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Abdominal US – r/o pyloric stenosisLabs: CBC r/o anemia & infectionManagement: small frequent meals, frequent burping, add weight to formula (cereal)Drug of choice: H2 antagonist, GI referralPYLORIC STENOSISPresent is younger infants 3wks – 4monthsCharacteristic features: blue eyes, blonde hair, flat feet (pes planus)Projectile vomiting, palpable pyloric mass, peristaltic wavesDiagnostic test: Abdominal US “string sign” narrow pyloric channel36
Management: refer to surgeryINTERUSSUSCEPTIONCause: Rotavirus vaccineBilious vomiting, sausage shape mass in RUQ, Progressive distention tenderness (acute abdomen)**Currant jelly stoolsRefer to surgeryHIRSCHSPRUNGS (Aganglionic Mega Colon)More common in malesFailure to pass meconium, jaundice, infrequent bowel movements, progressive abdominal distentionReferral to GINEUROBLASTOMAArises from the adrenal glandsUrine catecholaminesAbdominal US or CTGASTROENTESTINAL DISORDERSAPPENDICITIS: patients present with RLQ painBlumberg’s Sign or rebound tenderness: the examiner palpates the abdominal wall. (+) if pain is elicited with the removal of pressure. Assesses peritonitis or appendicitisMarkle’s Sign: found when there is abdominal pain with running. Pain in the RLQ of the abdomen is elicited byhaving the patient drop from standing on the toes to heels, with a jarring landing; found in acute appendicitisMcBurney’s Sign: tenderness on gentle pressure at the point (McBurney’s point) on the right side of the abdomen 2/3 of the way from the navel to the boney prominence on the front of the hip. Reliable sign for appendicitis. Other sings: psoas (pain with leg elevation), Rovsing (palpation on left abdomen produces rebound pain on the right), Obturator (pain with internal rotation of the hip)The presentation of fever & malaise with RLQ rebound tenderness is consistent with acute appendicitis and should be referred to ER for further assessment d/t potential for rupture. CT scan is the diagnostic test of choice. IV fluids and antibiotics are standardly given in the inpatient setting.**Sudden absence of pain in a patient previously presenting with pain indicates surgical emergency; high 37
risk for ruptureCHOLECYSTITISMurphy’s Sign: a maneuver during physical exam as part of the abdominal examination of the edge of the gallbladder. The patient is asked to breathe in, and with the examiner’s palpation, if the patient winces with a “catch” in the breath, the test is (+) for cholecystitits. Ultrasound is the GOLD STANDARD diagnostic examDIVERTICULITISPatients present with mild to moderate pain in the LLQ.Most common in older females, high incidence in those with low fiber dietAcute abdomen is an EMERGENT condition. (*air under the diaphragm on x-ray is consistent with peritonitis) Differentiates from Ulcerative colitis in that “bloody diarrhea” establishes diagnosis of UC.