00:01
Pediatric acute abdominal pain.
00:04
Things that you want to keep
in mind, acute abdominal pain.
00:07
We’ll be focusing
upon the following:
Acute gastroenteritis
being the most common.
00:12
We’ve talked about
rotavirus as being the –
the virus being very common.
00:16
We also talked about salmonella,
Campylobacter jejuni so and so forth.
00:21
Let’s start talking about
ages here once again.
00:23
Acute abdominal pain.
00:26
Less than two years of age:
trauma, intussusception,
incarcerated hernia.
00:33
What does that mean?
This was an inguinal hernia
which went through
the inguinal canal.
00:39
It became –
What became?
The intestine became strangulated.
00:44
It became incarcerated.
00:46
What are you worried about
in acute abdominal pain?
Rupture, peritonitis and death.
00:52
Volvulus, urinary
tract infection.
00:54
Less than two years of age.
00:55
2 to 5: African-American,
sickle cell anemia.
01:01
What does that mean to you?
This means that there is
vaso-occlusive crisis
especially when this African-American is playing.
01:09
There’s sickling of the RBC,
therefore, decreased blood supply to
the, maybe perhaps, the mesentery.
01:16
Welcome to acute abdominal
pain with sickle cell anemia.
01:20
Even amazingly -- look at
this, this is no joke --
Lower lobe pneumonia,
more common than you would
think in clinical practice.
01:28
This is a child
and you're thinking, “Dr.
Raj, is that a mistake?
You’re saying pneumonia causing
acute abdominal pain?”
When the lungs are in the chest,
remember this is a
child, so therefore,
lower lobe pneumonia which
is right above the diaphragm
is going to be very
close to his abdomen,
and in a child between ages
of two to five years of age,
in fact, is a very common cause
of acute abdominal pain.
01:55
And the x-ray here may or may not
even show changes in a child.
01:59
So it behaves atypical. Keep
that in mind. Big time.
02:03
Urinary tract infection here as well.
02:05
Older children, so now
we’re getting into
eight years, ten years,
eleven years and such,
and we have appendicitis.
02:13
Mittelschmerz, ectopic pregnancy
and pelvic inflammatory disease
Many of these are actually
very much in a female.
02:20
Mittelschmerz means --
Remember, in the middle of the
menstrual cycle is when the egg
egg is being released
from the ovary.
02:28
Picture that.
02:29
The follicles rupturing from
the ovary, there goes the egg.
02:33
Who’s going to catch it?
“I got, I got it.”
Who’s the mitt?
Who’s the catcher?
The fallopian tube
and the fimbriae.
02:42
And during that time when
the follicle ruptures,
you might get a little bit
of blood in the peritoneum.
02:48
That will cause acute
abdominal pain in a female.
02:51
Welcome to mittelschmerz.
02:53
And we have ectopic pregnancy.
02:55
Think about ectopic pregnancy.
02:58
As the egg which has not been fertilized
instead of being planted in
the uterus in that female
may get then obviously trapped
in the fallopian tube.
03:08
Acute abdominal pain and PID
being one of the most common
causes of ectopic pregnancy.
03:14
Use common sense,
use the information that we’ve
accumulated, accumulated, accumulated,
and go with the ages here and
make the correct diagnosis.
03:24
Age becomes, as you can see
here,
incredibly important
for differentials.
03:30
Diagnosis, all etiologies.
03:33
GI, reproductive, renal,
all of that area.
03:37
Consider CBC to help you figure out.
03:40
Urine analysis
becomes important.
03:42
Pregnancy test.
03:43
Maybe it’s pancreatitis, right?
Pancreatitis.
03:47
Cystic fibrosis, pancreatitis,
abdominal pain.
03:50
Liver function tests, chest
x-ray, abdominal x-ray, CT scan,
depending as to
what your cause is.