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Acute abdominal pain in children and adolescents

Clinical Discipline(s)/Organ System(s)
Digestive System, General Surgery, Paediatrics, Emergency Medicine, General Practice
Progress Test Topic(s)
Child health, Digestive
Description
An 8 month old Māori boy comes to the Emergency Department with intermittent screaming episodes and becoming pale, accompanied by curling his legs. His mother thinks his tummy is rigid and says he passed some mucous into his nappy that morning.
Applied Science for Medicine 
   - Structure, function and common pathologies of the gastrointestinal tract in infants and children
   - Embryology and fetal development of gut and congenital abnormalities of the gastrointestinal tract
   - Pathogenesis of acquired disorders of the gastrointestinal tract: acute appendicitis, intussusception
   - Pharmacology of pain relief and prescribing in children; paracetamol
Clinical and Communication Skills 
   - History from caregiver with consideration of red flags (blood in stools, vomiting bile)
   - Assessment of the infant or child presenting with an acute abdomen: examination for signs of shock, dehydration, peritonism
   - Examination of the abdomen; ability to detect abdominal mass
   - Differential diagnosis of acute abdominal pain in infancy and childhood including important surgical conditions (for example acute appendicitis, intussusception) which can be difficult to diagnose in infancy
   - Radiologic diagnosis of intussception, perforation and obstruction
   - Interpretation of laboratory data (urine, blood parameters)
   - Management of fluid status, preoperative assessment of child
   - Role of radiological investigations and procedures
Personal and Professional Skills 
   - Communicate empathetically with child and caregivers
   - Evaluation of social history
Hauora Māori 
   - Awareness of whānau dynamics (who is/are carers, whānau caregiving issues, impact of illness on whānau employment/income (if needing to take time off work to be with child)
   - Discussion about surgery in the context of Māori values and health beliefs
   - Culturally safe engagement with this patient, his whānau and communities
   - Appropriate engagement and consultation with whānau
   - Assess health literacy needs of whānau
Population Health 
   - Provision of paediatric surgical and emergency services nationally
Conditions to be considered relating to this scenario
Common
urinary tract infection, pyelonephritis, constipation, infectious gastronenteritis, acute appendicitis, mesenteric adenitis, pneumonia (lower lobe)
Less common but 'important not to miss'
intussusception, peritonitis, intestinal obstruction, non accidental injury (traumatic perforation or organ laceration)
Uncommon
Henoch-Schonlein purpura, diabetic ketoacidosis, Hirschprung disease