Bs 9 y o boy with abdominal pain
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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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BS 9 y/o boy with Abdominal Pain

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Bs 9 y o boy with abdominal pain

BS 9 y/o boy with Abdominal Pain


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


Bs 9 y o boy with abdominal pain

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


Bs 9 y o boy with abdominal pain

Ix

  • WTU

    • Glu neg; Ket 15mg/dL; Blo Trace; pH 5.5; Pro 100mg/dL; Nit neg, Leu neg

  • Bloods


Bs 9 y o boy with abdominal pain

DDx

  • Gastroenteritis

  • Appendicitis

  • Meckel’s

  • Mesenteric Adenitis


Alvarado score

Alvarado Score

8


Paediatric appendicitis score

Paediatric Appendicitis Score

9


Bs 9 y o boy with abdominal pain

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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