Podcasts about henoch sch

Henoch–Schönlein Purpura (HSP) is a common vasculitis seen in younger children. The classic skin finding is palpable purpura in gravity dependent areas of the body (buttocks and legs). Children can also have arthralgias, abdominal pain and intussusception, and even nephritis. Learn about the diagnosis and management of Henoch–Schönlein Purpura (HSP) in this brief podcast episode. PEMBlog @PEMTweets […]

A High-yield fully question-based review of childhood vasculitides

Looking for more information on this topic? Check out the IgA Nephropathy and Henoch-Schönlein Purpura brick. If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Twitter: https://twitter.com/mesage_hub Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including over 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology.

Meet Hannah! IgA Vasculitis Warrior. IgA Vasculitis was formerly known as Henoch-Schönlein purpura. Like so many of us she had to fight for people to believe that something was wrong with her. She was young, health conscious, and fit - so how could she be sick, right? She shares her symptoms, journey, and more. Follow Hannah: Tiktok: www.tiktok.com/@hannahthaiss   Instagram: www.Instagram.com/Januarymornings    Clothing brand: whocaresworld.com      Instagram for Who Cares: www.Instagram.com/whocares.world 

Good morning and welcome to your Tuesday dose of Your Daily Meds.Bonus Review: What are some of the actions of gastric acid?Answer: A few main ones - Activation of pepsinogens to produce pepsinsAssists protein digestion (pepsins require low pH for activity)Kills ingested bacteria - helps prevent infectionInhibited gastrin secretion from antral G-cells (negative feedback loop)Increases secretion of bile and pancreatic juicesFacilitates iron absorption in duodenumPaeds:A 4-year-old boy complains to his mother of acutely painful defaecation. The mother reports that there is spotting of blood on the toilet paper. Whish of the following is the most likely diagnosis?Meckel diverticulumIntussusceptionAnal fissureHenoch-Schönlein purpuraAppendicitisHave a think.More scroll for more chat.A Query:Which of the following biochemical abnormalities is most likely in Cushing’s syndrome due to ectopic ACTH secretion?Elevated ACTH, elevated cortisol, reduced serum potassiumElevated ACTH, elevated cortisol, elevated serum potassiumElevated ACTH, reduced cortisol, reduced serum potassiumReduced ACTH, markedly elevated cortisol, reduced serum potassiumMarkedly elevated ACTH, reduced serum cortisol, reduced serum potassium(Where ACTH = adrenocorticotrophic hormone)Have a think.More scroll for more chat.Spots and Pain:Anal fissure is the most common cause of painful rectal bleeding in this age group. It is often due to passage of a hard constipated stool. Intussusception can occur acutely, it is more likely to be reported as colicky pain and the stool classically has the appearance of red currant jelly. Meckel diverticula, when acute, are associated with central abdominal pain and can cause sufficient blood loss and result in haemodynamic instability, as opposed to spotting on the toilet paper. Henoch-Schönlein purpura is also associated with intussusception and bloody stools (as opposed to spotting) and often presents with abdominal pain, vasculitic rash and joint pain and swelling. Appendicitis classically presents as a central abdominal pain that localises to the right iliac fossa. It is associated with fever, nausea and vomiting and diarrhoea but is less likely to cause spotting.Cushingoid:Key to answering this question is understanding that Cushing’s syndrome is caused by excess activation of glucocorticoid receptors.Most commonly, Cushing’s syndrome is iatrogenic due to exogenous administration of glucocorticoids.Endogenous forms of Cushing’s syndrome are due to over-production of cortisol by the adrenal glands as a result of adrenal tumour, excess adrenocorticotrophic hormone (ACTH) secretion by a pituitary tumour (Cushing’s disease), or ectopic ACTH production by some other tumour. In ACTH-secreting tumours, there is likely to be impaired negative feedback sensitivity to cortisol, unlike in ACTH-secreting pituitary tumours, which retain this sensitivity.So patients would most likely exhibit elevated ACTH, elevated cortisol, reduced serum potassium.This inappropriately elevated ACTH is associated with pigmentation changes, as it binds to melanocortin-1 receptors in skin melanocytes. The elevated cortisol can overcome the kidney’s capacity to inactivate cortisol, resulting in Hypokalaemic alkalosis, contributing to the myopathy and hyperglycaemia typical of Cushing’s syndrome.Cast your mind back to awful feedback loops like this one:Bonus: What is bile?Answer in tomorrow’s dose.Closing:Thank you for taking your Meds and we will see you