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Non-Accidental Trauma

  • Estimated 10% of pediatric patients are victims of abuse
    • Sexual abuse
    • Physical abuse
    • Neglect
  • Common red flags
    • Changing story
    • Story that doesn’t make since
    • Delays in seeking care
    • Unusual bruising locations
      • Torso
      • Ears
      • Neck
  • Common tests if non-accidental trauma suspected
    • Skeletal survey x-rays
    • Head CT
      • Especially if altered mental status
    • Abdominal CT
      • Especially if abdominal trauma
  • Report to child protective services (CPS)

Tummy Ache

  • Necrotizing enterocolitis
    • Classic presentation
      • Premature baby
      • 1st month of life
      • Ill appearing
    • Classic finding on x-ray
      • “Pneumatosis intestinalis”
  • Volvulus
    • Classic presentation
      • 1st month of life but previously healthy
      • Distended abdomen
      • Bilious vomiting
    • Testing
      • Abdominal Xray
      • Upper GI Series (ideal test)
  • Toxic megacolon
    • Complication of Hirchsprung Disease
    • Seen on x-ray
  • Intussusception
    • Telescoping bowel resulting in ischemia
    • Classic presentation
      • 2 months – 2 years old
      • Intermittent abdominal pain followed by lethargy
    • Diagnose with abdominal ultrasound
  • Pyloric stenosis
    • Classic presentation
      • Projectile vomiting
      • Normal appetite/hungry
      • Palpable “olive” in epigastrium
    • Testing
      • Electrolyte panel
        • Hypokalemia
        • Hypochloremia
        • Alkalosis
      • Abdominal ultraound

Additional Reading