Pediatric Colic

by Carlo Raj, MD

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    00:01 Our topic is pediatric colic.

    00:04 So what does colic mean to you? This the persistent pain that a child is exhibiting to the point where usually three months of age, with quite a bit of crying taking place, and this is just sad, pediatric colic.

    00:23 Now, what does increased amount of colicky pain – let’s say there’s between two months and two years of age, you as a clinician are going to be looking for quite aggressively? Maybe things like intussusception.

    00:42 Etiology unknown, maybe perhaps temperament? Well, perhaps.

    00:47 However, also keep in mind that it could be serious issues as we will get into in a little bit.

    00:54 Before we move on though, make sure you know what colic means.

    00:58 It means that the child is in severe abdominal discomfort and you’re going to be noticing quite a bit of pain and this pain will be paroxysmal.

    01:09 Diagnosis: The clinical history becomes of utmost importance.

    01:13 No diagnostic test at this point.

    01:16 Rule out the following important pathologies: Intussusception, we’ll talk about this in greater detail.

    01:26 This is called “telescoping of the intestine.” Hernias or perhaps even intestinal obstruction.

    01:34 Serious issues such as volvulus.

    01:40 Our topic with small bowel obstruction and signs and symptoms that you would expect would be bilious vomiting.

    01:47 Now with the bilious vomiting that you might find with a child that is experiencing this colic pain is an emergency.

    01:57 We’ll talk about pediatric colic and small bowel obstruction being caused by the following: Adhesions, quite common.

    02:06 Appendicitis.

    02:07 Intussusception.

    02:09 Inguinal hernia, where the intestine is passing through the inguinal canal.

    02:14 Meckel's diverticulum, the remnant of the vitelline duct, and malrotation issues, referring to volvulus.

    02:24 Anytime that you find bilious vomiting in your neonate, this is an emergency.

    02:29 This is not good.

    02:31 You’re worried about so much constipation, so much obstruction, to the point that even infarction might be taking place of a neonatal GI system.

    02:42 And if this ruptures, my goodness, the child is dead.

    02:50 Here are two x-rays and I’d like for you to give me diagnosis.

    02:55 On the left, we’re seeing multiple, multiple, multiple gas bubbles.

    03:01 The child experiencing quite a bit of pain.

    03:04 The child doesn’t know how to express this, the neonate, and so therefore, the neonate is doing what? Crying like crazy.

    03:13 Your child, the neonate, come to find out was born at the age of – was delivered at 26 weeks, 25 weeks.

    03:26 With this type of abdominal x-ray in a preterm child, no doubt your diagnosis is NEC, necrotizing enterocolitis.

    03:38 And this is no joke.

    03:41 Now etiology and such still pretty much eludes us as clinicians.

    03:45 However, you will be looking for in a stem of a question as to when this neonate was delivered, And if your neonate was preterm, in this type of x-ray, no doubt it’s necrotizing enterocolitis.

    04:00 This x-ray shows you dilation of the intestine.

    04:06 And in addition to that, there is going to be bilious vomiting.

    04:10 Both of these, necroting enterocolitis and this diagnosis of volvulus results in bilious vomiting.

    04:20 This to you means an emergency.

    04:22 What you’re worried about, this severe distention or necrotizing enterocolitis.

    04:27 You’re worried about gangrene setting in, rupture of the intestine, and the peritonitis that’s going to take place in the child so severe that you’re worried about death and mortality of your child.

    04:39 Two important x-rays, two important differentials resulting in bilious vomiting.

    About the Lecture

    The lecture Pediatric Colic by Carlo Raj, MD is from the course Pediatric GI Pathology.

    Included Quiz Questions

    1. Pediatric colic
    2. Intussusception
    3. Meckel's diverticulum
    4. Appendicitis
    5. Renal stone
    1. Hypertrophic pyloric stenosis
    2. Intussusception
    3. Meckel's diverticulitis
    4. Volvulus
    5. Inguinal hernia
    1. Consider the situation an emergency, and try to rule out another diagnosis with investigations.
    2. Provide adequate rehydration.
    3. Have the parents continue feeding the child a semisolid diet.
    4. Start antibiotics.
    5. Reassure the parents that the situation is not an emergency.
    1. Necrotizing enterocolitis
    2. Hypertrophic pyloric stenosis
    3. Meckel's diverticulitis
    4. Volvulus
    5. Intussusception

    Author of lecture Pediatric Colic

     Carlo Raj, MD

    Carlo Raj, MD

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