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
Nonbilious projectile vomiting. Firm, nontender, and mobile structure (described as an "olive") is palpable in the right upper quadrant.
INVESTIGATIONS
Electrolyte abnormalities (hypochloremia and hypokalemic 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.[53]
Esophagitis
SIGNS / SYMPTOMS
Retrosternal chest pain, heartburn, coffee ground emesis.
INVESTIGATIONS
Esophagogastroduodenoscopy is the diagnostic test of choice, allowing visualization of the esophageal 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 diarrhea.
INVESTIGATIONS
Abdominal plain films, CT of the abdomen, and MRI can all generally diagnose large bowel obstruction.
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