tomorrow for your MANE dose. As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Bu Yazıda: Temporal Arterit Takayasu ArteritiKawasaki HastalıklarıPoliarteritis NodozaANCA İlişkili VaskülitlerMikroskopik Polianjit (MPA)Granülomatöz Polianjit (GPA, Wegener Granülomatozu)Eozinofilik Granülomatöz Polianjit (EGPA), Churg-Straus Sendromu)Diffüz Alveoler HemorajiIgA Vasküliti (Henoch Schönlein Purpurası) Behçet Hastalığı Sistemik Vaskülitler Vaskülitler damar duvarlarında inflamatuar lökositlerin varlığıyla reaktif hasar ve damar bütünlüğünün bozulmasına bağlı kanama, dokularda iskemi ve nekroza neden olan hastalıklar olarak tanımlanır. Non-spesifik semptomları ve diğer ayırıcı tanılarına göre daha nadir görülmeleri nedeniyle tanı konulması aslında zor. Hastalar hemoptizi, akut böbrek yetmezliği, stroke gibi mortal olabilen kliniklerin yanında yaygın ağrı, artrit, ateş, halsizlik ve kilo kaybı gibi belirsiz semptomlarla başvurabilir. Patogenezinde genelde kompleman bağımlı damar duvar hasarı ve buna bağlı stenoz ya da rüptür görülmekte. Oldukça heterojen bir hastalık grubu olan vaskülitler; tutulan damar çapına, histopatogenezlerine, etiyolojilerine veya organ tutulumlarına göre sınıflandırılabiliyor ama en sık kullanılanı damar çapına göre yapılan sınıflandırma. 1. Temporal Arterit Temporal arterit, nörolojik ve oftalmik tutulumlarla seyreden, ileri yaşlarda (ortalama yaş 70) görülen sistemik inflamatuar bir vaskülittir. İleri yaş ve kadın cinsiyet bu vaskülit için bilinen risk faktörleri. En yaygın semptomları temporal arteri de içeren baş boyun bölgesinin orta büyüklükteki damarlarının tutulumuna bağlı olarak görme bozuklukları, baş boyun ağrısı, çene kladikasyonu ve skalp hassasiyetidir. Halsizlik, iştahsızlık ve ateş gibi sistemik bulgular da eşlik edebilir. Özellikle 50 yaş ve üzerinde artmış sedimentasyon hızı ile birlikte görülen yeni başlangıçlı baş ağrılarında düşünülmesi gereklidir. Oftalmik tutulumlar hastaların %20'sinde görme kaybına neden olarak ciddi bir morbiditeye neden olmaktadır. Temporal arteritin oftalmik tutulumları gerçek bir acil olarak kabul edilmelidir. Tedavi Steroid tedavisinin erken başlanması iskemik sekellerin önlenmesinde oldukça önemli rol oynar. Bu hastalarda steroid tedavisinin 48 saat gecikmesi ciddi sekellerle ilişkili bu nedenle biyopsi sonucu beklenmeden steroid başlanmalı. Temporal arter biyopsisi de ilk 1 hafta içinde yapılmalıdır. Kortikosteroid başlangıç dozu tartışmalı bir konu. Temporal arteritten şüphelenilen ancak görme semptomu olmayan hastalarda 1 hafta içerisinde biyopsi planlanarak günlük 40-60 mg prednizon p.o., nörolojik veya oftalmik semptom varlığında ise günlük 80-100 mg prednizon p.o. verilmesi ve 72 saat içerisinde tedavi yanıtının değerlendirilmesi şeklinde öneriler mevcut.​1​ Alternatif bir yaklaşım, nöro-oftalmik tutulum varlığında ilk 3 gün yüksek doz metilprednizolon (500-1000 mg/gün) verilmek üzere yatırılarak takip şeklindedir.​2​ Yeterli kanıt olmasa da, daha hızlı istenilen konsantrasyonlara ulaşılması nedeniyle sıklıkla tercih edilmektedir. Aynı zamana bu yaklaşımın morbiditeyi azalttığını gösteren çalışmalar da mevcuttur.​3​ 2. Takayasu Arteriti Takayasu Arteriti (TA) aort ve ana dalları yanında pulmoner arterler gibi büyük damar tutulumu ile karakterize, kronik seyirli, nabızsızlık hastalığı olarak da adlandırılan bir vaskülittir. Daha çok kadınlarda görülen ve ortalama 20-30 yaşlarında tanı alan bir hastalık. Damar lümeninde darlıklara bağlı gelişen organ iskemileri hastalığın morbidite ve mortalitesinden sorumlu olan esas mekanizma. Tedavisinde kortikosteroidler ve immunsupresif ajanlar (siklofosfamid, metotreksat, azatioprin vb.) ve biyolojik ajanlar kullanılmakta. İleri evrede ise cerrahi ya da endovasküler girişimlerle revaskülarizasyon gerekebiliyor. Aort tutulumuyla boyun, kol, omuz ve sırtta ağrı sık görülür. Ekstremitelerde soğukluk veya intermitan kladikasyo ortaya çıkabilir. Geçici iskemik atak, inme, baş dönmesi, bayılma,

Uterine Fibroid and heavy bleeding might have a new drug if your normal drug was giving placebo. HPV Vaccine is still awesome and very very safe. Copper IUD has a new kid in town when it comes to emergency contraception and Colchicine should not be used for secondary prevention (at least not when I read the trial) HTTPS://WWW.NEJM.ORG/DOI/FULL/10.1056/NEJMOA2008283 Treatment of Uterine Fibroid Symptoms with Relugolix Combination Therapy international, double-blind, 24-week, phase 3 trials involving women with fibroid-associated heavy menstrual bleeding. Participants were randomly assigned in a 1:1:1 ratio to receive once-daily placebo, relugolix combination therapy (40 mg of relugolix, 1 mg of estradiol, and 0.5 mg of norethindrone acetate), or delayed relugolix combination therapy (40 mg of relugolix monotherapy, followed by relugolix combination