Differentials
Epiglottitis/supraglottitis (in children)
SIGNS / SYMPTOMS
Dysphagia, muffled voice, and difficulty handling oral secretions.
INVESTIGATIONS
Swab cultures from the epiglottis, trachea, or nasopharynx may yield growth of Haemophilus influenzae type B (Hib).
Peritonsillar abscess (in children)
SIGNS / SYMPTOMS
Spiking fever, neck pain/torticollis, neck swelling, and/or lymphadenopathy.
INVESTIGATIONS
CT shows a ring-enhancing lesion in the retropharyngeal tissues when performed with contrast.
Pyloric stenosis or hypertrophic pyloric stenosis (in children)
SIGNS / SYMPTOMS
Non-bilious projectile vomiting. Firm, non-tender, and mobile structure (described as an 'olive') is palpable in the right upper quadrant.
INVESTIGATIONS
Electrolyte abnormalities (hypochloraemia and hypokalaemic metabolic alkalosis) are frequently seen. In full-term infants, a pyloric muscle thickness of >4 mm and pyloric canal length of >17 mm on ultrasound is typically diagnostic for pyloric stenosis.[55]
Oesophagitis
SIGNS / SYMPTOMS
Retrosternal chest pain, heartburn, coffee ground emesis.
INVESTIGATIONS
Oesophagogastroduodenoscopy is the diagnostic test of choice, allowing visualisation of the oesophageal mucosa.
Small bowel obstruction
SIGNS / SYMPTOMS
Abdominal pain and bloating with inability to pass gas or have a bowel movement; vomiting may occur.
INVESTIGATIONS
Abdominal plain films, CT of the abdomen, and MRI can all generally diagnose small bowel obstruction.
Large bowel obstruction
SIGNS / SYMPTOMS
Abdominal pain and bloating; inability to pass gas or have a bowel movement. In cases of partial obstruction, the patient may have diarrhoea.
INVESTIGATIONS
Abdominal plain films, CT of the abdomen, and MRI can all generally diagnose large bowel obstruction.
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