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AAP National Conference: Pediatric surgeon to review diagnosis of abdominal diseases :

October 24, 2016

Can you distinguish viral gastroenteritis from appendicitis? Do you know when to order an ultrasound vs. a CT scan in a patient with abdominal symptoms? When would you consult with a pediatric surgeon?

Get the answers to these questions and more during an Audience Response Session titled “Abdominal Diagnoses Not to Miss.” The session will be held from 4-5:30 p.m. Monday (A3145) and again from 4-5:30 p.m. Tuesday (A4099) in Room 303 of Moscone South.

Benjamin Padilla, M.D., assistant professor of surgery at UCSF Benioff Children’s Hospital in San Francisco, plans to go through cases highlighting important diagnoses that primary care pediatricians should be aware of, including appendicitis, abdominal masses and ovarian torsion in young women. He also will review how to choose the best diagnostic maneuvers based on the literature and his own clinical experience.

While appendicitis is seen in children from 1 year to adults, most tumors occur in infants and young children.

Interestingly, abdominal masses in infants often are not detected by the parents.

“It’s sort of like watching your hair grow. You don’t really notice that it has changed from one day to the next,” Dr. Padilla said. “More commonly when I see children with abdominal tumors, it’s detected by some alternate caregiver like the babysitter, grandparents or the pediatrician.”

As he discusses abdominal masses in different age groups, Dr. Padilla might ask the audience to use the response system to indicate if they have detected a mass. He also might present a case and have attendees vote on what they think the best imaging study and diagnosis would be and to whom they would refer the patient.

While there is general agreement that ultrasound is the most appropriate diagnostic modality for suspected appendicitis, the operator must be skilled at detecting the appendix in a young child. Sonographers who work in hospitals that care largely for adults might have a limited skill set, since adults almost always go straight to a CT scan, Dr. Padilla said. In addition, ultrasound may not be available at certain times of the day or night.

If a child does undergo a CT scan, it’s vital that it be done with intravenous (IV) contrast.

“If you’re really concerned about what’s actually going on and you ultimately make the decision to get a CT, it’s important that the CT scan be done with IV contrast otherwise it renders the study almost useless,” Dr. Padilla said.

Another common pitfall is referring patients to the hospital or a surgeon too late.

“I think that it’s a mistake to not refer because you’re concerned that it might be a bother to the surgeon,” he said.

Dr. Padilla suggested that pediatricians develop a good working relationship with a surgeon so they feel comfortable referring patients.

“A good surgeon should be open and willing to help in the evaluation and treatment of a patient, so trying to establish that relationship and rapport is really important,” he said. “It’s definitely a two-way street, and I think the surgeons need to be receptive as well.”

For more coverage of the AAP National Conference & Exhibition visit
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