Male1: Doctor, if a parent was concerned about belly pain, what do you think it possibly could be surgical?
Male2: This is a very difficult question for pediatricians and for parents around the world. It is very, very common for children to say their belly hurts. They are constipated, they may say that their belly hurts. They are hungry, they may say their belly hurts. They get a cold, they often have belly pain and the problem is, how do you decide that a baby or a child whose belly hurts has something that is “surgical”, something that needs an operation. And the two common things that we think about are appendicitis in older kids and something called in intussusception in toddlers and the answer is not black and white, it requires understanding the whole group of symptoms, the whole gestalt of what the child is complaining about and what their symptoms are. So let us talk about appendicitis first of all.
Appendicitis is an inflammation of the appendix. The appendix is a little piece of intestine, almost the shape of your pinky that hangs down from where your colon joins with your small intestine. It is in the right lower quadrant of your belly. What happens is, the appendix gets inflamed, sometimes it maybe because of ball of stool that is called an appendicle lift blocks the lumen, blocks the opening inside the appendix, sometimes it may just be because the child has a cold and lymph nodes, glands around the appendix gets swollen and block it and sometimes, it may just be a colic where we do not know the reason.
So the appendix gets inflamed, now the first symptom that a child or an adult for that matter experiences when their appendix gets inflamed is a vague feeling of discomfort and the pain is described medically as epigastric, which means in the middle of the belly. That is because your nervous system and your brain are not really designed to interpret inflammation inside your belly very precisely.
You get this epigastric discomfort and as the inflammation progresses, the child may develop a little bit of a fever. He may develop a little bit of what we call anorexia. Anorexia means not wanting to eat. As time goes on, they may even get an upset stomach and vomit a few times. Now obviously, this is a similar set of symptoms to thousands and thousands of other diseases. Babies and children get gastroenteritis. They may get food poisoning and they may have vague pain and they may have some nausea and vomiting. They may have a little bit of fever. The thing that defines appendicitis or that raises our suspicion for appendicitis is that over 12 to 24 hours, that discomfort which is epigastric, that low grade fever persists and the pain changes as the inflammation spreads from the appendix to the surrounding tissues, you begin to have pain in your belly wall, and so the pain which started out in the epigastric region migrates to the right lower quadrant of the belly. The right side, down towards the hip because that is where the appendix sits.
So if a pediatrician sees a child who started with epigastric pain now is complaining of right lower quadrant pain, or if on examination, when they touch the child’s belly, it hurts specifically in the right lower quadrant, that is what would make them feel pain. Pain in the right lower quadrant would make a pediatrician suspicious that there might be appendicitis and then they would refer the patient to a pediatric surgeon, sometimes to the emergency room just because the logistics of getting to see a surgeon and getting all of the blood test and x-rays that are necessary is sometimes easier and logistically simpler in an emergency room.
Male1: Sometimes, they do a thing called a CAT scan for appendix, what is that all about?
Male2: The answer is that there are some situations where the diagnosis is clear. Appendicitis is most common at age 11. If you have an 11-year-old boy who starts out with epigastric pain that migrates to the right lower quadrant, where there is tenderness in the right lower quadrant, who has what we call a low-grade fever, a temperature that is higher than normal, but not very, very high, who has a blood test that shows an elevated blood cell count which implies that there is an infection—that child does not need radiation exposure from a CAT scan. That child does not need fancy sonogram or tests. That child has appendicitis.
Transcription by:
Scribe4you Transcription Services