbook of Paediatrics published in Pakistan as a comprehensive resource on pediatric diseases and child health.
Abdominal pain is a common complaint in pediatrics and can be caused by benign or life-threatening issues. A thorough history and physical exam is important to identify concerning red flags and determine if the pain is acute surgical, visceral, referred, or chronic/recurrent in nature. Based on the location and characteristics of the pain, appropriate lab tests, imaging, and procedures should be considered to arrive at an accurate diagnosis and guide management. Common etiologies include appendicitis, gastroenteritis, constipation, and functional abdominal pain.
acute abdominal pain in pediatrics. include background and approach also there are three cases included, intussusception, Hirschsprung's disease and DKA.
This document discusses the approach to recurrent abdominal pain in children. It defines acute, subacute, and chronic abdominal pain and discusses recurrent abdominal pain. The most common causes of abdominal pain seen in emergency departments are also summarized. A full history and physical exam are important for evaluating abdominal pain, and diagnostic testing should be guided by symptoms and exam findings. Home care and lifestyle advice are usually sufficient for recurrent abdominal pain in children without concerning alarm symptoms.
This document provides guidance on examining pediatric patients in the emergency department. It emphasizes taking a thorough history from parents and children, performing physical exams at the child's level, using distraction techniques, and focusing on vital signs and observation. Common pediatric surgical and non-surgical abdominal conditions are discussed, along with their presentations and appropriate diagnostic approaches. Rectal exams and laboratory tests are noted to have limited diagnostic value for many conditions. The importance of thorough evaluation and follow-up prior to discharge is also stressed.
This document provides definitions and diagnostic guidelines for recurrent abdominal pain (RAP) in children. It defines RAP as paroxysmal abdominal pain occurring between ages 4-16 years, affecting activities for at least 3 months. New definitions classify it as chronic abdominal pain without evidence of organic disease. RAP is a description, not a diagnosis, and can include various functional gastrointestinal disorders. Prevalence is reported as 10-15% of children. A thorough history and physical exam are important to identify alarm signals requiring further testing and to diagnose functional abdominal pain when organic causes are ruled out. Treatment involves reassurance, diet modification, pharmacotherapy like anticholinergics or TCAs, and psychological therapies like CBT.
This document discusses various types of abdominal pain in children, including acute organic pain, chronic organic pain, and functional or inorganic pain such as recurrent abdominal pain. It notes that a large percentage of abdominal pains in children are functional in nature, with no identifiable organic cause. The document advises that for cases of suspected functional pain, a thorough history, physical examination, and follow-up are sufficient and investigations like ultrasound or endoscopy are generally not needed if no alarm symptoms are present. The case discussed involved a child with recurrent epigastric pain and tenderness who was found to have irritable bowel syndrome from a poor diet, which resolved with diet modification and medication.
Neonatal necrotizing enterocolitis
NEC is the most common life-threatening emergency of the gastrointestinal tract in the newborn period. The disease is characterized by various degrees of mucosal or transmural necrosis of the intestine. The cause of NEC remains unclear but is most likely multifactorial. The incidence of NEC is 1-5% of infants in neonatal intensive care units (NICUs). Both incidence and case fatality rates increase with decreasing birthweight and gestational age. Because very small, ill preterm infants are particularly susceptible to NEC, a rising incidence may reflect improved survival of this high-risk group of patients.
Clinical Manifestations
Infants with NEC have a variety of signs and symptoms and may have an insidious or sudden catastrophic onset (Table 96-1). The onset of NEC is usually in the 2nd or 3rd week of life but can be as late as 3 mo in VLBW infants. Age of onset is inversely related to gestational age. The 1st signs of impending disease may be nonspecific, including lethargy and temperature instability, or related to gastrointestinal pathology, such as abdominal distention and gastric retention. Obvious bloody stools are seen in 25% of patients. Because of nonspecific signs, sepsis may be suspected before NEC. The spectrum of illness is broad, ranging from mild disease with only guaiac-positive stools to severe illness with bowel perforation, peritonitis, systemic inflammatory response syndrome, shock, and death. Progression may be rapid, but it is unusual for the disease to progress from mild to severe after 72 hr.
Diagnosis
A very high index of suspicion in treating preterm at-risk infants is crucial. Plain abdominal radiographs are essential to make a diagnosis of NEC. The finding of pneumatosis intestinalis (air in the bowel wall) confirms the clinical suspicion of NEC and is diagnostic; 50-75% of patients have pneumatosis when treatment is started (Fig. 96-4). Portal venous gas is a sign of severe disease, and pneumoperitoneum indicates a perforation (Figs. 96-4 and 96-5). Hepatic ultrasonography may detect portal venous gas despite normal abdominal roentgenograms .
