1. The document discusses the evaluation and management of various gastrointestinal disorders in children including abdominal pain, vomiting, diarrhea, constipation, and other issues.
2. Key points include recognizing signs and symptoms of conditions like appendicitis, intussusception, Hirschsprung's disease, gastroesophageal reflux, and infectious causes of diarrhea.
3. Management involves considering differential diagnoses, performing appropriate testing, and treating underlying causes or symptoms while monitoring for complications.
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.
Gastric volvulus is a twisting of the stomach by at least 180 degrees that causes an obstruction. It is rare in children but can be life-threatening if acute. Chronic volvulus may be more difficult to recognize. Causes include ligament abnormalities or issues with adjacent organs like the diaphragm or transverse colon. The most common pediatric presentation is in a child under 5 with non-bilious vomiting, epigastric distention, and abdominal pain. Diagnosis is made via upper GI imaging and treatment involves surgical repair of defects and fixing the stomach to the abdominal wall, with a mortality rate of around 5% for surgery.
A 9 month old male presented with recurrent episodes of screaming and abdominal pain. On examination, the physician noted a sausage-shaped mass in the right upper quadrant of the abdomen. Imaging showed signs consistent with intussusception, including a target or crescent shape mass. The patient was given IV fluids and recommended for an air contrast enema to diagnose and potentially treat the suspected intussusception.
1) The document describes a case of a 9-day old baby boy presenting with abdominal distention, vomiting of fecal matter, and constipation for 6 days. Examination found the baby to be ill and dehydrated.
2) Operative findings revealed ileal atresia type 3 at the distal ileum. Excision of the blind ends and primary anastomosis was performed.
3) The baby passed stool on the 3rd post-op day and was discharged in good condition on the 30th post-op day with increased weight.
This document discusses recurrent abdominal pain (RAP) in children. It provides information on the epidemiology, clinical profile, classification, pathophysiology, etiology, alarm symptoms and signs, diagnosis, investigations, and treatment of RAP. Treatment involves ruling out organic causes, reassurance, allowing normal activity, addressing stressors, and may include pharmacological interventions, dietary modifications, and behavioral therapies. The goal is to help the child return to normal activities and improve their pain over time.
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.
This document provides an overview of acute abdominal pain, including classifications, causes, symptoms, diagnostic tests, and treatment considerations. It describes three types of abdominal pain - visceral, parietal, and referred - and covers common intra-abdominal etiologies like appendicitis, cholecystitis, small bowel obstruction, and ischemic bowel. It also discusses extra-abdominal, toxic, metabolic, and neurogenic causes of abdominal pain and emphasizes the importance of thorough history taking and physical exam in diagnosing the source.
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 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.
Gastric volvulus is a twisting of the stomach by at least 180 degrees that causes an obstruction. It is rare in children but can be life-threatening if acute. Chronic volvulus may be more difficult to recognize. Causes include ligament abnormalities or issues with adjacent organs like the diaphragm or transverse colon. The most common pediatric presentation is in a child under 5 with non-bilious vomiting, epigastric distention, and abdominal pain. Diagnosis is made via upper GI imaging and treatment involves surgical repair of defects and fixing the stomach to the abdominal wall, with a mortality rate of around 5% for surgery.
A 9 month old male presented with recurrent episodes of screaming and abdominal pain. On examination, the physician noted a sausage-shaped mass in the right upper quadrant of the abdomen. Imaging showed signs consistent with intussusception, including a target or crescent shape mass. The patient was given IV fluids and recommended for an air contrast enema to diagnose and potentially treat the suspected intussusception.
1) The document describes a case of a 9-day old baby boy presenting with abdominal distention, vomiting of fecal matter, and constipation for 6 days. Examination found the baby to be ill and dehydrated.
2) Operative findings revealed ileal atresia type 3 at the distal ileum. Excision of the blind ends and primary anastomosis was performed.
3) The baby passed stool on the 3rd post-op day and was discharged in good condition on the 30th post-op day with increased weight.
This document discusses recurrent abdominal pain (RAP) in children. It provides information on the epidemiology, clinical profile, classification, pathophysiology, etiology, alarm symptoms and signs, diagnosis, investigations, and treatment of RAP. Treatment involves ruling out organic causes, reassurance, allowing normal activity, addressing stressors, and may include pharmacological interventions, dietary modifications, and behavioral therapies. The goal is to help the child return to normal activities and improve their pain over time.
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.
This document provides an overview of acute abdominal pain, including classifications, causes, symptoms, diagnostic tests, and treatment considerations. It describes three types of abdominal pain - visceral, parietal, and referred - and covers common intra-abdominal etiologies like appendicitis, cholecystitis, small bowel obstruction, and ischemic bowel. It also discusses extra-abdominal, toxic, metabolic, and neurogenic causes of abdominal pain and emphasizes the importance of thorough history taking and physical exam in diagnosing the source.
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 . ?????
1) Abdominal pain in children can be caused by many common and age-specific issues like intussusception in infants and appendicitis in older children.
2) A thorough history and physical exam are important for diagnosing the cause, with location and timing of pain providing clues. Common surgical issues include appendicitis, intussusception, and incarcerated hernias.
3) Further testing like bloodwork, imaging, and observation may be needed to determine if urgent surgery is required for problems like a perforated viscus or uncontrolled bleeding, or if the issue can be monitored as a potential "medical bellyache".
Summary of abdominal x ray and ultrasound findings in necrotizing enterocolitis.
