2025 – PAGE 231 – GASTROENTEROLOGY

CHOLECYSTITIS

Cholecystitis is an inflamed and thickened gallbladder wall, usually due to gallstone obstruction of the cystic duct. The illness presents with fever and RUQ abdominal pain (Murphy’s Sign). A RUQ mass is sometimes palpable. Unlike adults, many children also have JAUNDICE. Fatty meals exacerbate the pain, which may radiate to the right scapula or shoulder. Acalculous cholecystitis occurs in the absence of gallstones and may be associated with hemolysis, TPN sepsis, prolonged fasting, or obesity. Diagnosis is usually made by ultrasound, though a HIDA scan may be needed in some cases to confirm.

PEARL: Instead of abdominal pain, you may be presented with a child complaining of SHOULDER pain (referred).

NAME ALERT: CholeCYSTitis refers to the inflammation of the gallbladder (cyst = bladder, the same way cystitis refers to inflammation of the bladder). CholeLITHiasis simply means there are stones in the gallbladder. CholANGItis is a medical emergency that classically presents with Charcot’s triad of fever, RUQ pain, and jaundice from an infection in the biliary tract.

CHOLELITHIASIS

Cholelithiasis is a term for gallstones in the gallbladder. The patient may present with similar symptoms as cholecystitis. Patients are more likely to have jaundice and icterus (yellowing of the sclera). Unlike in cholecystitis, hepatosplenomegaly may be present. Cystic fibrosis, TPN use, and a history of ceftriaxone use increase the risk of cholelithiasis.

ICTERUS

Icterus is a yellowing of the sclera.

PEARL: A patient who presents with yellow-orange skin but DOES NOT HAVE ICTERUS likely has had excessive beta carotene ingestion (apricots, carrots, sweet potatoes, pumpkins, etc.).

CAUSES OF ABDOMINAL DISCOMFORT & PAIN

CLASSIC FUNCTIONAL ABDOMINAL PAIN OF CHILDHOOD

Classic functional abdominal pain of childhood is a periumbilical, crampy abdominal pain that does not radiate in an otherwise healthy, prepubertal child. It may be recurrent.

CONSTIPATION

For cases of constipation, use stool softeners, fiber supplements, and osmotic agents/laxatives to “clean them out.” Then focus on good bowel habits, appropriate fiber intake and avoidance of withholding through positive reinforcement.

PEARL: Avoid suppositories and enemas in simple constipation, as they may be traumatic.

FECAL OVERFLOW ENCOPRESIS

Patients with fecal overflow encopresis may present with LLQ pain. You may use more aggressive measures, such as enemas and suppositories for initial “clean out.”