GEMC - Gastrointestinal Bleeding in the Pediatric PatientOpen.Michigan
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document summarizes key information about inflammatory bowel disease (IBD) in children, including:
1) IBD comprises ulcerative colitis and Crohn's disease, which have distinct but overlapping characteristics. The peak incidence is in adolescents and young adults between 15-30 years of age.
2) Diagnosis involves clinical suspicion based on symptoms, exclusion of other illnesses, differentiation of UC vs Crohn's based on endoscopy and imaging, and identification of extraintestinal manifestations. Laboratory tests like fecal calprotectin can help distinguish IBD from non-inflammatory diarrhea.
3) Treatment depends on disease severity and location, ranging from 5-ASA for mild disease to immunosuppressants, bi
This document provides an overview of the clinical approach and differential diagnosis of acute abdominal pain. It discusses the three types of abdominal pain and lists important factors to consider during evaluation such as associated symptoms. Common and uncommon potential causes of abdominal pain are outlined. For selected differential diagnoses, examples of relevant history, physical exam findings, working diagnoses, and recommended investigations are provided. The goal is to guide clinicians in appropriately evaluating and diagnosing the source of a patient's acute abdominal pain.
Delayed passage of meconium can be caused by several intestinal obstructions and diseases. It is suspected in full-term infants who do not pass meconium in the first 24 hours and in premature infants who delay passage for over a week. Diagnostic workup includes abdominal x-rays, ultrasound, and contrast studies to locate the obstruction. Management requires gastric decompression, fluid resuscitation to address dehydration, and monitoring of electrolytes and glucose levels which may become imbalanced. The cause is determined based on the presentation and imaging findings, and treatment involves surgery for structural issues or supportive care for medical conditions.
Gastrointestinal causes are the most common causes of abdominal pain not requiring surgery, such as gastroenteritis. Appendicitis is the most common cause of abdominal pain requiring surgery in patients under age 60. In older patients over age 60, biliary diseases and intestinal obstructions are more common surgical causes of abdominal pain. The location, characteristics, and progression of abdominal pain can provide clues to diagnose the underlying cause and determine appropriate treatment. A thorough history, physical exam, and testing are important for correctly diagnosing acute abdominal pain.
1) Acute abdominal pain in children is commonly caused by non-specific abdominal pain, acute appendicitis, constipation, or urinary tract infections. Other potential causes include intestinal obstruction, gastroenteritis, or tropical diseases.
2) Acute appendicitis presents with anorexia, vomiting, central abdominal pain shifting to the right lower quadrant, fever, localized tenderness, and guarding. Ultrasound can show a thickened, edematous appendix. Treatment is resuscitation, antibiotics, and appendicectomy.
3) Intussusception is when one portion of the gut invaginates into an adjacent segment, most commonly the ileum into the colon. It typically affects
This document discusses abdominal pain in pediatrics. It begins by defining pain and nociception, and noting key differences in infant and adult nociception. It then covers the types, causes, pathophysiology, and differential diagnosis of abdominal pain. Specific gastrointestinal, genitourinary, metabolic, and other causes are examined. Functional abdominal pain is discussed. Indications for surgical consultation and approaches to specific conditions like intussusception are outlined. Non-surgical causes and management strategies are also summarized.
This document provides an overview of pediatric gastroesophageal reflux disease (GERD). It discusses the physiology of gastric acid secretion and the regulation of acid production. It defines GER and GERD and notes that GER is common in infants while GERD occurs when reflux causes symptoms. Common symptoms of pediatric GERD are then outlined. The document reviews diagnostic approaches and the relationship between GERD and asthma. It provides guidelines on the medical management of GERD in children, including lifestyle modifications and drug treatments like H2 receptor antagonists. It concludes by discussing signs that suggest a non-GER cause of vomiting and signs of complicated GERD.
1. Choledochal cysts are abnormal dilations of the bile ducts that are more common in Asia and women.
2. They are classified into 5 types based on location and extent of dilation.
3. Presentation varies from jaundice and abdominal mass in children to pain and cholangitis in older patients.
4. Investigation involves ultrasound, CT, MRCP and cholangiography to determine type and rule out complications.
5. Treatment is complete excision of the cysts and biliary tree with Roux-en-Y hepaticojejunostomy, except for type III which can be managed endoscopically.
Describes the concept of a surgical abdomen, acute abdominal pain, emergency intervention and approach to management, including the controversial use of analgesic and antibiotics in emergency room.