From Merrow AC Jr. Diagnostic Imaging: Pediatrics. 3rd ed. Elsevier; 2017.
MDCT in upper gastrointestinal obstruction: A pictorial review summarizes the causes, epidemiology, pathophysiology, and key MDCT findings of gastro-duodenal obstruction. Intrinsic causes include gallstones, tumors, ulcers, and hematomas. Extrinsic causes include pancreatitis, gastric volvulus, surgical complications, hiatal hernias, mesenteric artery syndrome, and external masses. MDCT is useful for differentiating mechanical from functional obstruction and identifying lesions, complications, and the level of obstruction to guide management. The document reviews anatomy and illustrates various pathologies through case examples.
This document discusses neonatal abdominal emergencies, including their causes, embryology, and anomalies. It begins by introducing abdominal emergencies in neonates, infants, and children. It then covers the embryology of the gastrointestinal tract, including the development of the foregut, midgut, and hindgut. Specific anomalies are discussed such as Meckel's diverticulum and intestinal malrotation. Diagnosis and treatment of some conditions are also mentioned.
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.
Your abdomen extends from below your chest to your groin. Some people call it the stomach, but your abdomen contains many other important organs. Pain in the abdomen can come from any one of them. The pain may start somewhere else, such as your chest. Severe pain doesn't always mean a serious problem. Nor does mild pain mean a problem is not serious.
Call your healthcare provider if mild pain lasts a week or more or if you have pain with other symptoms. Get medical help immediately if:
-- You have abdominal pain that is sudden and
sharp
-- You also have pain in your chest, neck or
shoulder
-- You're vomiting blood or have blood in your
stool
-- Your abdomen is stiff, hard and tender to
touch
-- You can't move your bowels, especially if
you're also vomiting
The document provides information about abdominal anatomy and examination, as well as causes and presentations of common abdominal conditions. It discusses:
1. The abdominal regions and organs are outlined, including the liver, gallbladder, pancreas, and intestines.
2. Abdominal pain has somatic and visceral components and can be caused by inflammation, obstruction, ischemia, perforation, or rupture.
3. Acute appendicitis presents with initially vague pain that localizes to the right lower quadrant, along with nausea, fever, and rebound tenderness on exam.
4. Acute pancreatitis has causes including gallstones, alcohol, hyperlipidemia and drugs. It involves activation of pancreatic
This document provides guidance on approaching and managing common pediatric emergencies. It emphasizes taking an age-appropriate approach, thorough history and examination, involving pediatric nurses and specialists as needed, following guidelines like NICE, and considering rare or serious diagnoses. Common presentations like fever, wheezing, injuries and seizures are discussed. The importance of senior review, ongoing assessment, and team-based care for sick children is stressed.
Intussusception - will test the doctor and will cost the patientMohan Samarasinghe
This document discusses intussusception, a condition where one segment of the intestine folds into another segment. It provides a historical overview of discoveries about intussusception from the 17th century onwards. It then describes the typical presentation of intussusception in children ages 1-5, including abdominal pain, vomiting, and bloody stools. Diagnosis is usually made using abdominal ultrasound. Treatment options discussed include saline enema reduction guided by ultrasound, operative reduction, or observation if symptoms are mild. Early diagnosis and treatment within 12 hours of onset improves survival rates.
Chronic abdominal pain is defined as pain persisting for more than 3 months. Up to 10% of children and 2% of adults experience chronic abdominal pain. The document outlines numerous potential physiologic causes of chronic abdominal pain involving various organ systems. It also discusses functional abdominal pain syndrome as a poorly understood cause involving altered pain signaling in the central nervous system and psychological factors. A thorough history and physical exam is important to identify potential causes and red flag findings warranting further testing. Initial testing should include basic labs and imaging may be considered depending on risk factors or abnormal findings.
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.
1. Acute abdominal pain has many potential causes that can be categorized by organ system affected or type of pain experienced.
2. A thorough history and physical exam is important to determine the likely cause and guide appropriate testing or treatment.
3. Common pediatric causes include gastroenteritis, appendicitis, urinary tract infections, while adolescent females should also be evaluated for gynecological issues.
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 contains summaries of three gastrointestinal pathology cases and additional information about achalasia, oesophageal carcinoma, small bowel malrotation, and midgut volvulus. Case 1 describes dilatation and narrowing of the esophagus resembling a rat tail or bird beak. Case 2 describes abnormal positioning of the duodenum and small bowel. Case 3 shows irregular narrowing and lack of peristalsis in the colon. Additional sections provide details on the causes, presentations, investigations and treatments of these conditions.
Three sentence summary:
Abdominal pain is a common complaint in children that can be caused by many different conditions. This document provides an overview of the various causes of abdominal pain in children, from functional or non-specific pain to signs of more severe diseases. Key points covered include the nature, location, onset, and aggravating/relieving factors of different types of abdominal pain, as well as guidelines for when further testing or surgical referral may be needed.
- The document describes a male patient who presented with a 7 month history of an abdominal lump and recent weight loss, decreased appetite, loose stools, and abdominal fullness. On examination, the patient was found to have multiple hard, irregular masses in his abdomen along with ascites. Based on the presentation and examination findings, the provisional diagnosis was carcinoma of unknown primary with omental metastases and ascites. Further diagnostic tests of FNAC and CECT abdomen were planned.
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.
