Paediatric acute abdomen
Red flags:
[edit | edit source]- 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
[edit | edit source]- 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
[edit | edit source]Malrotation volvulus
[edit | edit source]- Usually presents during first four weeks
- Bilious vomiting
- Abdo discomfort
- Often initially well but deteriorate rapidly
Hirschsprung Disease
[edit | edit source]- 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
[edit | edit source]- 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
[edit | edit source]- More common on right, generally indirect, more common in boys
Intussusception
[edit | edit source]- 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
[edit | edit source]- Consider differentials - ovarian, urological, gastrointestinal