C H A P T E R 3
Abdominal pain
Abdominal pain is a subjective feeling of discomfort in the abdomen that can be caused by a variety of
problems. The goal of initial clinical assessment is to distinguish acute lifethreatening conditions from
chronic/recurrent or acute mild, selflimiting conditions. Assessment is complicated by the dynamic rather than
static nature of acute abdominal pain, which can produce a changing clinical picture, often over a short period
of time. In addition, both children and older adults tend to deviate from the usual and anticipated clinical
pattern of abdominal pain. The following three processes can produce abdominal pain: (1) tension in the
gastrointestinal (GI) tract wall from muscle contraction or distention, (2) ischemia, and (3) inflammation of the
peritoneum. Pain can also be referred from within or outside the abdomen.
Colic is a type of tension pain. It is associated with forceful peristaltic contractions and is the most
characteristic type of pain arising from the viscera. Colicky pain can be produced by an irritant substance, from
infection with a virus or bacteria, or by the body’s attempt to force its luminal contents through an obstruction.
Another type of tension pain is caused by acute stretching of the capsule of an organ, such as the liver, spleen,
or kidney. The patient with this visceral pain is restless, moves about, and has difficulty getting comfortable.
Ischemia produces an intense, continuous pain. The most common cause of intestinal ischemic pain is
strangulation of the bowel from obstruction.
Inflammation of the peritoneum usually begins at the serosa covering the affected and inflamed organ,
causing visceral peritonitis. The pain is a poorly localized aching. As the inflammatory process spreads to the
adjacent parietal peritoneum, it produces localized parietal peritonitis. The pain of parietal peritonitis is more
severe and is perceived in the area of the abdomen corresponding to the inflammation. A patient with parietal
pain usually lies still and does not want to move.
Pain can be referred from within the abdomen or from other parts of the body (Box 3.1).
Box 3.1
S o m e C a u s e s o f P a i n P e r c e i v e d i n A n a t o m i c a l R e g i o n s
Right upper quadrant
• Duodenal ulcer
• Hepatitis
• Hepatomegaly
• Pneumonia
• Cholecystitis
Right lower quadrant
• Appendicitis
• Salpingitis
• Ovarian cyst
• Ruptured ectopic pregnancy
• Renal or ureteral stone
• Strangulated hernia
• Meckel diverticulitis
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0003-print-1560441994.xhtml 6/13/2019
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0003-print-1560441994.xhtml
• Regional ileitis
• Perforated cecum
Periumbilical
• Intestinal obstruction
• Acute pancreatitis
• Early appendicitis
• Mesenteric thrombosis
• Aortic aneurysm
• Diverticulitis
Left upper quadrant
• Ruptured spleen
• Gastric .
C H A P T E R 3
Abdominal pain
Abdominal pain is a subjective feeling of discomfort in the abdomen that can be caused by a variety of
problems. The goal of initial clinical assessment is to distinguish acute lifethreatening conditions from
chronic/recurrent or acute mild, selflimiting conditions. Assessment is complicated by the dynamic rather than
static nature of acute abdominal pain, which can produce a changing clinical picture, often over a short period
of time. In addition, both children and older adults tend to deviate from the usual and anticipated clinical
pattern of abdominal pain. The following three processes can produce abdominal pain: (1) tension in the
gastrointestinal (GI) tract wall from muscle contraction or distention, (2) ischemia, and (3) inflammation of the
peritoneum. Pain can also be referred from within or outside the abdomen.
Colic is a type of tension pain. It is associated with forceful peristaltic contractions and is the most
characteristic type of pain arising from the viscera. Colicky pain can be produced by an irritant substance, from
infection with a virus or bacteria, or by the body’s attempt to force its luminal contents through an obstruction.
Another type of tension pain is caused by acute stretching of the capsule of an organ, such as the liver, spleen,
or kidney. The patient with this visceral pain is restless, moves about, and has difficulty getting comfortable.
Ischemia produces an intense, continuous pain. The most common cause of intestinal ischemic pain is
strangulation of the bowel from obstruction.
Inflammation of the peritoneum usually begins at the serosa covering the affected and inflamed organ,
causing visceral peritonitis. The pain is a poorly localized aching. As the inflammatory process spreads to the
adjacent parietal peritoneum, it produces localized parietal peritonitis. The pain of parietal peritonitis is more
severe and is perceived in the area of the abdomen corresponding to the inflammation. A patient with parietal
pain usually lies still and does not want to move.
Pain can be referred from within the abdomen or from other parts of the body (Box 3.1).
