Emergency Medicine

Paediatric Emergencies 357

ABDOMINAL PAIN, DIARRHOEA AND VOMITING

(i) White cells are seen in the urine in peritonitis and appendicitis,

as well as in UTI.

8 Only request erect and supine abdominal X-rays if intestinal obstruction or
perforation is suspected.

9 Request an ultrasound scan to demonstrate pyloric stenosis, intussusception
and renal pathology.

MANAGEMENT

1 Suspected surgical abdomen
(i) Establish i.v. access and administer 20 mL/kg of normal saline
i.v. for marked dehydration, hypoperfusion and shock. Give
morphine 0.1 mg/kg for significant pain.
(ii) Place a nasogastric tube (NGT) if bowel obstruction is present.
(iii) Keep the patient fasted and refer for immediate surgical review.

2 Treat medical conditions according to the likely aetiology.

3 Arrange review within 24 h for a well child allowed home.

Diarrhoea, vomiting and dehydration

DIAGNOSIS

1 Diarrhoea and vomiting are common problems that require investigation
and treatment. Dehydration is a serious end result.

2 Causes of diarrhoea include:
(i) Gastroenteritis:
(a) viral: most common cause, including rotavirus and
adenovirus
(b) bacterial: e.g. Escherichia coli, Salmonella or Campylobacter
(c) protozoal: e.g. Giardia lamblia.
(ii) Infection: septicaemia, UTI, pneumonia, tonsillitis, otitis media.
(iii) Surgical conditions: appendicitis, intussusception and partial
bowel obstruction.
(iv) Drugs: particularly antibiotics such as ampicillin.
(v) Chronic relapsing conditions such as ulcerative colitis, Crohn’s
disease.

3 Vomiting is a common condition associated with a wide variety of causes:
(i) Causes in the newborn
(a) infection: meningitis and UTI
(b) intestinal obstruction from duodenal atresia, Hirschsprung’s
disease or meconium plug
(c) cerebral haemorrhage or oedema
(d) metabolic: galactosaemia and congenital adrenal hyperplasia.