This document provides information on evaluating and diagnosing acute and chronic abdominal pain. It discusses the history, physical exam, diagnostic studies, and management of various acute conditions like appendicitis, diverticulitis, cholecystitis, and perforated ulcer. It also covers chronic pain syndromes like irritable bowel syndrome and chronic pancreatitis. The goal is to distinguish between organic and functional causes of abdominal pain.
1. A 24-year-old male presents with right lower quadrant abdominal pain radiating to the groin. On exam, he has mild guarding and tenderness in the right lower quadrant. His differential diagnosis includes appendicitis.
2. A 68-year-old female presents with left lower quadrant pain, diarrhea, fevers and nausea. On exam, she has tenderness in the left lower quadrant. Her differential diagnosis includes diverticulitis.
3. The document discusses the history, exam, differential diagnosis, diagnostic workup, and treatment of common causes of acute abdominal pain such as appendicitis and diverticulitis.
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.
- Hashimoto's thyroiditis is the most common cause of goiter in adolescents. It can cause transient hyperthyroidism early on before developing into hypothyroidism, with symptoms like decreased growth, delayed puberty, constipation, and myxedematous facies. It is confirmed by elevated antibodies and labs showing hyper, hypo, or euthyroid states.
- Untreated congenital hypothyroidism can lead to decreased IQ and neurodevelopmental delays in neonates. Congenital causes include thyroid dysgenesis or dyshormonogenesis, while acquired causes are usually Hashimoto's or subacute thyroiditis.
- Thyroid nodules or masses
This document provides guidance on recognizing, evaluating, and managing various blood and neoplastic disorders in children. Key points include recognizing signs of quantitative or qualitative leukocyte disorders like recurrent infections; distinguishing causes of bruising or purpura; evaluating anemia based on cell size and shape; managing neutropenia with growth factors or addressing causes; treating thrombocytopenia based on count and symptoms; and surveillance for tumors in overgrowth syndromes. Evaluation involves a thorough history, physical exam, and interpretation of blood tests to identify underlying etiologies and guide therapeutic approaches like transfusions or medications.
1) Abdominal pain in children can be caused by many common and age-specific issues like intussusception in infants and appendicitis in older children.
2) A thorough history and physical exam are important for diagnosing the cause, with location and timing of pain providing clues. Common surgical issues include appendicitis, intussusception, and incarcerated hernias.
3) Further testing like bloodwork, imaging, and observation may be needed to determine if urgent surgery is required for problems like a perforated viscus or uncontrolled bleeding, or if the issue can be monitored as a potential "medical bellyache".
Summary of abdominal x ray and ultrasound findings in necrotizing enterocolitis.
From Merrow AC Jr. Diagnostic Imaging: Pediatrics. 3rd ed. Elsevier; 2017.
MDCT in upper gastrointestinal obstruction: A pictorial review summarizes the causes, epidemiology, pathophysiology, and key MDCT findings of gastro-duodenal obstruction. Intrinsic causes include gallstones, tumors, ulcers, and hematomas. Extrinsic causes include pancreatitis, gastric volvulus, surgical complications, hiatal hernias, mesenteric artery syndrome, and external masses. MDCT is useful for differentiating mechanical from functional obstruction and identifying lesions, complications, and the level of obstruction to guide management. The document reviews anatomy and illustrates various pathologies through case examples.
This document discusses neonatal abdominal emergencies, including their causes, embryology, and anomalies. It begins by introducing abdominal emergencies in neonates, infants, and children. It then covers the embryology of the gastrointestinal tract, including the development of the foregut, midgut, and hindgut. Specific anomalies are discussed such as Meckel's diverticulum and intestinal malrotation. Diagnosis and treatment of some conditions are also mentioned.
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.
Your abdomen extends from below your chest to your groin. Some people call it the stomach, but your abdomen contains many other important organs. Pain in the abdomen can come from any one of them. The pain may start somewhere else, such as your chest. Severe pain doesn't always mean a serious problem. Nor does mild pain mean a problem is not serious.
Call your healthcare provider if mild pain lasts a week or more or if you have pain with other symptoms. Get medical help immediately if:
-- You have abdominal pain that is sudden and
sharp
-- You also have pain in your chest, neck or
shoulder
-- You're vomiting blood or have blood in your
stool
-- Your abdomen is stiff, hard and tender to
touch
-- You can't move your bowels, especially if
you're also vomiting
The document provides information about abdominal anatomy and examination, as well as causes and presentations of common abdominal conditions. It discusses:
1. The abdominal regions and organs are outlined, including the liver, gallbladder, pancreas, and intestines.
2. Abdominal pain has somatic and visceral components and can be caused by inflammation, obstruction, ischemia, perforation, or rupture.
3. Acute appendicitis presents with initially vague pain that localizes to the right lower quadrant, along with nausea, fever, and rebound tenderness on exam.
4. Acute pancreatitis has causes including gallstones, alcohol, hyperlipidemia and drugs. It involves activation of pancreatic
This document provides guidance on approaching and managing common pediatric emergencies. It emphasizes taking an age-appropriate approach, thorough history and examination, involving pediatric nurses and specialists as needed, following guidelines like NICE, and considering rare or serious diagnoses. Common presentations like fever, wheezing, injuries and seizures are discussed. The importance of senior review, ongoing assessment, and team-based care for sick children is stressed.
