Abdominal pain (peds)

Background

• Bilious emesis is a surgical emergency until proven otherwise

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 Stone
	Tumor	HSP
		Inflammatory bowel disease
		Gastric ulcer disease/gastritis
		Ovarian cyst
		Pregnancy

Workup

1. UA, hCG
2. Chemistry: eval for dehydration
3. Imaging
   1. Abd xray
      1. Specific, not sensitive
   2. Ultrasound
      1. Appropriate for intussusception, ovarian/testicular, GB, IUP, appy
   3. CT
      1. May be a/w 1/1000 lifetime risk of malignancy

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