therapy, each for 12 weeks). The primary efficacy end point in each trial was the percentage of participants with a response (volume of menstrual blood loss 12 times/year) were 2.5 times more likely to be current smokers, to consume >14 alcoholic drinks/week, and to drink >6 cups of coffee daily. AND THERE WAS A –response relationship with increasing tanning frequency. Many of you will know that a dose response relationshop is one of the keys for causation in observational studies. So could it be the tanning causes the smoking, drinking, and coffee drinking.. not directly. But could it be that the personality traits that cause you do go above and beyond are active in all actions of your life?? YES When you go above and beyong you go above and beyond for everything—its almost never something like well I am crazy about working out but I eat like garbage and vice versa if you eat terrible rarely are you crazy about working out. You burn it at both ends of the stick or you don’t the problem is controlling it in a healthy way which is maybe the key to life. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2775955?guestAccessKey=d35250c2-a79e-486c-80e9-67a886cb9ef1&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=021521 #FDA tells the companies but the companies don't tell the public! (thread) #MedTwitter This should be a #publichealth issue. @MedTweetorials If there is question related to a drug products quality, safety, and efficacy then the FDA will issue a "refuse-to-file" to the COMPANY not to the public. However, shouldn't their be transparency? Over a decade ago the #FDA even had a task force for more transparency! https://fdanews.com/ext/resources/files/archives/f/FDA-2009-N-0247-0107.1.pdf https://www.fdanews.com/ext/resources/files/archives/f/FDA-2009-N-0247-0107.1.pdf I will say a "refuse-to-file" is a rare event (thank goodness). Between 2008-2017 only 4% or 103 out of 2475 applications received a refuse to file. BUT guess how many times the public was informed of these "refuse-to-file"? 15.5% of the time! Only 16/103! This is TERRIBLE! It may come as no surprise that NONE of these "refuse-to-file" letters were were published in their entirety but rather as a press release or abbreviated form. Just like there was a large push as one time for authors to post or register their #clinicaltrials I think there should be equal push for companies to register and publish their "refuse-to-file" letters. I didn’t know only copper IUD!! The New England Journal of Medicine Levonorgestrel vs. Copper Intrauterine Devices for Emergency Contraception N. Engl. J. Med 2021 Jan 28;384(4)335-344, DK Turok, A Gero, RG Simmons, JE Kaiser, GJ Stoddard, CD Sexsmith, LM Gawron, JN Sanders In this trial, the researchers randomized women to a copper IUD or levonorgestrel IUD for emergency contraception and found the levonorgestrel IUD to be noninferior to the copper for this purpose. In the US, the copper IUD is currently the only approved IUD for emergency contraception. This trial provides compelling evidence for the use of levonorgestrel for emergency contraception, providing more options for women in the 5 days following unprotected intercourse. Greenberg JC et al. Life saving therapy inhibition by phones containing magnets. Heart Rhythm 2021 Jan 4; [e-pub]. (https://doi.org/10.1016/j.hrthm.2020.12.032) he magnet in the iPhone 12 is strong enough to turn off therapies from implantable cardioverter–defibrillators. Implantable cardioverter-defibrillators (ICDs) are designed so that an application of a reasonably strong (10-gauss) magnet can inactivate the therapy. This safety feature enables the device's therapies to be suspended for surgeries with cauterization and inappropriate shocks caused by rapid atrial fibrillation (AF) and lead fractures, among other issues. Theoretical concerns have been raised about interference of ICDs by cell phones; however, this interaction in real-life patients has rarely, perhaps never, been reported. Apple's new iPhone 12 contains a powerful magnet, which enables it to correctly align with external accessories (e.g., for wireless battery charging). In an experiment with a single person with an implanted Medtronic transvenous ICD, investigators studied whether the magnet in an iPhone 12 could disable ICD therapies. And indeed, whenever the iPhone was brought near the ICD, the device's ventricular therapies were suspended. Inhibition of ICD therapies by an iPhone is a major concern. Cell phones are frequently carried in chest pockets, some of which are close to an implanted ICD. Even a turned-off iPhone might cause this interaction. Patients and physicians must be aware of this possibly harmful, potential inhibition of ventricular therapies by the iPhone 12, and patients must avoid carrying it in a left chest pocket. And speaking of, many people thought that 2020 would be the year that colchicine would find its way back into our hearts What many people call one of the top articles of 2020 was in the NEJM titled Nidorf SM, Fiolet ATL, Mosterd A, et al. Colchicine in patients with chronic coronary disease. N Engl J Med. 2020;383:1838-47. https://pubmed.ncbi.nlm.nih.gov/32865380 Which was a study that looked at the use of low-dose colchicine to reduce the risk of cardiovascular (CV) events? 