Box 3.1
S o m e C a u s e s o f P a i n P e r c e i v e d i n A n a t o m i c a l R e g i o n s
Right upper quadrant
• Duodenal ulcer
• Hepatitis
• Hepatomegaly
• Pneumonia
• Cholecystitis
Right lower quadrant
• Appendicitis
• Salpingitis
• Ovarian cyst
• Ruptured ectopic pregnancy
• Renal or ureteral stone
• Strangulated hernia
• Meckel diverticulitis
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0003-print-1560441994.xhtml 6/13/2019
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0003-print-1560441994.xhtml
• Regional ileitis
• Perforated cecum
Periumbilical
• Intestinal obstruction
• Acute pancreatitis
• Early appendicitis
• Mesenteric thrombosis
• Aortic aneurysm
• Diverticulitis
Left upper quadrant
• Ruptured spleen
• Gastric ...
Acute abdominal pain is a common complaint in children that requires prompt diagnosis and management to prevent complications. It can be caused by intra-abdominal issues like appendicitis, infections, or surgical problems. or extra-abdominal referred pain from issues like pneumonia. A thorough history, physical exam, and potential diagnostic tests are needed to identify the specific cause and direct treatment, whether through antibiotics, surgery, pain management, or addressing an underlying condition. Nurses play an important role in assessing for signs of pain, fluid status, and risk of infection while providing comfort and monitoring the patient's condition.
This document discusses the evaluation and differential diagnosis of abdominal pain. It notes that history and physical examination are important for diagnosis as subtle symptoms can indicate serious conditions. The document outlines key components of a patient's history and details the examination. It describes various causes of abdominal pain classified by location, mechanism, and onset. Radiological investigations that may assist diagnosis are also summarized. The document stresses that the severity of pain does not always correlate with the severity of the underlying condition.
The document discusses acute abdomen, defined as sudden abdominal pain lasting less than 24-72 hours. It summarizes the key points as:
1) Abdominal pain is the primary symptom and can be visceral, parietal, or referred pain.
2) Causes are divided into surgical (such as inflammation, perforation, obstruction), gynecological/obstetrical, medical, and non-specific.
3) Diagnosis involves history, physical exam focusing on abdominal tenderness and guarding, basic labs, and imaging like ultrasound or CT scan to identify potential causes like appendicitis or bowel obstruction.
The document discusses acute abdominal pain and the diagnostic process. It emphasizes that 60-80% of accurate diagnoses can be made through thorough history taking alone. A detailed history should inquire about the chief complaint of pain as well as related symptoms, onset, and previous medical history. The physical exam involves inspection, palpation, percussion, and auscultation of the abdomen, as well as a rectal exam when appropriate. Common etiologies of acute abdominal pain include appendicitis, perforated ulcers, pancreatitis, intestinal obstructions, and gynecological issues. The goal is to make an accurate diagnosis to prevent morbidity and mortality through immediate treatment.
This document discusses acute abdomen and provides information on evaluating and diagnosing various potential causes. It defines acute abdomen and outlines the challenges surgeons face. A full history, physical exam, and further investigations are needed to make an exact diagnosis. Common differential diagnoses include appendicitis, peptic ulcer disease, cholecystitis, bowel obstruction, pancreatitis, diverticulitis, renal colic, pelvic inflammatory disease, and ectopic pregnancy. Key diagnostic tests include bloodwork, imaging like CT scans, and ultrasound.
ACUTE ABDOMEN-CLINICAL PRESENTATION AND MANAGEMENT.pptxAjilAntony10
An acute abdomen refers to sudden, severe abdominal pain that is often an emergency requiring urgent diagnosis and treatment. The diagnostic process involves a thorough history and physical examination, as well as laboratory and imaging studies. The history focuses on the characteristics of the pain such as location, onset, radiation, and aggravating/relieving factors. The physical exam includes inspection, palpation, and examination of other organ systems. Common causes of acute abdomen that may require surgical intervention include appendicitis, cholecystitis, bowel obstruction, inguinal hernia, renal colic, and pancreatitis. An accurate diagnosis is important to prevent morbidity and mortality.
This document provides an overview of the management approach for acute abdomen. It begins with definitions and epidemiology, noting that acute abdomen is undiagnosed abdominal pain lasting less than 7-10 days. It then covers the surgical and medical causes, with etiological classifications including inflammatory/infective, perforation, obstruction, infarction, and spontaneous bleeding. Differential diagnoses are provided for different age groups. The management approach involves clinical evaluation, resuscitation, diagnostic tools like ultrasound and CT scan, and categorizing patients based on urgency of condition.
This document discusses the case of a patient named Abdul Rehman who was admitted to the hospital with acute abdominal pain after recently having his right leg amputated following an accident. The patient was initially resuscitated with IV fluids and other measures. Exploratory laparotomy was planned due to findings of free fluid in the abdomen. The document then provides information on defining an acute abdomen, common causes, characteristics of pain, examination techniques, investigations, initial resuscitation measures, pre-operative management, non-surgical causes, and indications for surgical exploration.
