Professional Documents
Culture Documents
In Children
Hai Ho, M.D.
Department of Family Practice
Pathophysiology of pain
• Visceral pain
– Mechanical – stretching
– Chemical – mucosa
– Aching and dull, poorly localized
• Parietal pain
– Sharp, well-localized
Pathophysiology of pain
• Referred pain
– Somatic and visceral afferent fibers
enter the spinal close to each other
• Localization of pain
– Bilateral – most GI tract, midline pain
– Unilateral – kidney, ureter, ovary,
somatic
History
• Usual: quality, location, severity,
associated symptoms,
aggravating/alleviating factors
• Kids cannot give a history
• Dangerous signs given by parents
My history: the red flags
• Duration – acute vs. chronic
• Fever – inflammation, infection
• Vomiting – stasis, obstruction,
dehydration
• Urine output – volume depletion
• Diarrhea - bloody
Examination
• Usual: inspection, auscultation,
percussion, palpitation
• Rectal – rectocecal appendicitis,
occult blood
• Pelvic – PID
• Scrotal - torsion
Tests?
• Chemistry – electrolyte abnormality,
BUN/creatinine, liver function test
• CBC – infection, bleeding
• Plain abdominal x-ray – free air,
obstruction
• Urinalysis – pyuria, hematuria
• Pregnancy test
Pyloric stenosis
What is pyloric stenosis?
Shoulder sign -
indentation of
pylorus into the
stomach
UGI
• String sign
• Pyloric spasm may
mimic the string
sign
Treatment?
• Medical resuscitation first
– IVF hydration with potassium
– Correction of alkalosis because of
postoperative apnea associated with general
anesthesia
• Pyloromyotomy
• Endoscopically-guided balloon dilation –
surgery is contraindicated or incomplete
pyloromyotomy
Pyloromyotomy
Pyloromyotomy
Pyloromyotomy:
laparoscopy
Postoperative
management
• May be fed within 12-24 hours, early
as 4 hours post-op in one study
• Vomiting
– Not a reason to delay feeding
– GER – up to 80% post-op
– Consider UGI if vomiting persists > 5
days
Intussusception
What is
intussusception?
Invagination of intestine into itself
Pathophysiology
• Proximal bowel
telescopes into distal
segment, dragging
along mesentery
• Compression of
mesenteric vessels &
lymphatics leads to
edema, ischemia,
mucosal bleeding,
perforation, and
peritonitis
Ileocolic intussusception
Causes of
intussusception?
• Idiopathic –
– 75% of ileocolic intussusception
– More likely in children < 5
Causes of intussusception
• Leading point
– Hyperplasia of Peyer patches in terminal
ileum
– Structural: small bowel lymphoma,
Meckel diverticulum
– Systemic: cystic fibrosis, Henoch-
Schönlein, Crohn disease
Epidemiology
• Male:female – 3:2
• Age –
– 3 months to 6 years with 80% < age 2
– Peak at 6-12 months
• Most common - ileocolic
Clinical manifestations?
• Intermittent, severe, crampy
abdominal pain with loud cry and in
curled up position
• Vomiting
• Appear normal between attack
• Currant-jelly stool
Currant-jelly stool