Severe Abdominal Pain In Pediatrics: Review

Severe abdominal pain is a common cause of pediatric emergency consultation. Although a small percentage is due to a strict process, the difference in time from the normal to the frequent causes can be a challenge. Childhood age greatly affects the likelihood of diagnosis. Taking a detailed history and careful physical examination remains the cornerstone of diagnostic guidance. In cases of doubt, it may be necessary to judiciously use some complementary tests, in which ultrasound appears for its benefit, since it is less invasive and provides useful information in many cases.         In this review, we will discuss some of the most common causes of pediatric age, as well as an analysis of syndromic groups. We emphasize the importance of adequate analgesia that is given even before the physical examination, which, without hiding the main signs, comforts the child and allows to do a physical examination and tranquility is important

Imaging of ischemia, obstruction and infection in the abdomen

Intestinal ischemia is a serious condition that continues to be associated with mortalities in excess of 70%. Intestinal obstruction and gastrointestinal tract sepsis are common conditions, accounting for a large proportion of patients admitted to emergency departments with acute abdominal symptoms. This article discusses the imaging methods and key findings of these entities in the emergency radiology department. The article includes imaging examples, diagnostic options, protocol selections, diagnostic criteria, and differential diagnoses

A Simulation and Small-Group Pediatric Emergency Medicine Course for Generalist Healthcare Providers: Gastrointestinal and Nutrition Emergencies

Audience and Type of Curriculum: This is a review curriculum utilizing multiple methods of education to enhance the skills of generalist healthcare providers in low- and middle-income countries (LMICs) in the identification and stabilization of pediatric respiratory emergencies. Our audience of implementation was Belizean generalist providers (nurses and physicians).Length of Curriculum: 8-10 hoursIntroduction: Early recognition and stabilization of critical pediatric patients can improve outcomes. Compared with resource-rich systems, many low-resource settings (i.e., LMICs) rely on generalists to provide most pediatric acute care. We created a curriculum for general practitioners comprising multiple educational modules focused on identifying and stabilizing pediatric emergencies. Our aim was to develop an educational framework to update and teach generalists on the recommendations and techniques of optimally evaluating and managing pediatric nutritional and gastrointestinal emergencies: bowel obstructions, gastroenteritis, and malnutrition.Educational Goals: The aim of this curriculum is to increase learners’ proficiency in identifying and stabilizing acutely ill pediatric patients with gastrointestinal medical or surgical disease or complications of malnutrition. This module focuses on the diagnosis and management of gastroenteritis, acute bowel obstruction, and deficiencies of feeding and nutrition. The target audience for this curriculum is generalist physicians and nurses in limited-resource settings.Educational Methods: The educational strategies used in this curriculum include didactic lectures, medical simulation, and small-group sessions.Research Methods: We evaluated written pretests before and posttests after intervention and retested participants four months later to evaluate for knowledge retention. Participants provided qualitative feedback on the module.Results: We taught 21 providers. Eleven providers completed the pretest/posttest and eight completed the retest. The mean test scores improved from 8.3 ± 1.7 in the pretest to 12.2 ± 2.6 in the posttest (mean difference: 1.4

THE ROLE OF HYALURONAN-RICH ECM IN THE REGULATION OF GUT AND VASCULAR MORPHOGENESIS

THE ROLE OF HYALURONAN-RICH ECM IN THE REGULATION OF GUT AND VASCULAR MORPHOGENESIS Aravind Sivakumar, Ph.D. Cornell University 2017 During embryonic development, organ morphogenesis is driven by coordination and alignment of local cellular behaviors with the three body axes: dorsal-ventral (DV), anterior-posterior (AP) and left-right (LR) axes. This involves translation and amplification of molecular chirality defined by genetically encoded spatial cues into asymmetric cell behavior that is critical for defining the organ’s form and function. The gastrointestinal tract, displaying profound LR asymmetries, presents itself as a powerful model to study the asymmetric mechanisms involved in the establishment of its stereotypical looping topology and patterning of its vasculature. Asymmetric looping morphogenesis of the gut initiates with a critical leftward tilt directed by the evolutionarily conserved LR pathway. Failure to do so leads to gut malrotation and the catastrophic midgut volvulus, highlighting an urgent need to define the molecular basis of this process. Previous research in mice and birds has shown that the leftward tilt of the gut is established by cellular and extracellular asymmetries across the LR axis of the dorsal mesentery (DM), which suspends the gut tube. The left DM condenses while the right expands causing the DM to tilt the gut tube leftward, and this critical bias determines gut chirality. Concomitantly, vasculogenesis of the gut proceeds within the left DM but is excluded on the right, suggesting that the cellular processes within the DM are also employed to pattern abdominal blood vessels. While the left DM has been shown to be under the control of the left-determining transcription factor Pitx2, the mechanisms that regulate the expansion and vascular exclusion specific to the right DM have remained unknown. Surprisingly, my research demonstrates that the expansion of the right DM precedes all other cell asymmetries that collectively deform this structure, suggesting that the key initiator of asymmetric gut tilting derives from the right side. Hyaluronan (HA), a unique and highly conserved glycosaminoglycan, predominates in the extracellular matrix (ECM) of the right DM. Targeted degradation of HA in the right DM ablates expansion, gut tilting and results in aberrant retention of vasculature in the right DM. This unexpected finding demonstrates that HA is a critical regulator of the ECM expansion and vascular exclusion necessary for asymmetric gut looping and vascular morphogenesis. Investigating into how HA enacts its functions, I show that the tumor necrosis factor alpha-inducible protein 6 (Tsg6/Tnfaip6), an enzyme that covalently modifies HA to form a stable heavy chain (HC) HA complex, is restricted to the right DM. Knockdown of Tsg6 on the right prevents ECM expansion, gut tilting, and disrupts the normal process of vascular exclusion, leading to aberrant gut vascular patterning. Furthermore, misexpression of Tsg6 in the left DM prevents the formation of abdominal blood vessels demonstrating that Tsg6 is both necessary and sufficient to inhibit gut vascular development. The ability of Tsg6 to mediate ECM expansion and vascular exclusion is dependent on its enzymatic ability to covalent modify HA. Further analysis of Tsg6 knockout mice revealed randomized gut looping chirality and gut malrotations in Tsg6 mutant embryos that predispose them volvulus. Collectively, my study identifies a new pathway during LR organogenesis initiated by HA-rich ECM on the right side of the embryo and presents a novel mouse model to understand the origin of gut malrotations and vascular anomalies