Intussusception - will test the doctor and will cost the patientMohan Samarasinghe
This document discusses intussusception, a condition where one segment of the intestine folds into another segment. It provides a historical overview of discoveries about intussusception from the 17th century onwards. It then describes the typical presentation of intussusception in children ages 1-5, including abdominal pain, vomiting, and bloody stools. Diagnosis is usually made using abdominal ultrasound. Treatment options discussed include saline enema reduction guided by ultrasound, operative reduction, or observation if symptoms are mild. Early diagnosis and treatment within 12 hours of onset improves survival rates.
Chronic abdominal pain is defined as pain persisting for more than 3 months. Up to 10% of children and 2% of adults experience chronic abdominal pain. The document outlines numerous potential physiologic causes of chronic abdominal pain involving various organ systems. It also discusses functional abdominal pain syndrome as a poorly understood cause involving altered pain signaling in the central nervous system and psychological factors. A thorough history and physical exam is important to identify potential causes and red flag findings warranting further testing. Initial testing should include basic labs and imaging may be considered depending on risk factors or abnormal findings.
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.
1. Acute abdominal pain has many potential causes that can be categorized by organ system affected or type of pain experienced.
2. A thorough history and physical exam is important to determine the likely cause and guide appropriate testing or treatment.
3. Common pediatric causes include gastroenteritis, appendicitis, urinary tract infections, while adolescent females should also be evaluated for gynecological issues.
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 contains summaries of three gastrointestinal pathology cases and additional information about achalasia, oesophageal carcinoma, small bowel malrotation, and midgut volvulus. Case 1 describes dilatation and narrowing of the esophagus resembling a rat tail or bird beak. Case 2 describes abnormal positioning of the duodenum and small bowel. Case 3 shows irregular narrowing and lack of peristalsis in the colon. Additional sections provide details on the causes, presentations, investigations and treatments of these conditions.
Three sentence summary:
Abdominal pain is a common complaint in children that can be caused by many different conditions. This document provides an overview of the various causes of abdominal pain in children, from functional or non-specific pain to signs of more severe diseases. Key points covered include the nature, location, onset, and aggravating/relieving factors of different types of abdominal pain, as well as guidelines for when further testing or surgical referral may be needed.
- The document describes a male patient who presented with a 7 month history of an abdominal lump and recent weight loss, decreased appetite, loose stools, and abdominal fullness. On examination, the patient was found to have multiple hard, irregular masses in his abdomen along with ascites. Based on the presentation and examination findings, the provisional diagnosis was carcinoma of unknown primary with omental metastases and ascites. Further diagnostic tests of FNAC and CECT abdomen were planned.
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.
This document provides information on evaluating and diagnosing acute and chronic abdominal pain. It discusses the history, physical exam, diagnostic studies, and management of various acute conditions like appendicitis, diverticulitis, cholecystitis, and perforated ulcer. It also covers chronic pain syndromes like irritable bowel syndrome and chronic pancreatitis. The goal is to distinguish between organic and functional causes of abdominal pain.
1. A 24-year-old male presents with right lower quadrant abdominal pain radiating to the groin. On exam, he has mild guarding and tenderness in the right lower quadrant. His differential diagnosis includes appendicitis.
2. A 68-year-old female presents with left lower quadrant pain, diarrhea, fevers and nausea. On exam, she has tenderness in the left lower quadrant. Her differential diagnosis includes diverticulitis.
3. The document discusses the history, exam, differential diagnosis, diagnostic workup, and treatment of common causes of acute abdominal pain such as appendicitis and diverticulitis.
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.
- Hashimoto's thyroiditis is the most common cause of goiter in adolescents. It can cause transient hyperthyroidism early on before developing into hypothyroidism, with symptoms like decreased growth, delayed puberty, constipation, and myxedematous facies. It is confirmed by elevated antibodies and labs showing hyper, hypo, or euthyroid states.
- Untreated congenital hypothyroidism can lead to decreased IQ and neurodevelopmental delays in neonates. Congenital causes include thyroid dysgenesis or dyshormonogenesis, while acquired causes are usually Hashimoto's or subacute thyroiditis.
- Thyroid nodules or masses
This document provides guidance on recognizing, evaluating, and managing various blood and neoplastic disorders in children. Key points include recognizing signs of quantitative or qualitative leukocyte disorders like recurrent infections; distinguishing causes of bruising or purpura; evaluating anemia based on cell size and shape; managing neutropenia with growth factors or addressing causes; treating thrombocytopenia based on count and symptoms; and surveillance for tumors in overgrowth syndromes. Evaluation involves a thorough history, physical exam, and interpretation of blood tests to identify underlying etiologies and guide therapeutic approaches like transfusions or medications.
This document discusses the history and use of animals in art and literature. It describes how early humans depicted animals in cave paintings and sculptures, often using them to represent gods or as symbols. Animals were commonly featured in ancient Egyptian and Assyrian art, and became a prominent focus of Greek art. During the Renaissance, animals were often painted or sculpted for their own aesthetic appeal rather than symbolic purposes. Later, animals were frequently used as moral allegories or to provide social commentary in fables and stories. Their depictions aimed to elicit empathy, sympathy, and interest from audiences.
This document discusses various topics in cardiology as they relate to pediatrics. It covers general aspects of blood pressure and chest pain, syncope, murmurs, congestive heart failure, cyanotic and acyanotic congenital heart disease, infectious endocarditis, and more. Key points include distinguishing innocent from pathological murmurs, signs of congestive heart failure, cardiac causes of cyanosis in newborns, complications of polycythemia, management of cardiogenic shock, indications for antibiotic prophylaxis, and initial management of a premature infant with a patent ductus arteriosus.