This document discusses the evaluation and management of patients presenting with acute abdominal pain. It begins by defining acute abdomen and emphasizing the importance of prompt diagnosis to prevent morbidity and mortality in patients requiring surgery. It then reviews the epidemiology, medical causes including infections, inflammation and referred pain from other organs, and surgical causes such as hemorrhage, infection, perforation and blockage. The document provides guidance on history taking, physical examination including specific signs, diagnostic testing for different regions of pain, and the initial approach to the acute care of these patients.
1) The acute abdomen refers to a clinical situation requiring immediate diagnosis and treatment for an acute change in the intraabdominal organs, usually related to inflammation or infection.
2) A history, physical exam, and serial exams are more important for diagnosis than tests. Common causes include appendicitis, cholecystitis, pancreatitis, diverticulitis, perforated ulcer, and inflammatory bowel disease.
3) CT scans accurately diagnose many conditions like appendicitis, diverticulitis, and pancreatitis but should only be used after developing a working diagnosis, as treatment may involve antibiotics, drainage, or surgery.
Evaluation of acute abdominal pain in the emergency department can be challenging as there are many possible diagnoses ranging from life-threatening to self-limiting conditions. A thorough history and physical exam is important to identify "red flags" that suggest serious underlying causes of pain such as sudden onset, maximal intensity pain or migration of pain. The physical exam focuses on vital signs, inspection of the abdomen, auscultation, percussion and gentle palpation to help localize the source of pain and identify signs of peritoneal irritation. Recognition of surgical or life-threatening causes is prioritized over establishing a firm diagnosis.
This document discusses the acute abdomen, including its definition, common causes, symptoms, and physical examination findings. An acute abdomen is any sudden abdominal disorder requiring urgent operation. Common causes include appendicitis, cholecystitis, pancreatitis, and bowel obstructions. The history should clarify the location, onset, character, and relieving/aggravating factors of pain. The physical exam involves a full examination with focus on signs confirming or ruling out differential diagnoses.
This document provides an overview of acute abdomen, including:
1. It defines acute abdomen as abdominal pain and tenderness that often requires emergency surgery. Common causes include inflammation, perforation, obstruction, ischemia, and hemorrhage.
2. Signs and symptoms are explored, including the differences between visceral and parietal pain. Location of pain can provide clues to the underlying pathology. Other symptoms include vomiting, diarrhea, and changes in vital signs.
3. Examination of the patient focuses on inspection, palpation, percussion, and auscultation of the abdomen, as well as relevant history and laboratory/imaging investigations.
This document discusses the evaluation and differentiation of acute abdominal pain as either surgical or nonsurgical in nature. It provides details on:
1. Characteristics that suggest a surgical condition include sudden onset of severe, continuous pain not relieved by changing position that began during rest and localized pain that shifts locations.
2. Nonsurgical conditions typically present with gradual onset of intermittent pain that is relieved by changing position and preceded by nausea.
3. The physical exam involves inspection, auscultation, palpation and focuses on vital signs, pain localization, and rebound tenderness to differentiate surgical from nonsurgical disorders.
1. The document discusses the diagnosis and treatment of acute abdomen in children. It describes the causes, which can include inflammatory conditions, perforations, hemorrhage, and medical conditions. (2) Diagnosis involves taking a thorough history, physical examination, and select laboratory and imaging tests. (3) Surgery is often required to treat many acute abdominal conditions like appendicitis, intestinal obstructions, or perforations.
The document provides information on acute abdomen including:
1) Causes of acute abdomen can include infection, obstruction, ischemia or perforation and vary by age and gender. Nonsurgical causes include endocrine, hematologic, toxins and drugs.
2) Evaluation involves history, physical exam, lab tests and imaging studies like CT scans and ultrasound to diagnose the specific cause.
3) Preparation for emergency surgery includes IV access, fluid resuscitation, antibiotics and correcting electrolyte abnormalities. Atypical patients like pregnant women require modified evaluation and treatment.
Similar to Abdominalpaininchildren 151122225844-lva1-app6891864 (2) (20)
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. OBJECTIVES: To be able to
Understand the causes and frequency of abdominal pain in
childhood
Develop a differential diagnosis based on age and symptoms
Formulate a plan for evaluation and management of abdominal
pain
Choose the appropriate imaging study for various diagnoses and
avoid when not
Identify patients with serious cause of abdominal pain that
require early intervention
3. DIAGOSTIC CHALLENGES:
children are limited in their ability to give an accurate
history
parents or guardians may also have difficulty
interpreting the complaints of small children
In many cases, the causes are benign an often no cause
is found
some require rapid diagnosis and treatment in order to
prevent significant morbidity or mortality
4.
