Abdominal Emergencies
Leah Harrington
Introduction
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Abdominal pain is a common presenting complaint to the emergency department
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Causes: medical vs surgical
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Etiology varies by age
Principles of Management
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Assess ABCs
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Fluid resuscitation 20 mL/kg normal saline bolus
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NPO
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Surgical consultation
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Pain management
Common Abdominal Emergencies
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Intussusception
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Bowel obstruction: malrotation
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Gastrointestinal bleeding (see Chapter 27)
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Appendicitis (see Chapter 28)
Intussusception
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Telescoping of the bowel at the ileocecal junction leading to ischemia, subsequent necrosis, and death if undiagnosed and untreated
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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
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Age 2 months to 6 years (peak 5-9 mo), male predominance
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High index of suspicion to avoid missed diagnosis
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May follow an episode of gastroenteritis, with enlarged mesenteric nodes acting as lead points
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Older children may present with intussusception especially if lead points are present (e.g., intestinal lymphosarcoma) or in association with Henoch-Schonlein Purpura
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Differential diagnosis: constipation, gastroenteritis, UTI, appendicitis
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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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