Pyloric Stenosis
Non-bilious projectile vomiting at 2–8 weeks; palpable 'olive-like' mass in RUQ; hypochloremic hypokalemic metabolic alkalosis; ultrasound shows pyloric muscle > 3 mm.
Intussusception Triad
Colicky intermittent abdominal pain (curling legs to chest), 'currant jelly' stools, and palpable sausage-shaped mass in RUQ; air/contrast enema is diagnostic and therapeutic.
Midgut Volvulus
Sudden-onset bilious emesis in first month of life; twisting of bowel around superior mesenteric artery; 'corkscrew' sign on upper GI series; surgical Ladd procedure emergency.
Hirschsprung Disease
Failure to pass meconium within first 48 hours + abdominal distension; absence of ganglion cells (Auerbach/Meissner) in distal rectum; rectal suction biopsy is gold standard.
Acute Pediatric Abdominal Emergencies Master Comparison
| Emergency Condition | Typical Age & Presentation | Diagnostic Modality & Pathognomonic Finding | Emergency Intervention |
|---|---|---|---|
| Hypertrophic Pyloric Stenosis | 3 to 6 weeks of life; firstborn male; non-bilious projectile vomiting immediately after feeds; ravenously hungry infant | Palpable 'olive-shaped' mass in epigastrium/RUQ; Abdominal ultrasound: pyloric thickness > 3 mm, length > 14 mm; Labs: Hypochloremic, hypokalemic metabolic alkalosis | 1. Correct fluid and electrolyte imbalances FIRST with IV normal saline + potassium, 2. Ramstedt surgical pyloromyotomy |
| Intussusception | 6 months to 3 years; episodic severe colicky abdominal pain with legs drawn up to chest; intervening lethargy; 'currant jelly' stools | Palpable 'sausage-shaped' mass in RUQ with emptiness in RLQ (Dance sign); Ultrasound: 'target' or 'donut' sign | Pneumatic (air) or hydrostatic (contrast) enema under fluoroscopic or US guidance; surgical manual reduction if perforation or peritonitis |
| Midgut Volvulus / Malrotation | First month of life (typically day 1–7); sudden bilious vomiting and acute abdominal distension; shock and bloody stools if bowel ischemia develops | Upper GI series (fluoroscopy with barium via NGT): ligament of Treitz on right side of abdomen and 'corkscrew' duodenal appearance | Emergent surgical exploratory laparotomy with Ladd procedure (detorsion of volvulus, division of Ladd bands, appendectomy) to prevent total midgut infarction |
| Hirschsprung Disease | Newborn; failure to pass meconium within 48 hours; chronic constipation, bilious vomiting, abdominal distension; 'squirt sign' / explosive stool release on DRE | Barium enema: transition zone between narrowed aganglionic distal rectum and dilated proximal colon; Gold standard: Rectal suction biopsy (absence of ganglion cells in submucosa) | Surgical resection of aganglionic segment with pull-through anastomosis (Swenson or Soave procedure) |
| Meckel Diverticulum | Age < 2 years; Rule of 2s: 2% of population, 2 inches long, 2 feet from ileocecal valve, 2 years old, 2 types of ectopic tissue (gastric 80%, pancreatic 20%) | Painless lower GI bleeding (melena / hematochezia); Technetium-99m pertechnetate scan (Meckel scan) shows ectopic gastric mucosa | Surgical surgical wedge excision or segmental bowel resection |
High-Yield Developmental Milestones Guide
| Age | Gross Motor | Fine Motor | Language | Social / Cognitive |
|---|---|---|---|---|
| 2 Months | Lifts head and chest prone | Hands unfisted half the time | Coos and vocalizes vowel sounds | Social smile; tracks past midline |
| 4 Months | Rolls front to back; steady head control | Reaches for objects, grasps rattle | Laughs aloud; squeals | Turns head to sound of voice |
| 6 Months | Sits independently (briefly tripod); rolls back to front | Transfers objects hand-to-hand; raking grasp | Babbles with consonant sounds ('da-da', 'ba-ba') | Stranger anxiety begins; responds to name |
| 9 Months | Crawls; pulls to stand; cruises furniture | Three-finger immature pincer grasp | Understands 'no'; repetitive consonant babbles | Plays peek-a-boo; wave bye-bye |
| 12 Months (1 Year) | Walks alone or with one hand held | Two-finger neat pincer grasp; releases cube into cup | Says 1–2 specific words besides 'mama/dada' | Imitates actions; points to objects (joint attention) |
| 2 Years | Runs; walks up/down stairs one step at a time; kicks ball | Stacks tower of 6 cubes; copies vertical line | 2-word phrases (50+ word vocabulary, 50% intelligible to stranger) | Parallel play; follows 2-step command |
| 3 Years | Rides tricycle; alternates feet going up stairs | Stacks tower of 9 cubes; copies circle; uses fork | 3-word sentences (75% intelligible to stranger) | Knows age and gender; cooperative play; group play |
| 4 Years | Hops on one foot | Copies cross and square; uses scissors | Tells stories (100% intelligible to stranger) | Understands rules; imaginative/fantasy play |
OMM Board Correlate: Pediatric Gastrointestinal Viscerosomatics
- Upper GI Reflexes (Pylorus & Duodenum): Sympathetic innervation originates from T5–T9 via greater splanchnic nerve to celiac ganglion. Pyloric spasm creates severe somatic dysfunction at the T6–T8 paraspinal musculature and anterior Chapman point on the sternum.
- Colonic Transit: In functional pediatric constipation, sacral base decompression and myofascial release of the pelvic diaphragm relieve hypertonicity in pelvic splanchnic nerves (S2–S4).
Board Traps & Common Distractors
- In infant hypertrophic pyloric stenosis, surgical pyloromyotomy is NEVER an emergency; operating before correcting the hypochloremic hypokalemic metabolic alkalosis causes postoperative apnea and fatal cardiac arrhythmias. Always correct fluid deficits and alkalosis first.
- Any newborn with bilious (green) emesis has midgut volvulus until proven otherwise; immediate upper GI fluoroscopy and emergent surgical consultation are mandatory to avoid total small bowel infarction.
- Air or contrast enema for intussusception is absolutely contraindicated if peritonitis, hemodynamic shock, or free intra-abdominal air on radiograph (pneumoperitoneum) is present; proceed immediately to exploratory laparotomy.