Pediatric emergency medicine trisk 2069 2069
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FIGURE 91.2 A, B: Gastric foreign body. A 9-year-old female accidentally ingested a 2.7cm nail when hanging stockings and was holding nail in her mouth.
TABLE 91.3
CAUSES OF ACUTE PANCREATITIS IN CHILDREN
Trauma: blunt, penetrating, surgical
Infectious: mumps, coxsackievirus B infection, hemolytic Streptococcus
infection, Salmonella infection, hepatitis A and B
Obstructive: cholelithiasis, ascaris infection, congenital duodenal stenosis,
duplications, tumor, choledochal cyst
Drugs: steroids, chlorothiazides, salicylazosulfapyridine, azathioprine,
alcohol, valproic acid, tetracyclines, borates, oral contraceptives
Systemic: systemic lupus erythematosus, periarteritis nodosa, malnutrition,
peptic ulcer, uremia
Endocrine: hyperparathyroidism
Metabolic: hypercholesterolemia, cystic fibrosis, vitamin A and D
deficiency
Hereditary
Idiopathic
Triage Considerations
Most patients with pancreatitis present with nonspecific signs and symptoms
and are hemodynamically stable. A minority of patients, especially those with
necrotic or hemorrhagic disease may present in shock or jaundice. These
patients require immediate recognition and appropriate stabilization.
Clinical Assessment
The abdomen may be distended but is usually not rigid, and the patient may
prefer sitting or lying on their side with knees flexed. There may be mild to
moderate voluntary guarding in the epigastrium. A palpable epigastric mass
suggests pseudocyst. Ascites is rare. Bowel sounds may be decreased or
absent. Associated physical findings may include signs of parotitis, mild
hepatosplenomegaly, epigastric mass, pleural effusions, and mild icterus.
Although rare, rebound tenderness or a rigid abdomen is a poor prognostic