This document contains a collection of short phrases and quotes related to global citizenship, cultural awareness, and international understanding. The quotes touch on themes of open-mindedness, cultural exploration, making positive impacts, and empowering future generations.
The document discusses renal disorders and abnormalities in children. It covers normal renal function and development, causes of proteinuria and hematuria, urinary tract infections, congenital abnormalities like renal dysplasia and posterior urethral valves, and hereditary and acquired kidney diseases. Key points include the appropriate evaluation and management of common pediatric renal problems based on presenting signs and symptoms.
The Child with Abdominal Pain: NHS Modernisation AgencyArm inarm
This document provides guidance on evaluating abdominal pain in children. It outlines taking a thorough history and performing a careful physical exam, paying attention to signs of serious conditions like appendicitis. Common causes of pediatric abdominal pain include constipation, infections, and nonspecific abdominal pain, though rarer surgical issues like intussusception may also need consideration. A systematic approach is advocated to identify potential medical or surgical conditions causing a child's abdominal symptoms.
Intestinal duplications are rare congenital anomalies consisting of tubular or spherical structures attached to the intestine with a shared blood supply and intestinal lining. They are classified into 3 categories: localized duplications occurring anywhere in the gastrointestinal tract, duplications associated with spinal cord anomalies, and duplications of the colon associated with urinary/genital anomalies. Clinical manifestations include bowel obstruction, abdominal pain, and palpable masses. Diagnosis is based on history and physical exam. Treatment involves surgical resection and management of any associated defects.
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.
Intussusception is the telescoping of the proximal bowel into the distal bowel. It is most common in children under 2 years old, with the majority of cases being idiopathic. The classic triad of symptoms includes intermittent abdominal pain, a sausage-shaped abdominal mass, and bloody stools, though this triad is present in less than 15% of cases. Ultrasound is the preferred diagnostic tool, showing a target or doughnut-shaped mass. Treatment involves rehydration and stabilization, with non-operative reduction via hydrostatic or pneumatic enema being first-line for stable patients without evidence of perforation. Surgery is pursued if non-operative reduction fails or if there are signs of
Intussusception is the telescoping of the proximal bowel into the distal bowel. It is most common in children under 2 years old and presents with intermittent abdominal pain, a palpable abdominal mass ("sausage-shaped"), and bloody stools. Ultrasound is the primary diagnostic tool, showing a target or doughnut sign. Treatment involves rehydration, antibiotics if infected, and non-operative reduction initially with air or barium enema. Surgery is needed if reduction fails or there is perforation with resection and anastomosis. Complications can include necrosis, perforation, sepsis but mortality is low (less than 1%) with prompt diagnosis and treatment.
This document provides an overview of common gastrointestinal abnormalities seen in pediatric patients. It discusses conditions such as vomiting, hypertrophic pyloric stenosis, duodenal atresia, intestinal malrotation, midgut volvulus, meconium ileus, necrotizing enterocolitis, Meckel's diverticulum, intussusception, appendicitis, Hirschsprung disease, mesenteric cysts, and anorectal malformations. For each condition, it provides a brief definition and discussion of relevant physical exam findings, diagnostic approaches, and treatment considerations for pediatric patients.
Intussusception is the telescoping of one part of the intestine into another part and is most common in children under 2 years old. The classic presentation includes intermittent abdominal pain, a sausage-shaped abdominal mass, and currant jelly stools. Ultrasound is the preferred diagnostic method and shows a target or "doughnut" sign. Treatment involves rehydration and antibiotics if infected. Non-operative reduction using hydrostatic or pneumatic pressure is usually attempted first but surgery may be needed if reduction fails or there are signs of perforation or necrosis. With prompt diagnosis and treatment, mortality from intussusception is less than 1%.
This document discusses intestinal obstruction, including its causes, classifications, symptoms, diagnosis and treatment. Some key points:
- Intestinal obstruction can be caused by adhesions, hernias, tumors, strictures and more. It is classified by the obstructed site and presence of blood flow issues.
- Symptoms include pain, vomiting, constipation and distension. Signs depend on obstruction location and duration. Strangulated obstructions require urgent surgery to prevent tissue death.
- Diagnosis involves medical history, physical exam, imaging like x-rays and CT scans. Treatment involves resuscitation, nasogastric drainage, and surgery to relieve the obstruction and address the underlying cause. S
Pediatric GI problems
Abdominal pain in children
DDx: Acute abdominal pain
Inflammatory:
• Abdominal infection: appendicitis, gastroenteritis, UTI, mesenteric adenitis (post URTI), mumps pancreatitis, hepatitis.
• Lower lobe pneumonia.
• Autoimmune: IBD, HSP, DKA.
Anatomical:
• GI obstruction, constipation.
• Meckel's complication e.g. obstruction, inflammation. However, Meckel's is usually asymptomatic.
• Renal and genitourinary: hydronephrosis, menstruation.
• Compressed anatomy: strangulated inguinal hernia, testis torsion.
Acute abdominal pain in children often has no specific cause ('non-specific abdominal pain'), and resolves in 24h.
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Volvulus nursing, medical, surgical managementsReynel Dan
This document provides information on nursing management, medical management, and surgical management of intestinal obstruction. For nursing management, it describes assessment, diagnoses, interventions, patient teaching, and expected outcomes. For medical management, it outlines the diagnostic evaluation and nonsurgical treatment options. For surgical management, it discusses the surgical procedure options to relieve the obstruction.
