Abdominal Emergencies
Leah Harrington
Introduction
Abdominal pain is a common presenting complaint to the emergency department
Causes: medical vs surgical
Etiology varies by age
Principles of Management
Assess ABCs
Fluid resuscitation 20 mL/kg normal saline bolus
NPO
Surgical consultation
Pain management
Common Abdominal Emergencies
Intussusception
Bowel obstruction: malrotation
Gastrointestinal bleeding (see Chapter 27)
Appendicitis (see Chapter 28)
Intussusception
Telescoping of the bowel at the ileocecal junction leading to ischemia, subsequent necrosis, and death if undiagnosed and untreated
Triad of intermittent abdominal pain, vomiting, RUQ abdominal mass, plus occult/gross blood per rectum has a positive predictive value of 100%; but only present in 10-20% cases
Age 2 months to 6 years (peak 5-9 mo), male predominance
High index of suspicion to avoid missed diagnosis
May follow an episode of gastroenteritis, with enlarged mesenteric nodes acting as lead points
Older children may present with intussusception especially if lead points are present (e.g., intestinal lymphosarcoma) or in association with Henoch-Schonlein Purpura
Differential diagnosis: constipation, gastroenteritis, UTI, appendicitis
Small bowel intussusception: short segment, no pathological lead point, in otherwise asymptomatic children: conservative observation
Table 26.1 Major Diagnosis for Age | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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