5. TYPES OF ABDOMINAL PAIN IN CHILDREN
Acute
O Organic
O Inorganic/ Idiopathic/ functional
Chronic
o Organic
o Inorganic/ Idiopathic/ functional
6. Abdominal Pain
Abdominal pain can result from:
• injury to the intra-abdominal organs
• injury to overlying somatic structures in the
abdominal wall
• extra-abdominal diseases.
7. Visceral pain
• nerves within the gut detect injury
• nonmyelinated nerve fibers are responsible
• mediate pain sensation, which is vague, dull, slow in
onset, and poorly localized
• Lower degrees of activation may result in perception of
nonpainful or perhaps vaguely uncomfortable sensations
• more intensive stimulation of these fibers results in pain
• Overactive sensation may be the basis of functional
abdominal pain
8. Somatic Pain
• results when overlying body structures are injured
• include the parietal peritoneum, fascia, muscles,
and skin of the abdominal wall
•fibers are myelinated and are capable of rapid transmission of well-
localized painful stimuli
• When intra-abdominal processes extend to cause inflammation or
injury to the parietal peritoneum or other somatic structures, poorly
localized visceral pain becomes well-localized somatic pain
Eg: In acute appendicitis, visceral fibers are activated initially by the
early phases of the infection. When the inflammatory process
extends to involve the overlying parietal peritoneum, the pain
becomes more acute and localizes generally to the right lower
quadrant. This is called somatoparietal pain.
9. Referred pain
• Referred pain is a painful sensation in a body region distant from the true
source of pain
• activation of spinal cord somatic sensory cell bodies by intense signaling
from visceral afferent nerves, located at the same level of the spinal cord
• predictable based on the locus of visceral injury
• Cardiac visceral pain is referred to left-sided T1-5 somatic
segments, causing left shoulder and arm pain
• Stomach pain is referred to the epigastric and retrosternal regions
• liver and pancreas pain is referred to the epigastric region
• Gall-bladder pain often is referred to the region below the right scapula
• Somatic pathways stimulated by small bowel affect the periumbilical area,
and a noxious event in the colon results in infraumbilical referred pain
10.
11. Assessment of pain severity in pre-verbal child:
0 = Relaxed and comfortable 1-3 = Mild discomfort 4-6 = Moderate pain 7-10 = Severe
discomfort/pain
12. Acute Abdominal Pain
Distinguishing Features:
• Acute abdominal pain can signal the presence of a dangerous intra-abdominal process,
such as appendicitis or bowel obstruction
• may originate from extraintestinal sources, such as lower lobe pneumonia or urinary
tract stone
• Not all episodes of acute abdominal pain require emergency intervention
• Appendicitis must be ruled out as quickly as possible; the evaluation must be
efficient, properly focused, and rapid
• Only a few children presenting with acute abdominal pain actually have a surgical
emergency.
• These surgical cases must be separated from cases that can be managed conservatively
13. most of the emergency visits presenting with acute abdominal pain are self-
limited and benign
AGE is the most common cause in all pediatric age group
surgical etiology may be present in up to 20%
below 1 year of age, the most common surgical etiology was reported to be
incarcerated inguinal hernia (45.1%), followed by intussusception (41.9%)
These etiologies were uncommon in school-age and adolescent children
In children above 1 year of age, the most common causes of acute surgical
diagnoses have been reported to be
acute appendicitis (64.0%)
incarcerated hernia (7.5%)
trauma (16.3%)
intussusception (6.3%)
intestinal obstruction (1.3%)
ovarian torsion (1.3%)
14.
