Abdominal Emergencies

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

INFANT

CHILD

ADOLESCENT

Medical

UTI

UTI

UTI

Constipation

Constipation

Constipation

Gastroenteritis

Gastroenteritis

Gastroenteritis

Sepsis

Functional

Functional

Gastroesophageal reflux

HSP

IBD

Colic

IBD

Pelvic inflammatory disease

HUS

Sickle cell crisis

Pneumonia

Diabetic ketoacidosis

Strep throat

Sickle cell crisis

Diabetic ketoacidosis

Mesenteric adenitis

Surgical

Malrotation/volvulus

Intussusception

Appendicitis

Hirschsprung’s disease

Appendicitis

Cholecystitis

Necrotizing enterocolitis

Testicular torsion

Ectopic pregnancy

Incarcerated hernia

Pancreatitis

Testicular torsion

Intussusception

Pyloric stenosis

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Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Abdominal Emergencies

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