American family physician
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American family physician · Dec 2024
ReviewAcute Abdominal Pain in Children: Evaluation and Management.
Acute abdominal pain in children is a common presentation in the clinic and emergency department settings and accounts for up to 10% of childhood emergency department visits. Determining the appropriate disposition of abdominal pain in children can be challenging. The differential diagnosis of acute abdominal pain, including gastroenteritis, constipation, urinary tract infection, acute appendicitis, tubo-ovarian abscess, testicular torsion, and volvulus, and the diagnostic approach vary by age. ⋯ Ultrasonography, including point-of-care ultrasonography, for the evaluation of acute abdominal pain in children is the preferred initial imaging modality due to its low cost, ease of use, and lack of ionizing radiation. In addition to laboratory evaluation and imaging, children with red-flag or high-risk symptoms should be referred for urgent surgical consultation. Validated scoring systems, such as the Pediatric Appendicitis Score, can be used to help determine the patient's risk of appendicitis.
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Bone stress injuries (BSIs) are a spectrum of overuse injuries caused by an accumulation of microdamage, from high physical demands on normal bone or normal physiologic loads on structurally compromised bone. They typically result from overuse in younger patients but are also caused by pathologic bone conditions, including relative energy deficiency in sport, which features decreased bone mineral density. Stress fractures, representing 20% of BSIs, are the most severe type and feature discernable sclerosis or fracture lines on imaging. ⋯ Severity of BSI (grade) and location (low- vs high-risk of complications) guide the management approach. Injuries in low-risk sites are treated conservatively, whereas fractures in high-risk sites warrant consultation with sports medicine or orthopedics. Femoral neck BSIs, especially when tension-sided, require urgent surgical consultation.
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American family physician · Dec 2024
ReviewAnemia in Infants and Children: Evaluation and Treatment.
Anemia affects more than 269 million children globally, including 1.2 million children in the United States. Although anemia can present with numerous symptoms, children are most often asymptomatic at the time of diagnosis. Anemia in infants and children most often arises from nutritional iron deficiency but can also be a result of genetic hemoglobin disorders, blood loss, infections, and other diseases. ⋯ Normocytic anemia is classified by reticulocyte count and can reflect hemolysis (high reticulocyte count) or bone marrow suppression (low reticulocyte count). Macrocytic anemia is less common in children and is typically a result of nutritional deficiencies or poor absorption of cobalamin (vitamin B12) or folate. Pediatric hematology referral might be beneficial for patients who do not respond to treatment, and referrals are critical for any bone marrow suppression that is diagnosed.
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For patients with chest discomfort, noninvasive cardiac testing can be used for the diagnosis of acute coronary syndrome and for the evaluation of the risk of future cardiovascular events and disease severity in patients with known coronary artery disease. Clinical prediction rules can guide risk assessment for patients with acute or stable chest discomfort. For acute chest discomfort, patients with low risk do not need urgent testing, and those at high risk should have invasive coronary angiography. ⋯ Exercise or pharmacologic stress testing with imaging allows dynamic assessment of ventricular function and perfusion. For stable chest discomfort in patients with low risk, coronary artery calcium scoring can be used to exclude calcified plaque or exercise stress testing can be used for the evaluation of future cardiac risk and prognosis. For stable chest discomfort in patients with intermediate or high risk, exercise stress testing or stress testing with imaging (ie, echocardiography, myocardial perfusion imaging, or cardiac magnetic resonance imaging) may be used for the evaluation for myocardial ischemia.