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.