2025 – PAGE 234 – GASTROENTEROLOGY

PANCREATITIS

Pancreatitis is an inflammation of the pancreas resulting in epigastric pain that can be associated with rebound, guarding, nausea, vomiting, or fever. Pain often radiates to the back. Possible etiologies include trauma, cystic fibrosis, hereditary pancreatitis, and pancreatic duct obstruction, but it’s most often idiopathic. Diagnose with abdominal ULTRASOUND (extremely specific) or CT of the abdomen. Supportive labs include elevated biomarkers, such as ISOamylase, amylase, and lipase. An ERCP may be obtained if the patient has RECURRENT bouts of pancreatitis.

PEARL: Many GI diseases result in hyperactive bowel sounds. With pancreatitis, bowel sounds can be DECREASED.

INTUSSUSCEPTION

Intussusception is a telescoping of the bowel into an adjacent segment of bowel, often in the ileocecal area (AKA ileocolic area). This can result in intermittent episodes of abdominal pain, currant jelly stools, bilious emesis, a palpable mass, and even a septic clinical picture without fever. It usually occurs in children 3 months to 36 months of age, and is typically idiopathic in these early years. When cases present outside of that age range, you should consider a pathologic cause which has created a “lead point” (polyp, hematoma, lymphoid hyperplasia, diverticulum, etc.). Most cases occur in the first year of life, but about 10% of cases are in patients older than 5 years of age (including teenagers and adults). Treatment options include either an air contrast enema with a small amount of barium, or a barium enema.

PEARLS: Buzz words include intermittent abdominal pain and currant jelly stools. Patient may not have ANY abdominal pain on exam. If given an option between air contrast enema and barium contrast enema, choose AIR contrast.

NAME ALERT:  “Currant jelly” is a buzz phrase for KLEBSIELLA pneumonia too (currant jelly SPUTUM).

(DOUBLE TAKE) GIARDIA

Giardia presents with intermittent watery diarrhea that has been going on for weeks. This may be accompanied by abdominal distension and may eventually cause malabsorption. Diagnose with direct fluorescent antibody testing (DFA) or ELISA, and then treat with metronidazole.

PEARLS: History may include a camping trip or a child in daycare.

ABDOMINAL PAIN PEARL

Keep in mind other causes of abdominal pain and discomfort, such as pneumonia, testicular torsion, torsion appendix, and inguinal hernias.