5522 patients who had evidence of coronary disease and had been clinically stable for ≥6 months were randomized after a 1 month run in phase. During the run in phase pateitns got colchicine, 0.5 mg/d. 15% of the patients were not randomized after randomization. 15%! Keep that in mind Basically 1 out of 6.5 people who were attempted to enter the trial were not able to tolerate the trial Remember a run in phase false elevates the results of the treatment arm. Because instead of having 100% of people taking place and only 85% taking the active drug since 15% could tolerate side effects. You only randomize people that could take the drug so then you have 100% taking the placebo and 100% taking the active arm. This makes it difficult because we don’t get run in phases in clinical practice. And the results were AMAZING! Or at least if you just read the conclusion “””In a randomized trial involving patients with chronic coronary disease, the risk of cardiovascular events was significantly lower among those who received 0.5 mg of colchicine once daily than among those who received placebo.” Not so fast- the risk of cardiovascular events—what is that?? It is the primary end point but what does it mean??? primary end point was a composite of cardiovascular death, spontaneous (nonprocedural) myocardial infarction, ischemic stroke, or ischemia-driven coronary revascularization. If you add enough outcomes you will always always find something…so you need to look at the individual outcomes MI = NNT- 81 ischemia-driven coronary revascularization= NNT 65 (which makes sense, cheating way to add more numbers to your outcome) cardiovascular death- no difference ischemic stroke, no difference now if you are actually reducing the number of heart attacks you would expect to see a decrease in the cardiovascular deaths but remember there was no difference in cardiovascular death. So if you are seeing a decrease in heart attacks and more patients are under going revascularization then these are suppose to be good things so why no change in cardiovascular deahts??? And people say yes but there was a trend towards decrease in cardiovascular dath with 20 in the colchicine arm and 25 in the placebo arm. BUT what no one is talking about is there was was more non cardiovascular deaths in the colchicine arm 53 vs 35 in the placebo arm. HR 1.51 (95% CI 0.99–2.31) which would cross one and suggest not significant but remember it is all a continuum that we make up it is not that at this rate it works and at this rate absolutely no benefit. So when you have 5 few cardiovascular deaths in the colchicine arm but 18 more noncardiovascular deaths in the colchicine arm it works out to a net increase of 13 more deaths from any cause in the colchicine arm. THIS IS BAD We don’t want more death! So was this just magic skills on the part of the trials where you move a few deaths this way and you slide a few more that way so you can say “there was a trend toward decrease cardiovascular death” or was this that maybe colchicine causes increase in nonCV death. OR Is it that MI and revascularization are really not that important?? Or is it that MI and revascularization are soft endpoints…. You ask 10 difference cardiologist if a patient needs to go for a cardiac cath and you might get 10 different answers. I don’t have the answer but I will tell you many people think this was a big practice changer in 2020 and everyone should get colchicine and I think well I think Based on a study that had 1 out of every 6 patients drop out during the run in phase and was only able to show a change in two very soft end points with no change in all cause death and almost a stastically significant negative change in the nonCVD death, I will not be prescribing this medication for my patients for secondary CV prevention anytime soon.

In the February episode of Critical Decisions in Emergency Medicine, Drs. Danya Khoujah and Wendy Chang unveil a new feature on Clinical Pediatrics and discuss immunoglobulin A vasculitis, formerly known as Henoch-Schönlein purpura. They are joined by author Dr. Ryan Spangler who describes important differences in the evaluation and management of elderly patients with chest pain. And, as always, you’ll hear about the hot topics covered in CDEM’s regular features, including Critical Image and Critical Procedure.