The document provides an overview of the approach to acute abdomen. It defines acute abdomen and outlines the general approach using the SOAP method - taking a history, performing a physical exam, ordering investigations, and creating a treatment plan. Common causes of acute abdomen are then discussed through various case scenarios involving factors like age, location of pain, onset, character, and associated symptoms. A detailed guide is given for examining the abdomen and evaluating vital signs, jugular venous pressure, lymph nodes, and potential referrals from other organ systems. Key blood tests are also outlined to check for indicators of issues like infection, hemorrhage, or electrolyte imbalances.
lower GIT bleeding: is bleeding from a source distal to the ligament of Treitz (duodenojejunal junction), presented as
Hematochezia is blood passed with stool from the anus,
Melena is black, tarry stool produced by the oxidation of heme by intestinal flora; as little as 50 mL of blood may result in melena, and it may persist for 3 to 5 days following resolution of the bleed.
Maroon-colored stool is associated with rapidly bleeding small bowel lesions in which the transit of blood is too fast for complete oxidation.
Currant-jelly stool is associated with ischemic small bowel or proximal colonic lesions such as may be seen in intussusception.
Upper GIT bleeding: is bleeding from a source proximal to the ligament of Treitz (duodenojejunal junction).
Discussion included the definition of bleeding per rectum, it's types according to child age groups, it's presentation, how to diagnose each type and how to treat.
acute abdominal pain in pediatrics. include background and approach also there are three cases included, intussusception, Hirschsprung's disease and DKA.
The patient presented with symptoms of intestinal obstruction including abdominal pain, nausea, vomiting and abdominal distension. Physical exam revealed abdominal tenderness and laboratory tests showed signs of dehydration and inflammation. Radiographic imaging confirmed multiple dilated loops of small bowel consistent with mechanical intestinal obstruction. The obstruction was determined to be complete based on symptoms. The patient's history of previous appendectomy suggested the underlying cause was likely adhesive obstruction. Treatment involved fluid resuscitation, gastrointestinal decompression and antibiotics, with potential for surgical lysis of adhesions if symptoms did not improve.
Abdominal pain during pregnancy can have many causes and requires careful diagnosis. A thorough history and physical exam are important to determine the nature, timing, and location of the pain. Common causes include conditions of the reproductive organs like ectopic pregnancy or ovarian cysts. Other medical issues like appendicitis, pancreatitis, or infections must also be considered. The diagnosis and treatment plan aim to address the mother's needs while minimizing risk to the fetus. Proper evaluation and early intervention are important to prevent life-threatening complications for both mother and baby.
This document discusses several congenital anomalies of the gastrointestinal tract, including Meckel's diverticulum, Hirschsprung's disease, and pyloric stenosis. Meckel's diverticulum is a true diverticulum of the small intestine resulting from persistence of the vitelline duct. It occurs in 2% of the population and can cause bleeding, obstruction, or inflammation. Hirschsprung's disease is caused by absence of ganglion cells in parts of the colon and is the most common cause of intestinal obstruction in neonates. Pyloric stenosis results from hypertrophy of the pyloric muscle and causes non-bilious vomiting in infants, usually starting after 3 weeks of age.
The document provides an overview of esophageal disorders, including their symptoms, diagnosis, and management. Key points include:
- Dysphagia can be caused by obstructive lesions like cancer/strictures or motility disorders. Diagnosis involves barium swallow, endoscopy, and manometry.
- Odynophagia can be due to conditions like GERD, infections, pill esophagitis, or radiation esophagitis.
- Barrett's esophagus develops in some with longstanding GERD and requires surveillance due to cancer risk.
- H. pylori testing is recommended if treating, for persistent dyspepsia, or lymphoma risk. Endoscopy is considered
Intussusception is a condition where part of the bowel folds into itself like a telescope, causing obstruction. It typically affects infants and young children under 5 years old. The cause is often unknown but may be due to viral infections or anatomical abnormalities. Symptoms include severe abdominal pain, vomiting, and bloody stools. Ultrasound is used to diagnose by identifying the "target sign" of folded bowel segments. Treatment involves air or liquid enemas to try to reduce the intussusception, while surgery may be needed if reduction fails or the bowel becomes damaged. Complications can include bowel obstruction, tissue death, perforation and even death if not properly treated.
This document discusses appendicitis, including its causes, symptoms, diagnosis, and treatment. The appendix is a small pouch connected to the cecum in the digestive system. Appendicitis occurs when the appendix becomes blocked and infected, causing swelling. Common symptoms include abdominal pain localized to the lower right side, nausea, loss of appetite, and fever. Doctors use physical exams, blood tests, imaging like CT scans, and ultrasounds to diagnose appendicitis and rule out other potential causes of abdominal pain. Untreated appendicitis can lead to a burst appendix, so surgical removal of the inflamed appendix (appendectomy) is usually required to treat appendicitis.
