Ectopic Pregnancy 1. Description of the problem What every clinician needs to know Ectopic pregnancy needs to be considered in adolescent women with severe abdominal pain. Symptoms often appear 6-8 weeks after the last menstrual period and include abdominal pain and occasionally vaginal bleeding. The most significant risk is a ruptured ectopic pregnancy. Clinical features…
Intussusception 1. Description of the problem What every clinician needs to know Intussusception is defined as a “telescoping” of the intestine into itself. Idiopathic intussusception occurs predominantly in children under the age of 3 years and is rare after the age of 6. However, if there is a pathologic cause intussusception can occur at any…
Also known as: Acute Appendicitis 1. Description of the problem What every clinician needs to know Acute appendicitis in children is similar to that in adults. Children often have less right lower quadrant (RLQ) pain than adults and may have more vomiting. Otherwise, the typical presentation is similar, with abdominal pain, anorexia, vomiting, fever, and…
Gastrointestinal Emergencies: Meckel’s Diverticulum Also known as: Omphalomesenteric Duct Remnant 1. Description of the problem The omphalomesenteric duct typically involutes, however, if it does not there is often a persistent connection to the ileum which is termed a Meckel’s diverticulum. A Meckel’s diverticulum is often asymptomatic, however, if gastric mucosa is present it can cause…
Esophageal Foreign Body and Ingestions 1. Description of the problem Foreign body ingestion often occurs in young children between the ages of 6 months and 3 years. Many foreign bodies will pass without complication, but if foreign bodies get lodged in the esophagus they should be removed. Button batteries, sharp objects, and magnets should be…
Also known as: Non-Variceal Upper GI Bleeding 1. Description of the problem Non-variceal upper gastrointestinal (UGI) bleeding in children is most often from gastric or duodenal ulcers, although severe gastritis and esophagitis can cause bleeding. Ulcer bleeding is often associated with critical illness. Critical features Hematemesis Melena Key management points Resuscitation Laboratory Examination Acid Suppression…
Necrotizing Enterocolitis (NEC) 1. Description of the problem NEC is characterized by ischemia and necrosis of the gastrointestinal tract and can lead to mortality and morbidity, including short bowel syndrome. It is most often found in premature infants and requires early recognition and treatment to prevent long segment bowel necrosis. Clinical features Most infants diagnosed…
Hirschspring Disease Also known as: Congenital Aganglionic Megacolon 1. Description of the problem Hirschsprung disease (HD) describes a failure of neural crest cell migration to the entire colon during intestinal development. The result is an aganglionic segment of colon that is unable to relax, causing obstruction and the potential for severe complications. Clinical features Distal…
Malrotation Also known as: Malrotation with volvulus 1. Description of the problem Malrotation refers to the incomplete rotation of the gastrointestinal tract during development. Malrotation itself may or may not be significant; however, malrotation can lead to volvulus or twisting of the small bowel around the superior mesenteric artery, ultimately causing vascular compromise and ischemia…
Gastrointestinal Emergencies: Pyloric Stenosis Also known as: Hypertrophic Pyloric Stenosis 1. Description of the problem Pyloric stenosis classically presents in the first two months of life, but not often at birth. The classic presentation includes projectile vomiting and an infant who remains hungry after vomiting. Early evaluation with a pyloric ultrasound and surgical management prior…
