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BS 9 y/o boy with Abdominal Pain

BS 9 y/o boy with Abdominal Pain. History. 9 y/o boy with 5/7 hx D & V assoc with lower abdominal pain. Anorexia 5/7, tolerating fluids Nil blood or mucous in stool Mild fever Lower abdo pain mostly RIF initially. Given buscopan and paracetamol by GP – no improvement.

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BS 9 y/o boy with Abdominal Pain

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  1. BS 9 y/o boy with Abdominal Pain

  2. History • 9 y/o boy with 5/7 hx D & V assoc with lower abdominal pain. • Anorexia 5/7, tolerating fluids • Nil blood or mucous in stool • Mild fever • Lower abdo pain mostly RIF initially. Given buscopan and paracetamol by GP – no improvement. • C/- abdo pain with bumps on the car ride

  3. Exam • T 37.4 P91 R24 BP105/48 99% on RA • Dehydrated • Holding abdomen, avoiding movement • CVS, Resp, Testes NAD • Abdo: • Soft, very tender • Rebound tenderness ++ in LIF and RIF (worst in LIF) • Nil masses • Unable to mobilise to examine hop due to pain • Unable to cough due to pain

  4. Ix • WTU • Glu neg; Ket 15mg/dL; Blo Trace; pH 5.5; Pro 100mg/dL; Nit neg, Leu neg • Bloods

  5. DDx • Gastroenteritis • Appendicitis • Meckel’s • Mesenteric Adenitis

  6. Alvarado Score 8

  7. Paediatric Appendicitis Score 9

  8. Mx • Immediate laparotomy Findings • Appendix: small perforation, gangrenous and purulent

  9. New Paediatric Abdominal Pain Procedure 1. Initial Assessment by ED Dr • History, exam • Ward Test Urine – UTI, Diabetes, Pregnancy • Pathology – FBC, CRP (During lab hours – 0700 to 2400) • Clinically rule out pneumonia • CXR if necessary (During Radiology hours 0800 to 2200) 2. Paediatric Dr to review • Initial Alvarado and PAS scores 3. After Hours ED Dr to follow as above and notify paed’s Dr on call.

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