Abdominal trauma can be accidental or intentional Blunt abdominal trauma is

Abdominal trauma can be accidental or intentional

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child's age (Ang, Chong & Daneman, 2011). Abdominal trauma can be accidental or intentional. Blunt abdominal trauma is more common than penetrating injury. Abdominal trauma may cause musculocutaneous injury, bowel perforation, intramural hematoma, laceration or hematoma of the liver or spleen, and avulsion of intra-abdominal organs or vascular pedicles (Allemann , Cassina , Röthlin & Largiader, 2013). Rectal and Pelvic Exam Films Another important assessment in a child, is to assess for signs of appendicitis in children with difficulty communicating. This is a very inducive signal of pain in the abdomen. Jaundice suggests hemolysis or liver disease. Pallor and jaundice point to sickle cell crisis. A positive iliopsoas test (passive extension of the right hip and flexion of the right thigh against resistance) or obturator test (rotation of the right flexed hip) suggests an inflamed retrocecal appendix, a ruptured appendix, or an iliopsoas abscess. (Fraser,2015).
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A positive Murphy's sign (interruption of deep inspiration by pain when the physician's fingers are pressed beneath the right costal margin) suggests acute cholecystitis. Cullen's sign (bluish umbilicus) and Grey Turner's sign (discoloration in the flank) are unusual signs of internal hemorrhage (Allemann , Cassina , Röthlin & Largiader, 2013). Management Treatment should be directed at the underlying cause. In many patients, the key to diagnosis is repeated physical examination by the same physician over an extended time. Indications for surgical consultations would be bile stained vomit, involuntary abdominal rigidity or guarding and rebound tenderness, just to name a few. Traditionally, the use of analgesics is discouraged in patients with abdominal pain for fear of interfering with accurate evaluation and diagnosis. However, several prospective, randomized studies have shown that judicious use of analgesics actually may enhance diagnostic accuracy by permitting detailed examination of a more cooperative patient (Allemann , Cassina , Röthlin & Largiader, 2013). References Scholer SJ, Pituch K, Orr DP, Dittus RS. Test ordering on children with acute abdominal pain. Clin Pediatr [Phila] . 2011;38:493–7. Saxena, A. (2017). Pediatric Abdominal Trauma. Medscape. Retrieved from Attard AR, Corlett MJ, Kidner NJ, Leslie AP, Fraser IA. Safety of early pain relief for acute abdominal pain. BMJ . 2014;305:554–6. Ang A, Chong NK, Daneman A. Pediatric appendicitis in “real-time”: the value of sonography in diagnosis and treatment. Pediatr Emerg Care . 2011;17:334–40. Allemann F, Cassina P, Röthlin M, Largiader F. Ultrasound scans done by surgeons for patients with acute abdominal pain: a prospective study. Eur J Surg . 2013;165:966–70. Fraser GC. Children with acute abdominal pain. Taking a reasonable approach. Can Fam Physician . 2015;39:1461– 2,1465–7.
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