|
|
(43 intermediate revisions by 7 users not shown) |
Line 1: |
Line 1: |
| == Background == | | {{Peds top}} [[abdominal pain]], [[abdominal pain in pregnancy]], and/or [[abdominal pain (geriatrics)]] |
| | ==Background== |
| | *Bilious emesis is a surgical emergency until proven otherwise |
|
| |
|
| *Bilious emesis is a surgical emergency until proven otherwise | | ==Clinical Features== |
| | [[File:Abdominal Quadrant Regions.jpg|thumb|Side-by-side comparison of quadrants and regions.]] |
| | [[File:1506 Referred Pain Chart.jpg|thumb|Chart of commonly reported referred pain sites.]] |
| | *Abdominal pain |
| | *May be associated with [[nausea]], [[vomiting]], or [[diarrhea]] |
| | *[[Fever]] may be present in pain from infectious etiology |
|
| |
|
| == Differential Diagnosis == | | ==Differential Diagnosis== |
| | {{Pediatric abdominal pain DDX}} |
|
| |
|
| {| class="wikitable"
| | ==Evaluation== |
| ! valign="top" align="left" bgcolor="#ffffff" | Age
| | ''Depends on location and history'' |
| ! valign="top" align="left" bgcolor="#ffffff" | Emergent
| | *Consider: |
| ! valign="top" align="left" bgcolor="#ffffff" | Nonemergent
| | **hCG |
| |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px"
| | ***Consider [[ectopic pregnancy]] in any female of reproductive age |
| | 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
| | **[[Urinalysis]] |
| | 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]]
| | **CBC |
| | 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]]
| | **Chemistry |
| |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px"
| | *Possible imaging: |
| | 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]]
| | **[[Ultrasound]] |
| | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Acute Gastroenteritis]]
| | ***Appropriate for [[intussusception]], [[ovarian torsion|ovarian]]/[[testicular torsion]], [[gallbladder]], [[pregnancy]], [[Appendicitis (peds)|appendicitis]] |
| |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px"
| | **CT |
| | 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]]
| | ***May be associated with 1/1,000 lifetime risk of malignancy |
| | 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]]
| | **[[Abdominal radiography]] |
| |- class="font12" style="font-size: 12px; margin: 0px 0px 9px; line-height: 17px"
| | ***[[acute abdominal series|Abdominal plain xray]] films are specific, but not sensitive. As such, they have very little utility in the workup of pediatric abdominal pain, unless concerned for a [[Esophageal foreign body|foreign body]]. Do NOT use films to "confirm" a diagnosis of "constipation," as this is not specific and may also be found during surgical emergencies (e.g. [[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" | [[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; 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" |
| |
| |- 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" |
| |
| |- 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" | Tumor
| |
| | 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; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" rowspan="7" | 3 mo–3 y 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" | [[Intussusception]]
| |
| | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Acute Gastroenteritis]]
| |
| |- 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" | [[Constipation]]
| |
| |- 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" | [[Urinary Tract Infections]]
| |
| |- 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" | HSP
| |
| |- 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" | [[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" |
| |
| |- 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" |
| |
| |- 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" |
| |
| |- 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" 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" | [[Constipation]]
| |
| |- 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" | [[Acute Gastroenteritis]]
| |
| |- 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" | 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; 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" | [[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; 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" | [[Urinary Tract Infections]]
| |
| |- 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" | [[Ovarian 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" | [[Pneumonia]]
| |
| |- 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" | [[Ectopic Pregnancy]]
| |
| | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[Pancreatitis]]
| |
| |- 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" | [[Cholecystitis]] | |
| |- 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" | [[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; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | Tumor
| |
| | class="font12" style="font-size: 12px; margin: 0px 0px 9px; color: rgb(51,51,51); line-height: 17px" valign="top" align="left" bgcolor="#ffffff" | [[HSP]]
| |
| |- 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" | [[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; 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; 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" | [[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; 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" | Pregnancy
| |
| |}
| |
|
| |
|
| == Workup == | | ==Management== |
| | *Based on diagnosis |
|
| |
|
| #UA, hCG
| | ==Disposition== |
| #Chemistry: eval for dehydration
| | *Depends on underlying etiology |
| #Imaging
| | **If symptoms are fully resolved and the patient has a benign abdominal exam, most patients go home with return precautions |
| ##Abd xray
| | **In general, unclear cases with continued pain should NOT be discharged home |
| ###Specific, not sensitive
| |
| ##Ultrasound
| |
| ###Appropriate for intussusception, ovarian/testicular, GB, IUP, appy
| |
| ##CT
| |
| ###May be a/w 1/1000 lifetime risk of malignancy
| |
|
| |
|
| == See Also == | | ==See Also== |
| *[[Abdominal Pain]] | | *[[Abdominal Pain]] |
| *[[Necrotizing Enterocolitis (NEC)]]
| |
| *[[Volvulus]]
| |
| *[[Pyloric Stenosis]] | | *[[Pyloric Stenosis]] |
| *[[Intussusception]]
| |
| *[[Meckel's Diverticulum]] | | *[[Meckel's Diverticulum]] |
| *[[Appendicitis (Peds)]]
| |
| *[[Inguinal Hernia (Peds)]] | | *[[Inguinal Hernia (Peds)]] |
|
| |
|
| == Source == | | ==References== |
| | | <references/> |
| Gausche 11/03- By Lampe
| |
| | |
| 7/2/09 PANI
| |
|
| |
|
| [[Category:Peds]] [[Category:GI]] | | [[Category:Pediatrics]] |
| | [[Category:GI]] |
| | [[Category:Symptoms]] |