Paediatric abdominal pain.
In children with appendicitis which of the following statements is WRONG?
If a pelvic appendix sits on the bladder you can get white cells in the urine.
This neonate has a complication of Necrotising Enterocolitis (NEC). What is it being shown?
90% of NEC occurs in premature infants mainly in the first 2 weeks of life. It is characterised by inflammation, ischemia and permeability of the bowel wall to bacteria. All of the answers above may occur with NEC but specifically here Pneumatosis intestinalis--or air in the bowel wall, was being demonstrated.
This infant had intermittant severe abdominal pain. What does the following abdominal xray show?
The arrow points to the intussuscepiens, the part of the ileum that has telescoped into the large bowel. Ultrasound can be also very useful in diagnosis. If the infant does not have an acute abdomen then reduction can usually be done by an air enema. This is especially true for infants < 12mths who usually have idiopathic intussusception rather than it being caused by a "lead point" like a Meckels diverticulum "pulling" the bowel.
Which of the following venous gas results would be most consistent with a 4 week old baby with pyloric stenosis?
Loss of K+ and HCl in the vomitus gives them a hypochloremic, hypokalemic metabolic alkalosis. This is compensated by hypoventilation and an elevated C02.
The picture shows a "trichobezoar" which had caused abdominal pain in a child. What is the mass made from?
The person eats either their hair, others hair, even dolls hair and it gets matted in the stomach. If it gets beyond the pylous often with a long tail in the duodenum it is known as "Rapunzel syndrome". I kid you not.
Which of the following is UNTRUE about abdominal migraine?
Children with abdominal migraines are prone to develop migraines as adults. Treatment is similar to normal migraine that is sleep, rest, and analgesia.
Which of these is the most common cause of urinary retention in children?
Cystitis and sometimes a general viral illnesses are probably the most common cause. The image shows simple constipation causing urinary retention. Medications with anticholinergic side effects (like anti histamines) can cause it as well a group of diseases affecting neuromuscular dysfunction (think Guillain Barre, Transverse myelitis).
Which of the following is CORRECT about gallstones in children.
Gallstones do occur in children especially pigment stones when you have a blood dyscrasia like Sickle cell disease. Cholesterol stones are not common in children but cause 75% of adult stones. Calcium carbonate stones, rare in adults, make up about 25% of paediatric stones.
About 50 to 60% of children with Henoch-Schonlein purpura get abdominal pain. What percentage however get intussusception?
This IGA vasculitis causes the characteristic palpable purpura along with joint swelling, nephritis and abdominal pain.
The generally colicky abdominal pain is caused by bowel wall oedema and haemorrhage. Children with severe abdominal pain, once perforation and intussusception have been ruled out, are sometimes given a course of 1-2mg./kg of Prednisone orally.
A 13yr old girl presented with lower abdominal pain. She has not reached menarche yet. What does the short ultrasound video show? Hint--the image is longitudinal, the bladder is the dark triangular shape at the top of the image.
An imperforate hymen causes a collection of blood in the vagina when the girl is meant to have her first periods. The large collection can cause constipation or urinary retention by compression. In this case 1200ml of old blood was drained.