This document discusses intestinal obstruction, including its definition, classification, etiology, pathophysiology, symptoms, signs, diagnosis, and management. Intestinal obstruction can be dynamic or mechanical in nature. Mechanical obstructions are further classified as luminal, intramural, or extrinsic lesions. Common causes include adhesions, hernias, tumors, and gallstones. Symptoms include abdominal cramps, vomiting, and constipation or diarrhea. Diagnosis involves examination of the abdomen and imaging tests. Initial management is conservative with NG tube, IV fluids, and antibiotics. Surgery is indicated for peritonism, deterioration, or failure of conservative treatment and may involve lysis of adhesions, resection, or
Bibliography for peds pain and symptomEmily Riegel
This document provides references on pediatric pain and symptom management, organized into textbooks, journal articles on specific topics, and other symptoms. It lists 8 textbooks that cover topics like pain in neonates and infants, palliative care for children, care of dying children, and pain management guides. It also lists several journal articles on managing pain, as well as other common symptoms experienced by pediatric patients, such as gastrointestinal issues, fatigue, dyspnea, neurological symptoms, existential suffering, and the withdrawal of life-sustaining treatments.
This document summarizes several craniofacial and genetic syndromes, listing their key signs and symptoms as well as inheritance patterns. Some of the syndromes discussed include Treacher-Collins syndrome, characterized by cleft palate and lower eyelid abnormalities; Apert syndrome, which involves craniosynostosis and syndactyly; and Williams syndrome, seen in individuals with mental retardation, stellate iris, and heart defects. Many of the syndromes described have autosomal dominant or recessive inheritance patterns.
This document provides guidance on preventive pediatrics including immunizations, screening tests, disease prevention, and anticipatory guidance. It details immunization schedules and indications for vaccines such as hepatitis A/B, meningococcal, tetanus, varicella and outlines contraindications. It also covers screening recommendations for blood pressure, lead levels, hearing and vision. Anticipatory guidance is provided on safety, poison prevention, water safety, sun exposure and firearm risks.
Bone age radiographs can provide information about a child's adult height potential and exposure to sex steroids if their bone age is advanced compared to their chronological age. Children with familial short stature usually have a normal bone age, while those with constitutional delay of growth usually have delayed bone age. The cause of failure to thrive is nonorganic in the majority of patients, and extensive lab evaluation should be deferred until outpatient dietary management has been tried. Regular, periodic developmental screening using tools such as PEDS, ASQ, or M-CHAT can help identify developmental delays or risks. Key motor, cognitive, and language milestones include the ability to sit independently by 9 months and speak in 3 word sentences by 36 months
1. Newborn infants require careful management in the delivery room to prevent heat loss through drying, swaddling, and use of a radiant warmer. The Apgar score is used to assess the infant's transition and need for additional support.
2. Abnormal findings in a newborn such as delayed passage of meconium or lethargy require prompt evaluation which may include a physical exam, labs, imaging, or specialist consultation to identify potential issues such as infection, metabolic disorder, or obstruction.
3. Infants exhibiting signs of neonatal abstinence syndrome from in utero drug exposure require specialized care including a controlled environment and potential pharmacologic treatment to manage withdrawal symptoms over weeks. Their discharge
1. Newborn infants require careful management in the delivery room to prevent heat loss through drying, swaddling, and use of a radiant warmer. The Apgar score is used to assess the infant's transition and need for additional support.
2. Abnormal findings in a newborn such as delayed passage of meconium or lethargy require prompt evaluation which may include a physical exam, labs, imaging, or specialist consultation to identify potential issues such as infection, metabolic disorder, or obstruction.
3. Infants exhibiting signs of neonatal abstinence syndrome from in utero drug exposure require specialized care including a controlled environment and potential pharmacologic treatment to manage withdrawal symptoms over weeks. Their discharge
This document discusses normal nutritional requirements and deficiencies in infants and children. It covers age-related nutritional needs, breastfeeding benefits, formula feeding, and vitamin deficiency states including iron deficiency anemia, rickets, and vitamin B12 deficiency. The key points are:
1) Nutritional requirements vary based on age and developmental stage. Breastfeeding provides antibodies and benefits but human milk is low in iron. Formula is carefully formulated but some infants are at risk for allergies.
2) Iron deficiency is the most common nutritional deficiency and can cause developmental delays if severe. Rickets results from vitamin D or calcium/phosphorus deficiencies and causes bone deformities.
3) Vitamin deficiencies may result from
The document discusses various respiratory disorders in children. It covers signs and symptoms of conditions like stridor, cough, wheezing, and apnea. It describes common etiologies of different respiratory problems in infants and children of various ages. It also outlines approaches to evaluating respiratory symptoms, distinguishing between conditions, and managing specific disorders like croup, epiglottitis, pneumonia, tracheomalacia, and hemoptysis.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
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29. Occurs when a part of the intestine “telescopes” into an adjoining segment of bowel. Can drag mesentery in along with it, leading to venous obstruction, edema of the bowel. The edema can then eventually lead o arterial obstructionischemiaperforation
31. Presents with abd pain, vomiting and bloody stools; currant jelly stools can occur days after the initial abd pain; if an infant they may have episodes where they draw up the legs, scream, and then after awhile they go back to normal – this is b/c it can be episodic in nature but then eventually it gets constant
32. During an episide you might be able to feel the sausage shaped mass in the upper abd
33. Diagnostic and therapeutic test of choice is the air-contrast enema, it will actually reduce the intussusception 90% of the time without needing surgery; but don’t do it if they have peritonitis, instead they need surgery
35. Most commonly caused by nonrotation; in this case the cecum is on the left side and the small intestine is all on the right side of the superior mesenteric artery. Leads to a short mesentery and minimal fixation of the bowel to the posterior peritoneal cavity. The duodenum is small and it fuses with the colon via a common mesentery around the superior mesenteric artery. Adhesions known as Ladd bands fix the mesentery to the right abdominal wall.
