Abdominal pain (peds): Difference between revisions
Ostermayer (talk | contribs) No edit summary |
(→DDX) |
||
| Line 3: | Line 3: | ||
*Bilious emesis is a surgical emergency until proven otherwise | *Bilious emesis is a surgical emergency until proven otherwise | ||
== | == Differential Diagnosis == | ||
{| class="wikitable" | {| class="wikitable" | ||
| Line 12: | Line 12: | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" rowspan="7" | 0–3 mo old | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" rowspan="7" | 0–3 mo old | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Necrotizing Enterocolitis]] | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Necrotizing Enterocolitis]] | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Colic | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Colic]] | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Volvulus]] | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Volvulus]] | ||
| Line 18: | Line 18: | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Testicular Torsion]] | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Testicular Torsion]] | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Constipation | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Constipation]] | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Incarcerated hernia | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Incarcerated hernia]] | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| Line 26: | Line 26: | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Toxic megacolon | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Toxic megacolon]] | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| Line 37: | Line 37: | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Testicular Torsion]] | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Testicular Torsion]] | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Constipation | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Constipation]] | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Trauma | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Trauma | ||
| Line 48: | Line 48: | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Toxic megacolon | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Toxic megacolon]] | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| Line 56: | Line 56: | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" rowspan="14" | 3 y old–adolescence | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" rowspan="14" | 3 y old–adolescence | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Appendicitis]] | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Appendicitis]] | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Constipation | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Constipation]] | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Diabetic Ketoacidosis]] | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Diabetic Ketoacidosis]] | ||
| Line 62: | Line 62: | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Vaso-occlusive crisis | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Vaso-occlusive crisis | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Nonspecific viral | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Nonspecific [[viral syndrome]] | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Toxic ingestion | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Toxic ingestion]] | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Streptococcus pharyngitis]] | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Testicular Torsion]] | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Testicular Torsion]] | ||
| Line 79: | Line 79: | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Cholecystitis]] | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Cholecystitis]] | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Toxic megacolon | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Toxic megacolon]] | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Renal Stone]] | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Renal Stone]] | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| Line 86: | Line 86: | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Inflammatory bowel disease | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Inflammatory bowel disease]] | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Gastric ulcer disease/gastritis | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Gastric ulcer disease]]/[[gastritis]] | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Ovarian cyst | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Ovarian cyst]] | ||
|- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px" | ||
| class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | | ||
Revision as of 12:13, 14 January 2015
Background
- Bilious emesis is a surgical emergency until proven otherwise
Differential Diagnosis
| 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 syndrome | |
| Toxic ingestion | Streptococcus pharyngitis | |
| Testicular Torsion | Urinary Tract Infections | |
| Ovarian Torsion | Pneumonia | |
| Ectopic Pregnancy | Pancreatitis | |
| Trauma | Cholecystitis | |
| Toxic megacolon | Renal Stone | |
| Tumor | HSP | |
| Inflammatory bowel disease | ||
| Gastric ulcer disease/gastritis | ||
| Ovarian cyst | ||
| Pregnancy |
Workup
- UA, hCG
- Chemistry: eval for dehydration
- Imaging
- Abd xray
- Specific, not sensitive
- Ultrasound
- Appropriate for intussusception, ovarian/testicular, GB, IUP, appy
- CT
- May be a/w 1/1000 lifetime risk of malignancy
- Abd xray
See Also
- Abdominal Pain
- 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