Question

Discuss the presentation of acute appendicitis in a child. What might be other causes of abdominal pain in a child? What would be the clinical evaluation to determine if appendicitis is the true cause of the child’s abdominal pain? What actions could you take to minimize the stress of hospitalization of a 5 y/o child admitted with appendicitis?

Answer 1

1.

Appendix is a pouch- like structure attached at the start of the large intestine that has no known purpose. A condition in which the appendix becomes inflamed and filled with pus, causing pain.

Typical presentation of Acute Appendicitis in a child :

- Somatic pain is usually worsening with movement and is accompanied by anorexia.

- Nausea and vomiting usually follow the abdominal pain.

- Fever is usually low- grade with tachycardia.

- Less than 50% of childrenwill have a classic presentation of appendicitis, despite having appendicitis.

2.

Other causes of abdominal pain in children are:

Gasto intestinal causes

Gastroenteritis,Constipation,colic or irrritable bowel,Kidney or bladder infections, too much food,food poisoning or food allergies,

Appendicitis, bowel obstruction or intussusception.Mesentric lymphadinitis,Peritonitis,Intestinal obstruction,Peptic ulcer,Meckel's diverticulum,inflammatory  bowel disease ,lactose intolerance.

Liver, spleen, and billiarytract disorders.

Hepatitis,Cholecystitis, cholelithiasis,splenic infarction,rupture of the spllen,pancretitis

Genitourinary causes

Urinary tarct infection,urinary calculi,Dysmenorrhea,mitttelschmerz,Pelvic infalmmatory diseases,endometriosis, Testicular tortion,Hematocolpos.

Metabolic disorders

Diabetic ketoacidosis,hypoglycemia,acute adrenal insufficiency,porphyria.

Dugs and Toxins

Erythromycin, salicylates,lead poisoning,venoms, insects bites

Pulmonary causes

Pneumonia,diaphramatic,pleurisy

Miscellaneous

infantile colic,functional pain,pharyngitis,angioneurotic edema,familial.

3.

Abdomial examination is the best clinical evaluation mathod to determine whether the cause of child,s abdominal pain is Appendicitis or not.The breathing pattern should be observed, and the patient should be asked to distend the abdomen and then flatten it. After the child is asked to indicate, with one finger, the area of maximal tenderness, the abdomen should be gently palpated, moving toward (but not palpating) that area. The physician should examine for Rovsing,s sign (when pressure on the left lower quadrent distends the column of colonic gas, causing pain in the right lower quadrent at the site of appendiceal inflammation), then gently assess muscle rigidity. Gentle percussion best elicits rebound tenderness. Deeperpalpation is necessory to dicover masses and organomegaly.

4.

inorder to minimize the pressure of hospital stay in children consider the following 7 steps.

a). Practice calmness.

b). Talkthrough the expeience.

c). Play Music.

d). employ distractions

e). Offer a treat.

f). Be educational.

g). Make Physicl comfort a top priority.