In this show, we are speaking with friend and long-time user of Plum Dragon products, Tomm Voss. Tomm is a Qigong teacher and world champion martial artist as well as a holistic nutrition, fitness and life coach. After a decade as a professional bodybuilder and spokesperson for Men’s Fitness and Muscle & Fitness magazines, the extreme demands of that industry took a toll on Tomm’s body. In 2007, he was sent to the ICU and diagnosed with a severe autoimmune disease known as Henoch-Schönlein Vasculitis, the treatment of which caused Hypothyroidism. He was told he would need to take prescription drugs for the rest of his life.  Tomm then embarked on a journey to heal himself.  He became a student of Grandmaster Zhou of the 18th generation Wudang Dragon Gate Qi Gong lineage. Through the guidance of Master Zhou, Tomm learned to balance his system through Qigong and holistic nutrition, and cleared himself of any need for medication. In 2015, Tomm traveled with his mentor to the holy temples in the Wudang Mountains of China. When he returned to the US, it was clear that the time had come to begin teaching the art of Qigong.  Tomm now supports groups and private clients in healing themselves from imbalances and chronic illnesses such as Parkinson’s, autoimmune diseases, diabetes, high blood pressure and cancer. He facilitates people in learning Qigong anywhere in the world on Skype, or in-person in Los Angeles. Over the years, Tomm has studied many forms of martial arts. In 2016, Tomm became the Eskrima World Champion, and attributes much of his success in competition to the strong foundation that Qigong has given him. As a Qigong, nutrition, fitness, and life coach, Tomm is honored to help guide people of all ages and walks of life in achieving the balance and vitality required to live their greatest lives now. Show Notes: 1:50 Tomm explains what Qi Gong is and the philosophy of a balanced qi. 3:57 How Tomm ended up in the ICU, staring down the idea of being on medicine for the rest of his life. 6:37 Pushing his body to the extreme and having to be fit all the time for photo shoots created very unhealthy balances in his life. 11:00 Learning Qi Gong and applying principles of Chinese medicine was the life-changing solution Tomm needed to overcome thyroid disease naturally. 17:00 The ancient practice of Qi Gong teaches us how to replenish our qi and how to clear out any stagnant qi. 22:00 Not only was Tomm able to regain his health, but he went on to becoming a world champion stick fighter (in escrima). 28:00 With an interest in helping everyone from young executives to elderly clients restore balance in their body and incorporate holistic practices, Tomm began teaching Qi Gong in studios and more recently, with a new online course. 31:00 One of Tomm's clients, who was diagnosed with Parkinson's disease, saw rapid success with his Qi Gong instruction. In the first 20 minutes of practice, her symptoms were greatly reduced. She would remain symptom-free for several hours after sessions and was eventually able to reduce her medications. 38:00 Having a mindset of positivity and service has been life-changing for Tomm, who says he used to have an ego-driven pursuit of life. 49:00 We've become so accustomed to looking for the quick fix to solve our health problems, which has caused a great disconnect with understanding our bodies. 50:00 Tomm's new Qi Gong course provides access to everyone wanting to learn this self-healing art. 56:00 Using Plum Dragon's Dit Da Jow for both his escrima and qi gong practices has allowed Tomm to heal faster and remove qi stagnation. 57:10 Helping people believe that they can accomplish anything is one of Tomm's key messages. Connect With Tomm Voss: https://www.qiwithin.com https://www.facebook.com/tomm.voss.3 https://www.instagram.com/tommvoss/ https://plumdragonherbs.com/pages/courses-classes Find out more about Plum Dragon Dit Da Jow: Bruise Juice Dit Da Jow Dit Da Jow Collection Connect with Plum Dragon Herbs: YouTube |  Facebook | Instagram | Twitter  | LinkedIn  Thank You For Listening! How did you like this episode? We’d love to continue the discussion with you.  Share your comments and takeaways below.   And if you liked this episode, please subscribe to our iTunes and YouTube channels and be sure to follow, like and comment! Podcast Music Credit: Motherlode Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/

Today’s guests are Dr. Jens Goebel and Dr. Robert Fuhlbrigge, here to discuss Henoch-Schönlein purpura (HSP). Dr. Goebel is the Section Head of Nephrology at Children’s Colorado and Professor of Pediatrics at the University of Colorado School of Medicine. Dr. Fuhlbrigge is Section Head of Rheumatology at Children’s Colorado and Professor of Pediatrics also at the University of Colorado School of Medicine.

