management of acute abdomen in children

1. MANAGEMENT of
Acute Abdomen in
Children
Treatment should be directed at
the underlying cause.

2. Indications for Surgical
Consultation in Children
Severe or increasing abdominal pain
progressive signs of deterioration
Bile stained or feculent vomitus
Involuntary abdominal
guarding/rigidity
Rebound abdominal tenderness

3. Indications for Surgical
Consultation in Children
Marked abdominal distension with
diffuse tympany.
Signs of acute fluid or blood loss
Significant abdominal trauma
Suspected surgical cause for the pain
Abdominal pain without an obvious
etiology

4. INTUSSUSCEPTION
90% < 2 years of age
More common in males
Associated with URI
Diarrhoea
rotavirus vaccine
hematoma(HSP)
Hemangioma
lymphoma

5. symptoms
• Pain abdomen of sudden onset
• Vomiting
• Sausage shaped mass
• Normal in between pain
• Blood stained finger on PR
examination

6. Investigations
Ba enema:Thin streak of Ba in intussusce-
ptum
USG: Target lesion in transverse plane

7. INTUSSUSCEPTION

8. INTUSSUSCEPTION

9. INTUSSUSCEPTION

10. Treatment
• Reduction with air enema
• Reduction with saline enema
• Reduction with radiocontrast
material

11. Other surgical causes

12. JEJUNAL ATRESIA

13. ATRESIA JEJUNUM

14. Congenital Megacolon

15. HIRSCHSPRUNGS

16. DUPLICATION CYST

17. DUPLICATION CYST

18. TORSION OVARY

19. ASCARIASIS

20. Abdominal Tuberculosis

21. Choledochal Cyst( intraop)

22. Functional abdominal
pain

23. Functional abdominal pain includes
several different types of
chronic abdominal pain
recurrent abdominal pain
three or more bouts of abdominal pain (belly ache) in
children 4-16 years old over a three-month period severe
enough to interfere with his/her activities.
located around the umbilicus
functional dyspepsia,
upper abdominal pain
nausea, vomiting,
irritable bowel syndrome (IBS).
pain relieved by motion
change in stool frequency
change in stool consistency

24. DIFFERENTIAL
DIAGNOSIS OF CHRONIC
ABDOMINAL PAIN
CONSTIPATION
ACID REFLUX
LACTOSE INTOLERANCE
CROHNS DISEASE
ULCERATIVE COLITIS
PARASITIC INFESTATION
HEPATITIS
PANCREATITIS
UTI
APPENDICITIS
INTESTINAL INFECTION

25. Implications
 Interference with school attendance
 Depression
 Anxiety
 Emotional disturbances

26. Absence of red flag signs
Fever
Fever
Wt. loss
Poor growth
Joint pain
Mouth ulcer
Unusual rashes
Loss of appetite
Hemetemesis
Melena
Night time awakening due to pain or
diarrhoea

27. Diagnosis
Normal physical examination
Absence of abnormal pathological
tests
Absence of red flag signs

28. Goals of management
Provide quality life through
Support
Education
Medication
Better coping skills

29. Management
Stick to the diagnosis
Avoid unnecessary invasive tests
Antispasmodics
Low dose tricyclic antidepressents
Avoid carbonated drinks
Psychological treatment:behavioural therapy
relaxation exercises
hypnosis

30. physician
parents
school
NORMAL LIFE

31. Colic
Excessive paroxysmal crying
Most often in evening hours
Healthy baby
Difficult to console
Equal frequency in male & female

32. Wessels criteria
Cry lasting > 3 hrs
Occuring > 3 days
for > 3 weeks

33. Etiology
Increased level of motilin
lactalbumin
5 HIAA
Psychological stress
Drugs during pregnancy

34. Frequency
10 to 30 % Infants worldwide
Sex : Equal frequency
Age : 2 wks to 4 months

35. History
Diagnosis of exclusion
Evening hours
Peaks at 6 weeks
High pitched cry
Exclude other causes : hair in eye
strangulated hernia
otitis
sepsis

36. Physical examination
Shows normal weight gain
Differential diagnosis
-Overfeeding
-Underfeeding
-Milk Allergy
-Early introduction of foods
-GERD
-No burping after feeds

37. MANAGEMENT
SIMETHICONE
Reduces the surface tension of
bubbles over intestinal surface.
Anticholinergic drugs
dicyclomine/ dicycloverine
relax muscles in the wall of the gut

38. Dietary management
Elimination of cows milk
eggs
wheat
nut products
Herbal tea
Car ride simulators
Reduced stimulation
Focussed parent counselling

39. Abdominal crisis sickle
cell anemia
• Belongs to a particular community
• H/o blood transfusion, joint pain
• May be associated with jaundice
• Anemia

40. Abdominal crisis in SCA
Sequestration crisis
Sudden enlargement of spleen
Shock
Pallor
Treatment: Blood transfusion

41. vaso occlusive crisis
Liver : microinfarct
Kidney: microscopic hematuria
gross hematuria
proteinuria
Spleen: infarct

42. Treatment of VOC
Blood transfusion -low Hb
IV fluides -dehydration
NSAID -Acetaminophen
ibuprofen
naproxen
Opoides -morphine

43. Pelvic inflammatory
disease
• Endometritis
• Tubo ovarian abscess
• Salpingitis
• Pelvic peritonitis

44. PID
Lower abdominal pain
Abnormal vaginal discharge
Adnexal temderness
Painful cervical movement
Dysmenorrhoea

45. Causes of PID
• N. gonorrhoeae
• C.trachomatis
• B hemolytic streptococci
• Peptostreptococus
• E.coli
• Gardenella
• Mycoplasma hominis