15. Initial Diagnostic Evaluation
• Important clues to the diagnosis can be
determined by History and physical examination
• The onset of pain can provide some clues
• Events that occur with a discrete, abrupt onset,
such as passage of a stone, perforation of a
viscus, or infarction, result in a sudden onset
• Gradual onset of pain is common with infectious
or inflammatory causes, such as appendicitis and
IBD
16. • A standard group of laboratory tests usually is
performed for abdominal pain
• An abdominal x-ray series also is usually
obtained
• Further imaging studies may be warranted to identify
specific causes
• CT can visualize the appendix if the examination and
laboratory findings suggest a possibility of appendicitis
but the diagnosis remains in doubt
• If the history and other features suggest
intussusception, a barium or pneumatic (air) enema
may be the first choice to diagnose and treat this
condition with hydrostatic reduction
17. Diagnostic Approach to Acute
Abdominal Pain
History
Onset
Sudden or gradual, prior episodes, association with
meals, history of injury
Nature Sharp versus dull, colicky or constant, burning
Location
Epigastric, periumbilical, generalized, right or left
lower quadrant, change in location over time
Fever Presence suggests appendicitis or other infection
Extraintestinal
symptoms
Cough, dyspnea, dysuria, urinary frequency, flank
pain
Course of symptoms
Worsening or improving, change in nature or
location of pain
18. Physical Examination
General Growth and nutrition, general
appearance, hydration, degree of
discomfort, body position
Abdominal Tenderness, distention, bowel sounds,
rigidity, guarding,
mass,hepatosplenomegaly
Genitalia Testicular torsion, hernia, pelvic
inflammatory disease, ectopic pregnancy
Surrounding structures Breath sounds, rales, rhonchi, wheezing,
flank tenderness, tenderness of
abdominal wall structures, ribs,
costochondral joints
Rectal examination Perianal lesions, stricture, tenderness,
fecal impaction, blood
Diagnostic Approach to
Acute Abdominal Pain
19. Laboratory
CBC, C-reactive protein, ESR Evidence of infection or inflammation
AST, ALT, GGT, bilirubin Biliary or liver disease
Amylase, lipase Pancreatitis
Urinalysis Urinary tract infection, bleeding due to stone,
trauma, or obstruction
Pregnancy test (older
females)
Ectopic pregnancy
Radiology
Plain flat and upright
abdominal films
Bowel obstruction, appendiceal fecalith, free
intraperitoneal air, kidney stones
CT scan Rule out abscess, appendicitis, Crohn disease,
pancreatitis, gallstones, kidney stones
Barium enema Intussusception, malrotation
Ultrasound Gallstones, appendicitis, intussusception,
pancreatitis, kidney stones
Endoscopy
Upper endoscopy Suspected peptic ulcer or esophagitis
20. Differential Diagnosis
• With acute pain, the urgent task of the clinician is
to rule out surgical emergencies
• In young children, malrotation, incarcerated
hernia, congenital anomalies, and
intussusception are common concerns
• In older children and teenagers, appendicitis is
more common
• An acute surgical abdomen is characterized by
signs of peritonitis, including tenderness,
abdominal wall rigidity, guarding, and absent or
diminished bowel sounds
23. Distinguishing Features of
Abdominal Pain in Children
Disease Onset Location Referral Quality Comments
Functional: irritable
bowel syndrome
Recurrent Periumbilical,
splenic and
hepatic
flexures
None Dull, crampy,
intermittent;
duration 2 hr
Family stress, school
phobia, diarrhea and
constipation;
hypersensitive to pain
from distention
Esophageal reflux Recurrent,
after meals,
at bedtime
Substernal Chest Burning Sour taste in mouth;
Sandifer syndrome
Duodenal ulcer Recurrent,
before
meals, at
night
Epigastric Back Severe burning,
gnawing
Relieved by food, milk,
antacids; family history
important; GI bleeding
Pancreatitis Acute Epigastric-
hypogastric
Back Constant, sharp,
boring
Nausea, emesis,
marked tenderness
24. Distinguishing Features of Abdominal
Pain in Children
Disease Onset Location Referral Quality Comments
Intestinal obstruction Acute or
gradual
Periumbilical-lower
abdomen
Back Alternating
cramping (colic)
and painless
periods
Distention,
obstipation, bilious
emesis, increased
bowel sounds
Appendicitis Acute Periumbilical or
epigastric; localizes
to right lower
quadrant
Back or
pelvis if
retrocecal
Sharp, steady Nausea, emesis,
local tenderness, ±
fever, avoids
motion
Meckel diverticulum Recurrent Periumbilical-lower
abdomen
None Sharp Hematochezia;
painless unless
intussusception,
diverticulitis, or
perforation
Inflammatory bowel
disease
Recurrent Depends on site of
involvement
Dull cramping,
tenesmus
Fever, weight loss,
± hematochezia
Intussusception Acute Periumbilical-lower
abdomen
None Cramping, with
painless periods
Guarded position
with knees pulled
up, currant jelly
stools, lethargy
25. Distinguishing Features of
Abdominal Pain in Children
Disease Onset Location Referral Quality Comments
Lactose intolerance Recurrent with
milk products
Lower
abdomen
None Cramping Distention, gaseousness,
diarrhea
Urolithiasis Acute, sudden Back Groin Severe,
colickypain
Hematuria
Pyelonephritis Acute, sudden Back None Dull to sharp Fever, costochondral
tenderness, dysuria, urinary
frequency, emesis
Cholecystitis and
cholelithiasis
Acute Right upper
quadrant
Right
shoulder
Severe,
colickypain
Hemolysis ± jaundice, nausea,
emesis
26. Recurrent (Chronic) Abdominal Pain
• Recurrent abdominal pain is defined as the occurrence of
multiple episodes of abdominal pain over at least 3 months
that are severe enough to cause some limitation of activity
• Recurrent abdominal pain is a common problem in
children, affecting more than 10% of children at some time
during childhood
• The peak incidence occurs between ages 7 and 12 years
• Although the differential diagnosis of recurrent abdominal
pain is fairly extensive , most children with this condition
are not found to have a serious (or even identifiable)
underlying illness causing the pain
29. Differential Diagnosis
• The most common disorder to consider is functional
abdominal pain
• characteristically occurs daily or nearly every day
• not associated with or relieved by eating or defecation
• associated with significant loss of the ability to function
normally
• typically have personality traits that include a tendency
toward anxiety and perfectionism, which result in stress at
school and in social situations
• pain often is worst at the start of the school day and before
returning to school after vacations
• A child with suspected functional pain must be evaluated
carefully to exclude other causes of discomfort
30. • Functional abdominal pain differs from irritable
bowel syndrome (IBS) in minor ways
• Children with IBS have pain beginning with a
change in stool frequency or consistency
• a stool pattern fluctuating between diarrhea
and constipation, and relief of pain with
defecation.
