You are called to see a 7-year-old with acute abdominal pain
Patient
Gender: male
Age: 7 years
Weight: 60 lb/27.2 kg
Height: 49 in/124 cm
Vitals
Temperature: 98 F/36.7 C
Blood Pressure: 125/79
Heart Rate: 112
Respiratory Rate: 28
Pulse Oximetry: 96% RA
Signs and Symptoms
2d RLQ abdominal pain; 103 F fever; nausea/vomiting
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Patient will present as → a 14-year-old boy with nausea, vomiting, constipation, and periumbilical pain that has settled in the lower right quadrant. The patient’s mom gave him a piece of toast and some water about 5 hours ago but he vomited 30 minutes after eating. On physical exam, he has tenderness and guarding in the lower right quadrant, pain upon flexion and internal rotation of right lower extremity, RLQ pain with right hip extension, and RLQ pain with palpation of the LLQ. Blood tests reveal leukocytosis with a shift to the left.
The first symptom is crampy or "colicky" pain around the navel (periumbilical) → then pain over McBurney’s point (RLQ)
There is usually a marked reduction in or total absence of appetite, often associated with nausea, and occasionally, vomiting and low-grade fever
Most common etiology ⇒ fecalith
As the inflammation increases, the abdominal pain tends to move downward - begins in epigastrium → umbilicus → RLQ
Right lower quadrant= "McBurney's point." This "rebound tenderness" suggests inflammation has spread to the peritoneum
You are called to see a 12-month-old with episodic abdominal pain and vomiting
Patient
Gender: Female
Age: 12 months
Height: Not Available
Weight: 16.3 lb/7.4 kg
Vitals
Temperature: 99.4 F/37.4 C
Blood Pressure: 102/60
Heart Rate: 130
Respiratory Rate: 36
Pulse Oximetry: 99% RA
Signs and Symptoms
Episodic abdominal pain and vomiting
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Sudden onset of significant, colicky abdominal pain that recurs every 15 to 20 min, often with vomiting. Affects children after viral infections or adults with cancer
You are called to see a 61 y/o with acute onset severe abdominal pain and vomiting
Patient
Gender: Female
Age: 61
Vitals
Temperature: 99.4ºF/37.4ºC
Heart Rate: 67
Respiratory Rate: 16
Pulse Oximetry: 99% on RA
Blood Pressure: 130/79
Signs and Symptoms
Acute onset severe abdominal pain and vomiting
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Patient will present as → a 65-year-old female with diffuse abdominal pain and vomiting. She has not had a bowel movement in three days. PE reveals high-pitched, hyperactive bowel sounds, tympany to percussion, no rebound tenderness, and a temperature of 100.4 F. Abdominal radiograph reveals distended loops of bowel with a step ladder pattern of differential air-fluid levels.
What are the 4 cardinal signs of strangulated bowel?
The 4 cardinal signs of strangulated bowel: fever, tachycardia, leukocytosis, and localized abdominal tenderness.
Hyperactive bowel sounds (early) or hypoactive bowel sounds (late), prior abdominal surgery
Dehydration + electrolyte imbalances
MCC: adhesions or hernias, cancer, IBD, volvulus, and intussusception
KUB shows dilated loops of bowel with air-fluid levels with little or no gas in the colon
Large bowel obstruction
Gradually increasing abdominal pain with longer intervals between episodes of pain, abdominal distention, obstipation, less vomiting (feculent), more common in the elderly
Febrile, tachycardia → shock
Dehydration + electrolyte imbalances
MCC: cancer, strictures, hernias, volvulus, and fecal impaction
KUB shows dilated loops of bowel with air-fluid levels with little or no gas in the colon
Look for vomiting of partially digested food, severe abdominal distensions and high pitched hyperactive bowel sounds progressing to silent bowel sounds.
KUB shows dilated loops of bowel with air-fluid levels with little or no gas in the colon
Dilated loops of bowel and air-fluid levels in the abdomen
Treatment: Bowel rest, NG tube placement, surgery as directed by the underlying cause