36. 90% of cases present in the first year of life; often in the first month of life
37. Presents as an acute process with episode of bilious emesis due to an acute midgut volvulus; later signs include rectal bleeding, hematemesis, palpable bowel loops, and a distended abdomen with possible respiratory compromise and systemic shock
38. Radiographs will often show a gasless colon with the “double bubble” sign due to duodenal obstruction
55. Weiht loss, unexplained fevers, pain radiating to the back, bilious emesis, hematemesis, hematochezia/melena, chronic diarrhea, GI blood loss, oral ulcers, dysphagia, unexplained rashes, nocturnal sx, arthritis, anemia/pallor, delayed puberty, decel of linear growth velocity, family h/o inflammatory bowel dz
56. Any of these require further evaluation to look for an organic cause prior to a dx with a functional bowel disorder assocated with abdominal pain or discomfort
57. Know how to recognize and manage irritable bowel syndrome
58. IBS = abdominal pain or discomfort that is relieved with defecation and is associated with either a change in frequency or consistency of the stool
59. Management is initially addition of a fiber supplement, which can help in 50% of cases. Other txes are antispasmodics (hyoscyamine), antidiarrheals (loperamide), cholestyramine, probiotics. Second line therapies include psychotherapy, CBT, hypnosis
137. lack of lab or radiographic evidence to support an alternative dx
138. During an episode, to establish the dx must rule out other pathology. Need to check for intraabd pathology, CNS pathology
139. During an episode it is helpful to check lytes, and get some metabolic studies (ammonia, urine organic acids, acylcarnitine, plasma amino acids, pyruvate and lactate
140. TX: if older than age 5 often ppx with amitryptiline; if under age 5 cyproheptadine is of choice
151. GI sx can include dysphagia, excessive drooling, poor feeding, vomiting, gagging, retching, anorexia, neck or throat pain, sensation of foreign body in the throat, refusal to eat or drink
152. Respiratory sx can be caused due to the object compressing on the posterior tracheal wall or larynx. It could produce cough, stridor, wheezing, choking
162. If they have persistent reflux (more than 3 months) or complicated reflux (having hematemsis or respiratory sx) then they need more involved workup
163. Includes GI films to r/o malrotation and hiatal hernia; pH probe or esophageal impedance, gastric emptying scan, esophageal motility eval, upper endoscopy w or w/o bx
170. GER itself usually does not need direct tx since it is physiologic, parental reassurance is what AAP wants with otherwise healthy babies
171. Formula can be thickened as a means to address the vomiting; addition of 1-2 tbs of rice cereal per oz of formula is the recipe in medstudy; note that this can cause some other feeding probs
172. Don’t give meds if otherwise uncomplicated GER. If pharmacologic tx is done, start with an H2 blocker or a PPI. If there are more severe and persistent complications, especially respiratory, then apparently okay to start with PPI
173. Surgical tx is a final option (note that in this case the kis has GERD, not just GER)
181. Know the common etiologic agents of infectious diarrhea in children
182. Infants and ToddlersChildren age 5 to 12 yearsAdolscentsRotavirusNorwalk virusNorwalk and Norwalk-likeEnteric adenovirusGiardiaCampylobacterSalmonellaEPECETECShigellaEHECEHECCampylobacterETECSalmonellaYersiniaSalmonellaShigellaGiardiaCampylobacter
198. Important to know that the shiga-toxin producing e. coli (STEC, formerly known as EHEC) cannot ferment sorbitol and to culture it you have to use MacConkey agar; therefore know that a special test has to be ordered if this infection is suspected and then it has to be verified often by a state lab
199. Remember it causes HUS (TCP, hemolytic anemia, nephropathy) and therefore those lab problems
200. Illness often biphasic, starts off as a bad diarrhea and then the next phase is more systemic, possibly more severe diarrhea (this is when the HUS would be seen)
204. Recognize the sx, available tests and tx of milk protein intolerance
205. Recognize that colitis in a breastfed infant is a possible manifestation of food allergy secondary to allergens in the mother’s diet
206. Know the ddx of noninfectious intractable diarrhea in infancy
207. Enteric infection and associate compromise in food intake and absorption lead to a variable loss of digestive and absorptive capacity in infants; a milder form is transient lactose intolerance (post0infectious lactose intolerance)
212. Understand the dx and px of chronic nonspecific diarrhea of early childhood (toddler’s diarrhea)
213. Onset at age 6-18 months; have multiple (6-12/day) loose, explosive bowel movements containing food particles; growth is normal as long as not on a restricted diet
214. Tx = reassurance, lifestyle modifications (reducing intake of high carb load beverages) and avoidance of restrictive diets
215. Recognize that poor growth, fever, melena are incompatible with the dx of chronic nonspecific diarrhea
216. Understand that extremely low fat diets, sorbitol, fruit juices, and excessive water consumption may cause chronic nonspecific diarrhea
223. Enterocolitis; usually occurs at age 2-4 weeks and is characterized by explosive foul smelling stool with a fever, abd distentions; diarrhea may be bloody
225. Know how to distinguish between simple constipation and Hirschsprung dz in the newborn period
226. Simple constipation: child will have passed meconium as expected; normal caliber stools; frequent encopresis; usually no associated anomalies; abundant stool in the vaut
227. Hirschprung: failure to pass meconium in first 24 hours; “pencil thin” stools; no encopresis; associated with other anomalies (Down syndrome); absence of stool in rectal vault