Today we are discussing the diagnosis and treatment of Henoch–Schönlein purpura, HSP with Jens Goebel, MD, and Robert Fuhlbrigge, MD. Dr. Goebel is the Chief of Nephrology at Children’s Colorado and professor of pediatrics at the University of Colorado School of Medicine. Dr. Fuhlbrigge is Chief of Rheumatology at Children’s Colorado and Professor of Pediatrics also at the University of Colorado School of Medicine.  Key Points From This Episode: Effects of systemic corticosteroids on HSP symptoms and potential complications. The incidence of HSP in the community and what ages are most likely to be affected. Classification criteria for the onset of HSP in patients. Understanding the events and drive of HSP at a molecular level. Tests that are helpful to understand risk of progression or to confirm diagnosis of HSP. How often HSP patients who are at risk for nephritis should be screened. Treatment decisions for patients with more severe HSP and complications. The percentage of recurrent flares of HSP symptoms in patients. Unusual presentation of HSP symptoms in pediatric patients.

Abdominal pain is common; so are strongly held myths and legends about what is concerning, and what is not.   One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain.  Morbidity and mortality varies by age and condition.   Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. Essentials: Typically presents in 1st week of life (case reports to 6 months in chronically ill children) Extend suspicion longer in NICU graduates Up to 10% of all cases of necrotizing enterocolitis are in full-term children Pathophysiology is unknown, but likely a translocation of bacteria Diagnosis: Feeding intolerance, abdominal distention Abdominal XR: pneumatosis intestinalis Management: IV access, NG tube, broad-spectrum antibiotics, surgery consult, ICU admission Intestinal Malrotation with Volvulus Essentials: Corkscrew Sign in Malrotation with Volvulus Bilious vomiting (80-100%) in the 1st month; especially in the 1st week May look well initially, then rapidly present in shock Ladd’s bands: abnormally high tethering of cecum to abdominal wall; peristalsis, volvulus, ischemia Diagnosis: History of bilious emesis is sufficient to involve surgeons Upper GI series: corkscrew appearance US (if ordered) may show abnormal orientation of and/or flow to superior mesenteric artery and vein Management: Stat surgical consult IV access, resuscitation, NG tube to decompress (bowel wall perfusion at risk, distention worsens) Hirschprung Disease Essentials: Problem in migration of neural crest cells Aganglionic colon (80% rectosigmoid; 15-20% proximal to sigmoid; 5% total colonic aganglionosis) colon (known as short-segment disease) Poor to no peristalsis: constipation, perforation, and/or sepsis Diagnosis: May be diagnosed early as “failure to pass meconium in 1st 48 hours” In ED, presents as either bowel obstruction or enterocolitis Contrast enema Beware of the toxic megacolon (vomiting, distention, sepsis) Management: Resuscitation, antibiotics, NG tube decompression, surgical consultation; stable patients may need rectal biopsy for confirmation Staged surgery (abdominoperineal pull-through with diverting colostomy, subsequent anastomosis) versus one-stage repair. Infant and Toddler (1 month to 2 years) Pyloric Stenosis Essentials: Hypertrophy of pyloric sphincter; genetic, environmental, exposure factorsString Sign in Pyloric Stenosis. Diagnosis: Hungry, hungry, not-so-hippos; they want to eat all of the time, but cannot keep things down Poor weight gain (less than 20-30 g/day) US: “π–loric stenosis” (3.14); pylorus dimensions > 3 mm x 14 mm UGI: “string sign” Management: Trial of medical treatment with oral atropine via NGT (muscarinic effects decrease pyloric tone) Ramstedt pyloromyotomy (definitive) Intussusception Essentials: Majority (90%) ileocolic; no pathological lead point Small minority (4%) ileoileocolic due to lead point: Meckel’s diverticulum, polyp, Peyer’s patches, Henoch-Schönlein purpura (intestinal hematoma) Diagnosis: Target Sign (Donut Sign). Ultrasound sensitivity and specificity near 100% in experienced hands Abdominal XR may show non-specific signs; used mainly to screen for perforation before reduction Management: Hydrostatic enema: contrast (barium or water-soluble contrast with fluoroscopy) or saline (with ultrasound) Air-contrast enema: air or carbon dioxide (with either fluoroscopy or ultrasound); higher risk for perforation than hydrostatic (1% risk), but generally safer than perforation from contrast Consider involving surgical service early (precaution before reduction) Traditional disposition is admission; controversial: home discharge from ED Young Child and Older (2 years and up) Appendicitis Essentials: Appendicitis occurs in all ages, but rarer in infants. Infants do not have fecalith; rather they have some other anatomic or congenital condition.  