By Robert J. Hoffman MD MS, Vincent J. Wang MD MHA, Dr. Richard J. Scarfone MD, Dr. Sandip A. Godambe MD PhD MBA, Dr. Raymond Pitetti MD MPH
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Additional resources for Fleisher and Ludwig’s 5-Minute Pediatric Emergency Medicine Consult
DIAGNOSTIC TESTS & INTERPRETATION Lab Initial Lab Tests Obstructive bowel process is common cause, and laboratory testing is of limited value for diagnosis but can be used as an adjunct for patient management: r CBC with peripheral smear is recommended to evaluate for inflammatory or infectious process or malignancy. r Assess electrolytes if an ileus is suspected r Order BUN/creatinine if concerned for renal disease. xml April 15, 2011 13:20 ABDOMINAL DISTENTION A Imaging r A 2- or 3-view abdominal radiograph is the most helpful initial diagnostic study to perform for a patient presenting with abdominal distention.
Imaging Soft tissue US may be employed to aid in diagnosis or to guide drainage. d. d. d. xml April 15, 2011 13:20 ABSCESS, BARTHOLIN GLAND A r Local anesthetics: – Infiltration with a local anesthetic may achieve significant analgesia. 1 mg/kg IV/SC may be repeated q15–20min until pain is controlled, then q2h PRN. – Fentanyl 1–2 μg/kg IV q2h PRN: ◦ Initial dose of 1 μg/kg IV may be repeated q15–20min until pain is controlled, then q2h PRN. 1 mg/kg of hydrocodone component PO q4–6h PRN Issues for Referral Recurrence COMPLEMENTARY & ALTERNATIVE THERAPIES r Warm compresses r Sitz baths SURGERY/OTHER PROCEDURES r Incision and drainage is the mainstay of therapy.
Delayed passage of meconium can be seen in cystic fibrosis and Hirschsprung disease. – Fever may be from an infectious process such as sepsis causing ileus, a GI infection, or peritonitis due to perforation. – A weak urinary stream may be secondary to posterior urethral valves causing hydronephrosis. r In the infant and older child: – Inquire about previous abdominal surgeries. – Inquire about the stooling pattern. – Pain should be thoroughly evaluated and differentiated, as it may render important clues to the etiology of the disease: ◦ Acute onset of inconsolability or increased irritability should alert toward abdominal emergencies such as intussusception, obstruction, or infection.