Treatment and outcome of lower gastrointestinal bleeding: an observational multicentre study in East Coast region of Peninsular Malaysia

OBJECTIVE The objective of this study is to determine the type of treatment and its patients’ outcome with new onset of LGIB in the East Coast of Peninsular Malaysia. METHOD This was a cross-sectional study conducted at hospitals in the East Coast region of Peninsular Malaysia. Observational data were collected from patients with a new onset of non-traumatic LGIB. The patient was observed from beginning of treatment until discharged from the hospital to study its outcome. This study commenced from September 2019 until September 2020. RESULT 54 patients with LGIB were recruited. Male was reported to be more common than female to have lower gastrointestinal bleeding (40.7% vs 59.3%). The incidence of LGIB is most common at the age of 65 years and above (35.2%). The most common cause of LGIB is haemorrhoid. 8 patients from the study came with massive bleeding. 27 patients underwent colonoscopy. 64% of the patients were treated conservatively. 47 patients (87%) were resolved upon the same admission and 7 patients (12.9%) had a recurrence. 2 patients died due to sepsis which was non-bleeding related. The amount of blood transfusion ranges from 0-18 pints of packed cells. The bivariate analysis revealed that there was no statistical significance in the findings. CONCLUSION LGIB is common among Malay, males aged more than 65 years old. The common cause of bleeding is haemorrhoid and most patients were treated conservatively. The majority of bleeding was resolved and rarely caused morbidit

Fetal Abdominal Wall Defects

Abdominal wall defects (AWDs) represent a group of congenital anomalies that can be diagnosed early during pregnancy even at the time of the first trimester assessment, with direct impact on pre- and postnatal fetal prognosis and management decisions. The most frequent anomalies in this group are gastroschisis and omphalocele. The key method available, that allows the detection of any deviation from the physiologic midgut herniation, is the ultrasound (US) assessment. A precise algorithmic scan approach is imposed not only for an accurate detection of any abdominal wall defect, but also for a proper location of the defect and of the spatial relation to the umbilical cord insertion, fundamentally important in differentiating among various malformations. Other structural or chromosomal anomalies should be excluded. Suitable multidisciplinary counseling should be considered. Unfortunately, in utero surgery, in these cases, has not been yet successful. Postnatal early interventions are usually required in specialized pediatric centers

Acute incarceration prolapsed solitary rectal ulcer: a rare case of anorectal emergency

OBJECTIVE We aim to report a case of acute incarceration prolapsed giant solitary rectal ulcer that was treated successfully by transanal excision. CASE REPORT A 17-year-old male presented to emergency department with acute an incarcerated mass protruding from the anal canal 3 hours prior. Patient was diagnosed with a solitary rectal ulcer syndrome for one year-old and started receiving medical treatment with signs of partial recovery. On clinical examination, vital signs within normal limits. His abdomen was not tender and had no signs of peritoneal irritation. Rectal examination revealed 15cm x 10cm incarcerated prolapsed mass, looked like cauliflower, because of the failure of external manual reduction we decided to bring the patient to the operating room. The mass was removed by transanal excision under spinal anesthesia and the histopathologic result is consistent with solitary rectal ulcer. CONCLUSION Our case is a rare presentation of SRUS, although less common than other causes of prolapsed anal mass, it should be considered as part of the differential diagnosis

Ultrasound Imaging

Ultrasound Imaging - Current Topics presents complex and current topics in ultrasound imaging in a simplified format. It is easy to read and exemplifies the range of experiences of each contributing author. Chapters address such topics as anatomy and dimensional variations, pediatric gastrointestinal emergencies, musculoskeletal and nerve imaging as well as molecular sonography. The book is a useful resource for researchers, students, clinicians, and sonographers looking for additional information on ultrasound imaging beyond the basics

Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging - IDKD Book

Gastrointestinal disease; PET/CT; Radiology; X-ray; IDKD; Davo