More common in school-aged children (5-12 years) and adolescents Younger children present atypically, more likely to have perforated when diagnosed. Diagnosis: Non-specific signs and symptoms Often have abdominal pain first; vomiting comes later Location/orientation of appendix varies Appendicitis scores vary in their performance Respect fever and abdominal pain   Management: Traditional: surgical On the horizon: identification of low-risk children who may benefit from trial of antibiotics If perforated, interval appendectomy (IV antibiotics via PICC for 4-6 weeks, then surgery) Obstruction SBO. Incarcerated Inguinal Hernia. Essentials: Same pathophysiology and epidemiology as adults: “ABC” – adhesions, “bulges” (hernias), and cancer. Diagnosis: Obstruction is a sign of another condition. Look for cause of obstruction: surgical versus medical Abdominal XR in low pre-test probability CT abdomen/pelvis for moderate-to-high risk; confirmation and/or surgical planning Management: Treat underlying cause NG tube to low intermittent wall suction Admission, fluid management, serial examinations   Take these pearls home: Consider surgical pathology early in encounter Resuscitate while you investigate Have a low threshold for imaging and/or consultation, especially in preverbal children   Selected References Necrotizing Enterocolitis Neu J, Walker A. Necrotizing Enterocolitis. N Eng J Med. 2011; 364(3):255-264. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nature. 2016; 13:590-600. Walsh MC et al. Necrotizing Enterocolitis: A Practitioner’s Perspective. Pediatr Rev. 1988; 9(7):219-226. Malrotation with Midgut Volvulus Applegate KE. Intestinal Malrotation in Children: A Problem-Solving Approach to the Upper Gastrointestinal Series. Radiographics. 2006; 26:1485-1500. Kapfer SA, Rappold JF. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. J Am Coll Surg. 2004; 199(4):628-635. Lee HC et al. Intestinal Malrotation and Catastrophic Volvulus in Infancy. J Emerg Med. 2012; 43(1):49-51. Martin V, Shaw-Smith C. Review of genetic factors in intestinal malrotation. Pediatr Surg Int. 2010; 26:769-781. Nehra D, Goldstein AM. Intestinal malrotation: Varied clinical presentation from infancy through adulthood. Surgery. 2010; 149(3):386-391. Hirschprung Disease Amiel J, Sproat-Emison E, Garcia-Barcelo M, et al. Hirschsprung disease, associated syndromes and genetics: a review. J Med Genet 2008; 45:1. Arshad A, Powell C, Tighe MP. Hirschsprung's disease. BMJ 2012; 345:e5521. Aworanti OM, McDowell DT, Martin IM, Quinn F. Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Eur J Pediatr Surg 2016; 26:192. Clark DA. Times of first void and first stool in 500 newborns. Pediatrics 1977; 60:457. Dasgupta R, Langer JC. Evaluation and management of persistent problems after surgery for Hirschsprung disease in a child. J Pediatr Gastroenterol Nutr 2008; 46:13. De Lorijn F, Reitsma JB, Voskuijl WP, et al. Diagnosis of Hirschsprung's disease: a prospective, comparative accuracy study of common tests. J Pediatr 2005; 146:787. Doig CM. Hirschsprung's disease and mimicking conditions. Dig Dis 1994; 12:106. Khan AR, Vujanic GM, Huddart S. The constipated child: how likely is Hirschsprung's disease? Pediatr Surg Int 2003; 19:439. Singh SJ, Croaker GD, Manglick P, et al. Hirschsprung's disease: the Australian Paediatric Surveillance Unit's experience. Pediatr Surg Int 2003; 19:247. Suita S, Taguchi T, Ieiri S, Nakatsuji T. Hirschsprung's disease in Japan: analysis of 3852 patients based on a nationwide survey in 30 years. J Pediatr Surg 2005; 40:197. Sulkowski JP, Cooper JN, Congeni A, et al. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. J Pediatr Surg 2014; 49:1619. Pyloric Stenosis Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pedaitr Surg. 2007; 16:27-33. Dias SC et al. Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. Insights Imaging. 2012; 3:247-250. Kawahara H et al. Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the olive? J Pediatr Surg. 2005; 40:1848-1851. Mack HC. Adult Hypertrophic Pyloric Stenosis. Arch Inter Med. 1959; 104:78-83. Meissner PE et al. Conservative treatment of infantile hypertrophic pyloric stenosis with intravenous atropine sulfate does not replace pyloromyotomy. Pediatr Surg Int. 2006; 22:1021-1024. Mercer AE, Phillips R. Can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to pyloromyotomy? Arch Dis Child. 