Notes from HMRI Paeds Update from Dr Bowkett

Vomiting baby

• Check for hernia with inspection and palpation

• Ask for bile yellow, green or orange vomit

• Look and feel for sausage re: intussusception

• If sick > hospital

• If well but bile consider malrotation

Bile

• Yellow = rapid exit

• Green = mixed with acid

• Orange = blood

Malrotation

• The narrow base of the mesentery

Intussusception

• Breastfeeding protective

• Main cause is inflamed Peyer’s patches

Symptoms

• 6-7 months commonly

• colicky pain 80%

• Recent URTI 25%

• Screaming and pallor

• Blood and mucous in stools 55%

• Lethargy 70%

• Vomiting 90%

• Diarrhoea 30%

Signs of intussusception

• Mass 70% - often non-tender

• Blood in stools 55%

• Tender 40%

• Dehydration 15%

Pyloric Stenosis

• Usually boys

• Usually 6 weeks

• No weight gain over 2 to 3 weeks with or without vomiting then consider

• The sensitive sign is to watch for gastric peristalsis

Hernia

• Female infant, swelling groin is 90% hernia + ovary contained

• If ovary out, leave it alone

• Tenderness, vomiting + hernia = refer urgency

• If the hernia not reducible consider urgent referral

• If trying to reduce gentle and short attempt

Hernia guide

• Easily reducible and non-tender and no vomiting or irritability then

  • <3 months = see that week and operate within 2 weeks

  • 3 to 6 months = see in 3 weeks and operate within 6 weeks

  • 6 to 12 months = see within 4 weeks and operate within 8 weeks

Hydrocoele

• See around 18 months and operate at 2 years

• If irritability consider concurrent hernia

• Hydrocoele are slow to progress in size

• Progression tension, separate from testicle and thickening above the hydrocoele are signs to consider hernia

Undescended testicle

• Pain = urgent

• Neither palpable = urgent

• One palpable in the scrotum and hypospadias = urgent

• Otherwise no longer than 6 months

Hard firm scrotum in first months on life

• Usually non-tender

• Can look black or blue

• Child well

• = neonatal torsion = emergency as other side can also go

Testicular torsion

• Painful scrotum nearly always needs to be explored

• Anorexia and vomiting = likely serious ischaemia

• A child can appear very well

Non-specific abdominal pain

• Localised away from the midline

• Night pain

• Nausea vomiting bile

• = Early ultrasound

• Can signify ureteric obstruction, chronic appendicitis, torsion, crohn’s

• Always check scrotum in boys with non midline abdo pain as can be referred

Appendicitis

• Pain localised, constant, colicky

• Distension

• Tachycardia

• 5 years and under

• Rectal seldom required

• Diarrhoea can occur if retroilial

• Dysuria

• Bile vomiting

• Constipation diet causes faecolith

Bruised scrotum

• Consider child abuse

• HSP (look at legs)