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BS 9 y/o boy with Abdominal Pain. History. 9 y/o boy with 5/7 hx D & V assoc with lower abdominal pain. Anorexia 5/7, tolerating fluids Nil blood or mucous in stool Mild fever Lower abdo pain mostly RIF initially. Given buscopan and paracetamol by GP – no improvement.

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history
History
  • 9 y/o boy with 5/7 hx D & V assoc with lower abdominal pain.
  • Anorexia 5/7, tolerating fluids
  • Nil blood or mucous in stool
  • Mild fever
  • Lower abdo pain mostly RIF initially. Given buscopan and paracetamol by GP – no improvement.
  • C/- abdo pain with bumps on the car ride
slide3
Exam
  • T 37.4 P91 R24 BP105/48 99% on RA
  • Dehydrated
  • Holding abdomen, avoiding movement
  • CVS, Resp, Testes NAD
  • Abdo:
    • Soft, very tender
    • Rebound tenderness ++ in LIF and RIF (worst in LIF)
    • Nil masses
    • Unable to mobilise to examine hop due to pain
    • Unable to cough due to pain
slide4
Ix
  • WTU
    • Glu neg; Ket 15mg/dL; Blo Trace; pH 5.5; Pro 100mg/dL; Nit neg, Leu neg
  • Bloods
slide5
DDx
  • Gastroenteritis
  • Appendicitis
  • Meckel’s
  • Mesenteric Adenitis
slide8
Mx
  • Immediate laparotomy

Findings

  • Appendix: small perforation, gangrenous and purulent
new paediatric abdominal pain procedure
New Paediatric Abdominal Pain Procedure

1. Initial Assessment by ED Dr

  • History, exam
  • Ward Test Urine – UTI, Diabetes, Pregnancy
  • Pathology – FBC, CRP (During lab hours – 0700 to 2400)
  • Clinically rule out pneumonia
    • CXR if necessary (During Radiology hours 0800 to 2200)

2. Paediatric Dr to review

  • Initial Alvarado and PAS scores

3. After Hours

ED Dr to follow as above and notify paed’s Dr on call.

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