Sudden attacks of paroxysmal abdominal pain and severe loud crying that may persist for hours.
Earliest sign of appendicitis.
s/s of appendicitis other than periumbilical pain.
- child awakens with pain that peaks, then subsides and migrates to the RLQ
- low stool volume w/ mucus
- evolves over 12 hours
When may symptoms lessen w/ appendicitis?
- following perforation
- (also, child may be quiet b/c movement hurts)
Most common cause of intestinal obstruction in children between 3 months and 6 yrs of age.
Most common age and gender for intussusception occurence.
What is the "rule of threes"?
- crying for more than 3 hrs, more than 3 days/week, & more than 3 weeks
- refers to Colic
Three s/s of Colic (other than crying).
- distended abdomen
- drawn up legs
- clenched hands
What is the first thing you should check with suspicion of colic?
check stool for occult blood to r/o diary allergy
Most common cause of intestinal obstruction b/w 3 mos-6 yrs old.
Intermittent colicky pain (spasms), with vomiting q 5-30 min.
What will stools be like with intussusception?
- currant jelly
- bloody w/ mucus
Sausage-like mass in URQ with distended, tender abdomen in young child.
Functional abdominal pain must be at least _____ per week for at least _______ prior to dx.
Age of kids who are typically dx w/ functional abdominal pain
< 2 yrs
Two important questions to ask to r/o functional abdominal pain.
- Nighhttime awakenings?
- Repetitive emesis?
Where is the pain with functional abdominal pain?
At what age is pyloric stenosis typically dx?
What imbalances can occur w/ pyloric stenosis?
- metabolic acidosis
What might you palpate with pyloric stenosis?
olive shaped mass
What race is pyloric stenosis most common?
Management of pyloric stenosis.
- send to radiology for upper GI
- surgical repair
Other name for Hirschsprung's Disease.
congenital aganglionic megacolon
What else needs to be done with a dx of Hirschsprung's?
Most common cause of lower intestinal obstruction in babies.
Suspect _________ if no meconium w/in first 48 hours of life.
Generally no intervention is needed if a foreign body has been swallowed and what? Unless what?
- it is in stomach or intestines & asymptomatic
- no passage w/in two weeks; or it was a battery
A swallowed foreign body should be removed if it has been in the esophagus for _____ or small intestine for ________.
Failure to thrive, food refusal, vomiting, epigastric pain, PPIs don't work, can happen in kids or adults. What is it and what is the tx?
- eosinophilic esophagitis
- id food allergies, work w/ allergist
- consider amino acid based formula
- inhaled steroids swallowed
Abrupt onset of abdominal pain is < ______.
Severe pain, very still and ill.
- peritonitis or appendicitis
Why would you check the eyes & skin with abdominal pain?
- pallor (anemia, GI bleed)
Why would you do a rectal exam with c/o abdominal pain?
anterior wall tenderness can mean peritonitis or other emergency
What are some red flags for abdominal pain?
- awaken from sleep
- pain > 6 hrs, change from original pattern
- syncope, vaginal or GI bleeding
- rebound tenderness, diminished BS
- chest or back pain
First signs of appendicitis in adults.
- anorexia & pain
- pain starts epigastric or periumbilical then
- RLQ w/ n & v
Six F's for cholelithiasis.
Who is at higher risk for cholelithiasis (other than 6 f's)?
- women on OCs
- pts taking thiazides
- obese pregnant
- high fat diet
- Native Americans
Where and when is the pain with a biliary stone?
- RUQ, radiates to scapula
- ~1 hr after meals, lasts up to 6 hrs
- if > 6hrs, can be infection
Positive Murphy's sign indicates?
RF for diverticulosis.
- low fiber diet, red meat, processed foods
What can be a cause of acute pancreatitis in females?
What can be a typical cause of acute pancreatitis in males?
heavy alcohol abuse
How can acute pancreatitis lead to atelectasis?
b/c pain is so severe, pt shallow breaths
Two enzymes drawn with suspected acute pancreatitis. Which is more specific?
Why would you do a chest x-ray with suspected acute pancreatitis?
to r/o pna
What three things does IBD encompass?
- ulcerative colitis
Typical age of onset for IBD.
Colonoscopy or sigmoidoscopy for Crohns and colitis?
- Crohns = colonoscopy
- Colitis = sigmoidoscopy (avoid colonoscopy!!)
Tx for UC and CD can include Azo-compounds. If so, what else should they be on and why?
Folic acid b/c they interfere w/ absorption
What meds should be avoided with ulcerative colitis?
Avoid what kind of drugs with diarrhea?
Stool studies should be done if diarrhea lasts how long?
>14 days? or >7?
A full workup for diarrhea should be done when?
- fever >102
- > 6 stools in 24 hours
- elderly or immunocompromised
- diarrhea w/in 3 days of hospitalization
- bloody or profuse watery stool
Most common pathogen for travelers diarrhea.
Enterotoxigenic e. coli
Increased risk of travelers diarrhea when traveling where?
- Latin America
- Middle East
Who is at higher risk for travelers diarrhea?
- taking H2 blockers or antacids
What defines travelers diarrhea?
> 10 loose stools in 8 hrs
If a pt with diarrhea is on abx and not doing better, what should you do?
Check for parasitic infections
Constipation is less than _______ in _______.
What two endocrine DO can cause constipation?
When is it not recommended to introduce a high fiber diet to treat constipation?
pts who have had a life long hx & have slow transit
What laxatives are recommended for constipation?
What should pts with constipation NOT be using OTC? Why?
- hyperosmolar saline meds
- can cause extensive dehydration or
- acute kidney injury or
- worsen HF
When should hyperosmolar saline meds especially be avoided?
- over 55
- take BP meds, NSAIDs, or diuretics
A neuro-endocrine gut tumor that causes PUD.
______ used to be considered a RF for PUD but is not longer.
Burning, nonradiating upper abdominal pain can be a sign of?
Eating often relieves pain with this type of ulcer. What is typical age?
_______ ulcers typically present with nausea & anorexia, and food worsens pain. Typical age?
- older patients
- *elderly may be asymptomatic until perforation or GI bleed*
_________ should never be mixed with NSAIDs or ASA and pose a risk for PUD; when combined they are high risk for what?
PE for PUD should include any s/s of __________ in case of GI bleed or perforation.
For PUD, if over _______ or _________, refer to endoscopy.
- new onset of symptoms or red flags
For PUD and under 55 with no red flags, what should you do?
test for H. pylori
When might you get a false negative result for H. pylori?
if pt has been on PPIs or abx in the last 2 wks
Tx for H. pylori
PPI or H2 blocker + two abx x 10 or more days
After tx for H. pylori, pt tests neg on 4-week follow up. Then what?
- Continue 4 weeks acid suppression
- if doing better, continue for 2 more weeks
If H.pylori negative for PUD, assume what is cause? How to treat?
IF pos for H. pylori, when do you retest?
four weeks after treatment
Board-like rigid abdomen, low grade fever, s/s hypovolemia, absent BS.
perforate peptic ulcer - call EMS
Perforated peptic ulcers are more common in which type of ulcers?
What are lower GI bleeds usually due to?
- infectious colitis
- IBS if < 50 yo
- diverticular hemorrage if > 50 yo
How long should you tx GERD with PPIs? Why not longer?
- 8 weeks
- to avoid rebound hypersecretion
What are some safety concerns with PPIs, especially long-term use?
- increased fracture risk, osteoporosis
- decreased Mg++ absorption
Criteria for functional abdominal pain.
- All other things ruled out
- at least once/week for at least 2 mos
In malabsorption DO, ________ drops before ____.