Editing Paediatric acute abdomen

== Red flags: ==

* Bilious vomiting (SBO)
* Recurrent projectile vomiting (pyloric stenosis)
* Baby hungry after vomiting (pyloric stenosis)
* Faltering growth
* Bloodstained vomit or stool
* Severe dehydration
* Failure to pass meconium
* Signs of peritonism

== Initial management ==

* Fluid resus (correct hypovolaemia, hypoglycaemia, acid-base disturbance). Can initially give 10-20mL/kg of 0.9% NS
* NBM +/- NGT
* Bloods - FBE, UEC, LFT, BGL, coags, G+H, ?AXR
* Liaise w/ paeds surg

== Specific diseases ==

=== Malrotation volvulus ===

* Usually presents during first four weeks
* Bilious vomiting
* Abdo discomfort
* Often initially well but deteriorate rapidly

=== Hirschsprung Disease ===

* Failure of migration of ganglionic precursor cells within the bowel
* Most commonly affects rectum/sigmoid
* Failure to pass meconium, bilious vomiting, dehydration (also consider meconium ileus as a complication of CF)
* Needs rectal biopsy
* Treat with resection of affected region, then pull-through of normal bowel. Good prognosis.
** Complicated by Hirschsprung enterocolitis in about 25% of cases - bilious vomiting, explosive/foul-smelling stools, distended abdomen. Needs antibiotics and regular rectal washouts

=== Vomiting in newborn ===

* Overfeeding (most common by far) - related to feeds, generally bottle-fed
* GORD - small vomits, not related to feeds
* Pyloric stenosis (look for red flags above)
** Palpable olive-sized mass in right hypochondrium
** If no mass, get an USS
* Medical - systemic infection, cows milk protein allergy, gastroenteritis, poisoning

=== Hernias ===

* More common on right, generally indirect, more common in boys


=== Intussusception ===

* Colicky abdo pain, between 6 months and 2 years
* Most common at ileo-caecal junction
* 90% are idiopathic, otherwise consider Meckel's or polyps or lymphoma
* Severe colicky abdo pain, vomiting, palpable sausage-like mass in the abdomen, passage of redcurrant jelly stools (late)
* Resuscitate as above, including NGT. Confirm diagnosis with USS.
* Treat with air or fluid enema (success rate 75-95%, recurrence 10%)

=== Appendicitis ===

* Consider differentials - ovarian, urological, gastrointestinal

[[Category:Paed Surg]]