Allow me to present a common clinical scenario. The patient presents with right lower quadrant abdominal pain. Appendicitis is in the differential diagnosis. After an appropriately thorough H&P you have ascertained that it is not gastro/UTI/strep/pneumonia/constipation/porphyria/pregnancy etc., etc,. and obtain an ultrasound which shows a [...]
Perforation is more likely in younger kids because: 1. The appendix has a thinner wall 2. Younger children can’t communicate as well, resulting in prolonged symptoms before diagnosis 3. The level of suspicion for appendicitis is lower in younger age groups Pro-Tip: In addition, appendicitis [...]
Check out this study from Johnson et al. in Pediatrics. In "Association of Race and Ethnicity With Management of Abdominal Pain in the Emergency Department" the authors reviewed NHAMCS data and noted that patients who were categorized as non-Hispanic black were less likely to receive any [...]
Check out all four posts of the intussusception series right here. Part 1: The basics Part 2: Ultrasound-ing good Part 3: Air it out Part 4: Stuck in the middle with you (small bowel-small bowel)
Hopefully you've checked out part 1, part 2, and part 3. Though ileocolic is the most common type - small bowel-small bowel occur as well. Generally they present with similar symptoms (intermittent colicky pain etc,.). They are also diagnosed similarly with ultrasound being the best study, but [...]
Hopefully you've checked out part 1 and part 2 - Let's now shift the focus to the treatment. Nonoperative reduction OK, so you made the diagnosis of ileocolic intussusception - so let's fix this problem. The current standard is nonoperative reduction using pneumatic pressure - [...]
Welcome to part 2 of the intussusception series - check out part 1 here. Let's suppose that you work in a place without 24 hour ultrasound, and you get a toddler that is having intermittent episodes of belly pain. You think she has intussusception. You [...]
Ah, intussusception, the Mississippi (at least in terms of spelling) of medicine. For my latest series I thought I'd look into this common diagnosis in the Peds ED. Is it really that common? Well, it is the #1 cause of intestinal obstruction in children 6 [...]
A 3 year old previously presents to the ED with the chief complaint of "purple donut coming out of his butt" - seriously. It happened after he was going to the potty. The parents are understandably freaked out, and the child initially appeared mildly uncomfortable - [...]
[column col="1/2"]What is the Pediatric Appendicitis Score for the following patient? What does this score say about their risk of acute appendicitis? Does he need further testing to confirm the diagnosis? A 7 year old male presents with 18 hours of abdominal pain that was [...]