2013; 95(6): 474-477. Pandya S, Heiss K, Pyloric Stenosis in Pediatric Surgery.Surg Clin N Am. 2012; 92:527-39. Peters B et al. Advances in infantile hypertrophic pyloric stenosis. Expert Rev Gastroenterol Hepatol. 2014; 8(5):533-541. Intussusception Apelt N et al. Laparoscopic treatment of intussusception in children: A systematic review. J Pediatr Surg. 2013; 48:1789-1793. Applegate KE. Intussusception in Children: Imaging Choices. Semin Roentgenol. 2008; 15-21. Bartocci M et al. Intussusception in childhood: role of sonography on diagnosis and treatment. J Ultrasound. 2015; 18 Gilmore AW et al. Management of childhood intussusception after reductiion by enema. Am J Emerg Med. 2011; 29:1136-1140.:205-211. Chien M et al. Management of the child after enema-reduced intussusception: hospital or home? J Emerg Med. 2013; 44(1):53-57. Cochran AA et al. Intussusception in traditional pediatric, nontraditional pediatric, and adult patients. Am J Emerg Med. 2011; 523-527. Loukas M et al. Intussusception: An Anatomical Perspective With Review of the Literature. Clin Anatomy. 2011; 24: 552-561. Mendez D et al. The diagnostic accuracy of an abdominal radiograph with signs and symptoms of intussusception. Am J Emerg Med. 2012; 30:426-431. Whitehouse et al. Is it safe to discharge intussusception patients after successful hydrostatic reduction? J Pediatr Surg. 2010; 45:1182-1186. Appendicitis Amin P, Chang D. Management of Complicated Appendicitis in the Pediatrc Population: When Surgery Doesn’t Cut it. Semin Intervent Radiol. 2012; 29:231-236 Blakely ML et al. Early vs Interval Appendectomy for Children With Perforated Appendicitis. Arch Surg. 2011; 146(6):660-665. Bundy DG et al. Does This Child Have Appendicitis? JAMA. 2007; 298(4):438-451. Cohen B et al. The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study? J Pediatr Surg. 2015 Jun;50(6):923-7 Herliczek TW et al. Utility of MRI After Inconclusive Ultrasound in Pediatric Patients with Suspected Appendicitis. AJT. 2013; 200:969-973. Janitz et al. Ultrasound Evaluation for Appendicitis. J Am Osteopath Coll Radiol. 2016; 5(1):5-12. Kanona H et al. Stump Appendicitis: A Review. Int J Surg. 2012; 10:4255-428. Kao LS et al. Antibiotics vs Appendectomy for Uncomplicated Acute Appendicitis. Evid Based Rev Surg. 2013;216(3):501-505. Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012; 10:115-119. Mazeh H et al. Tip appendicitis: clinical implications and management. Amer J Surg. 2009; 197:211-215. Puig S et al. Imaging of Appendicitis in Children and Adolescents. Semin Roentgenol. 2008; 22-28. Schizas AMP, Williams AB. Management of complex appendicitis. Surgery. 2010; 28(11):544-548. Shogilev DJ et al. Diagnosing Appendicitis: Evidence-Based Review. West J Emerg Med. 2014; 15(4):859-871. Wray CJ et al. Acute Appendicitis: Controversies in Diagnosis and Management. Current Problems in Surgery. 2013; 50:54-86 Intestinal Obstruction Babl FE et al. Does nebulized lidocaine reduce the pain and distress of nasogastric tube insertion in young children? A randomized, double-blind, placebo-controlled trial. Pediatrics. 2009 Jun;123(6):1548-55 Chinn WM, Zavala DC, Ambre J. Plasma levels of lidocaine following nebulized aerosol administration. Chest 1977;71(3):346-8. Cullen L et al. Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial. Ann Emerg Med. 2004 Aug;44(2):131-7. Gangopadhyay AN, Wardhan H. Intestinal obstruction in children in India. Pediatr Surg Int. 1989; 4:84-87. Hajivassiliou CA. Intestinal Obstruction in Neonatal/Pediatric Surgery. Semin Pediatr Surg. 2003; 12(4):241-253. Hazra NK et al. Acute Intestinal Obstruction in children: Experience in a Tertiary Care Hospital. Am J Pub Health Res. 2015; 3(5):53-56. Kuo YW et al. Reducing the pain of nasogastric tube intubation with nebulized and atomized lidocaine: a systematic review and meta-analysis. J Pain Symptom Manage. 2010 Oct;40(4):613-20.  . Pediatric Surgery Irish MS et al. The Approach to Common Abdominal Diagnoses in Infants and Children. Pedaitr Clin N Am. 1998; 45(4):729-770. Louie JP. Essential Diagnosis of Abdominal Emergencies in the First Year of Life. Emerg Med Clin N Am. 2007; 25:1009-1040. McCullough M, Sharieff GQ. Abdominal surgical emergencies in infants and young children. Emerg Med Clin N Am. 2003; 21:909-935. Pepper VK et al. Diagnosis and Management of Pediatric Appendicitis, Intussusception, and Meckel Diverticulum. Surg Clin N Am. 2012   This post and podcast are dedicated to Mr Ross Fisher for his passion and spirit of collaboration in all things #FOAMed.  Thank you, sir!