• Pain is commonly accompanied in both groups of
children by school avoidance, secondary gains,
anxiety about imagined causes, lack of coping
skills, and disordered peer relationships
31. Distinguishing Features..
• One needs to distinguish between functional pain
and IBS and more serious underlying disorders
• should ask about the warning signs for
underlying illness
• If any warning signs are present, further
investigation is necessary
• Even if the warning signs are absent, some
laboratory evaluation is warranted
32. Warning Signs of Underlying Illness in
Recurrent Abdominal Pain
•Vomiting
•Abnormal screening laboratory study
•Fever
•Bilious emesis
•Growth failure
•Pain awakening child from sleep
•Weight loss
•Location away from periumbilical region
•Blood in stools or emesis
•Delayed puberty
33. • The physician and the parents must feel assured that
no serious illness is being missed
• a judicious laboratory evaluation after a careful
history and complete physical examination can
accomplish this
• One mistake that must be avoided in treating recurrent
pain is performing too many tests
• The initial evaluation recommended in avoids these
problems.
34. • While waiting for laboratory and ultrasound results, a 3-day trial of
a lactose-free diet should be instituted to rule out lactose
intolerance
• If tests are normal and no warning signs are present, testing should
be stopped
• If there are warning signs, worrisome symptoms, progression of
symptoms, or laboratory abnormalities that suggest a specific
diagnosis, additional investigation may be necessary
• If antacids consistently relieve pain, an upper GI endoscopy is
indicated
• If the child is losing weight, a barium upper GI series with a small
bowel follow-through or contrast CT is a good idea to look for
evidence of CD
• Celiac disease also should be considered
35. Suggested Evaluation of Recurrent
Abdominal Pain
Initial Evaluation Follow-up Evaluation*
Complete history and physical
examination
CT scan of the abdomen and pelvis with
oral, rectal, and intravenous contrast
Ask about "warning signs" Celiac disease serology-endomysial
antibody or tissue transglutaminase
antibody
Determine degree of functional
impairment (e.g., missing school)
Barium upper GI series with small bowel
follow-through Endoscopy of the
esophagus, stomach, and duodenum
CBC Colonoscopy
ESR
Amylase, lipase
Urinalysis
Abdominal ultrasound-examine liver,
bile ducts, gallbladder, pancreas,
kidneys, ureters
Trial of 3-day lactose-free diet
36. Treatment of Recurrent Abdominal Pain
• A child who is kept home or sent home from school
because of pain receives a lot of attention for the
symptoms, is excused from responsibilities, and
withdraws from full social functioning
• This situation rewards complaints and increases the child's
anxiety about health
• When the child observes that the adults are worried, the
child worries too
• To break this cycle of pain and disability, the child must return
to normal activities immediately, even before all test results
are available.
37. Treatment of Recurrent Abdominal Pain
• The child should not be sent home from school with stomachaches;
rather, the child may be allowed to take a short break from class in the
nurse's office until the cramping abates
• It is useful to inform the child and the parents that the pain is likely to be
worse on the day the child returns to school
• Anxiety worsens dysmotility and pain perception
• Sometimes, medications can be helpful
• Fiber supplements are useful to manage symptoms of IBS
• In difficult and persistent cases, amitriptyline or a selective serotonin
reuptake inhibitor may be beneficial
38. Outcome of recurrent abdominal pain in
children…
After 5 years,
1/3 of children with RAP will have resolution of
their pain,
1/3 continue to complain of the same
symptoms, and
1/3 will have a different recurrent pain
complaint.
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