Abdominal pain (peds)

Background

bilious emesis in a kid is a surgical emergency until proven otherwise

Visceral pain is dull & non-specific

Somatic pain is sharp & localized d/t peritoneal or diaphragm irritation

Guarding & TTP/rebound are most c/w surgical DZ in kids

Infants eat, sleep & poop, probs w/ these can be a bad sign

DDX

Age	Emergent	Nonemergent
0–3 mo old	Necrotizing enterocolitis	Colic
	Volvulus	Acute gastroenteritis
	Testicular torsion	Constipation
	Incarcerated hernia
	Trauma
	Toxic megacolon
	Tumor
3 mo–3 y old	Intussusception	Acute gastroenteritis
	Testicular torsion	Constipation
	Trauma	Urinary tract infections
	Volvulus	HSP
	Appendicitis
	Toxic megacolon
	Vaso-occlusive crisis
3 y old–adolescence	Appendicitis	Constipation
	Diabetic ketoacidosis	Acute gastroenteritis
	Vaso-occlusive crisis	Nonspecific viral syndromes
	Toxic ingestion	Streptococcus pharyngitis
	Testicular torsion	Urinary tract infections
	Ovarian torsion	Pneumonia
	Ectopic pregnancy	Pancreatitis
	Trauma	Cholecystitis
	Toxic megacolon	Renal stones
	Tumor	HSP
		Inflammatory bowel disease
		Gastric ulcer disease/gastritis
		Ovarian cyst
		Pregnancy

Epidemiology

Ten most common Dx in order:

1. AGE (26%)
2. Nonspecific AP (26%)
3. Viral Illness (6%)
4. Constipation (5%)
5. UTI (5%)
6. Pharyngitis (5%)
7. Appy (4%)
8. Asthma (2%)
9. OM (2%)
10. PNA (2%)

Also look for extra-abdominal (collagen dz, HSP, DKA, poison, IBD, CF, nephrotic syndrome)

DDx 1

• Infancy
  • gastroenteritis, intussusception, volvulus, incarcerated hernia, Hirschrung's dz, NEC, perforation, colic, pneumonia, pyloric stenosis
• Childhood
  • AGE, appy, pancreatitis, HSP, HUS, Incarcerated Hernia, constipation, UTI, pyelo, PNA, GAS phryngitis, ulcers, meckels, IBD
• Adolescence
  • same as before but add ectopic, PID, torsion (testicular, ovarian), IBD, biliary disease, nephrolithiasis

DDX 2

Infant

green vomit: bad sign

obstruction: volvulus, malrotation

abd pain also caused by trauma, intuss.(air enema is dx and tx), intestinal anomalies, incarcerated hernia, sickling syndromes, (acute intermittent porphyria), appy, milk allergy, wilms tumor, toxins (heavy metals), disaccharide deficiency.

2-5 years

viral, gastroenteritis, pnemonia, asthma, constipation, trauma, appy, sickling syndrome, UTI, meckel's diverticulum, HSP, nephrotic syndrome, intuss, IBD, HUS, DM, pancreatitis

order: amylase, LFT's

5-12 years

appy (CT c rectal contrast-very sens. + spec.), testicular torsion (or appendix testis torsion), functional abd pain, gastroenteritis, constipation, URI, CF, DM, torsion, renal calculi, Rheumatic fever

Adolescent

ectopic: get ßhCG, type + cross (rhogam), pelvic US--be sure well-hydrated for US for optimal imaging, PID, IBP, Rheumatic fever, abd abscess

Workup

1. UA, Upreg
2. Dehydration: electrolytes, renal fxn tests
3. Vomiting without diarrhea: LFTs, lipase, toxin screen
4. Fever: CBC, CRP
5. Diagnostic imaging
6. Role of abdominal xrays: only good if positive (ann emerg med-1992 rothrock et al)
7. 50% of of patients with major disease had normal radiographs

See Also

Necrotizing Enterocolitis (NEC)

Volvulus

Pyloric Stenosis

Intussusception

Meckel's Diverticulum

Appendicitis (Peds)

Inguinal Hernia (Peds)

Source

Gausche 11/03- By Lampe

7/2/09 PANI