Abdominal pain (peds): Difference between revisions
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== Background ==
<languages/>
<translate>
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{{PediatricPage|abdominal pain| abdominal pain in pregnancy|abdominal pain (geriatrics)}}
<translate>
 
 
 
==Background==


*Bilious emesis is a surgical emergency until proven otherwise
*Bilious emesis is a surgical emergency until proven otherwise


== Differential Diagnosis  ==


{| class="wikitable"
! valign="top" align="left" bgcolor="#ffffff" | Age
! valign="top" align="left" bgcolor="#ffffff" | Emergent
! valign="top" align="left" bgcolor="#ffffff" | Nonemergent
|- 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" | 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" | [[Colic]]
|- 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" | [[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" | [[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" | &nbsp;
|- 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" | &nbsp;
|- 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" | &nbsp;
|- 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" | &nbsp;
|- 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" | &nbsp;
|- 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" | &nbsp;
|- 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" | &nbsp;
|- 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" | &nbsp;
| 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" | &nbsp;
| 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" | &nbsp;
| 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" | &nbsp;
| 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  ==
==Clinical Features==
#UA, hCG  
 
#CBC
[[File:Abdominal Quadrant Regions.jpg|thumb|Side-by-side comparison of quadrants and regions.]]
#Chemistry
[[File:1506 Referred Pain Chart.jpg|thumb|Chart of commonly reported referred pain sites.]]
#Possible imaging:
*Abdominal pain
##Abd xray
*May be associated with [[Special:MyLanguage/nausea|nausea]], [[Special:MyLanguage/vomiting|vomiting]], or [[Special:MyLanguage/diarrhea|diarrhea]]
###Specific, not sensitive
*[[Special:MyLanguage/Fever|Fever]] may be present in pain from infectious etiology
##Ultrasound  
 
###Appropriate for intussusception, ovarian/testicular, GB, IUP, appy
 
##CT
 
###May be a/w 1/1000 lifetime risk of malignancy
==Differential Diagnosis==
 
</translate>
{{Pediatric abdominal pain DDX}}
<translate>
 
 
 
==Evaluation==
 
''Depends on location and history''
*Consider:
**hCG
***Consider [[Special:MyLanguage/ectopic pregnancy|ectopic pregnancy]] in any female of reproductive age
**[[Special:MyLanguage/Urinalysis|Urinalysis]]
**CBC
**Chemistry
*Possible imaging:
**[[Special:MyLanguage/Ultrasound|Ultrasound]]
***Appropriate for [[Special:MyLanguage/intussusception|intussusception]], [[Special:MyLanguage/ovarian torsion|ovarian]]/[[Special:MyLanguage/testicular torsion|testicular torsion]], [[Special:MyLanguage/gallbladder|gallbladder]], [[Special:MyLanguage/pregnancy|pregnancy]], [[Special:MyLanguage/Appendicitis (peds)|appendicitis]]
**CT
***May be associated with 1/1,000 lifetime risk of malignancy
**[[Special:MyLanguage/Abdominal radiography|Abdominal radiography]]
***[[Special:MyLanguage/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 [[Special:MyLanguage/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. [[Special:MyLanguage/appendicitis|appendicitis]]).
 
 
 
==Management==
 
*Based on diagnosis
 
 
 
==Disposition==
 
*Depends on underlying etiology
**If symptoms are fully resolved and the patient has a benign abdominal exam, most patients go home with return precautions
**In general, unclear cases with continued pain should NOT be discharged home
 
 
 
==See Also==
 
*[[Special:MyLanguage/Abdominal Pain|Abdominal Pain]]
*[[Special:MyLanguage/Pyloric Stenosis|Pyloric Stenosis]]
*[[Special:MyLanguage/Meckel's Diverticulum|Meckel's Diverticulum]]
*[[Special:MyLanguage/Inguinal Hernia (Peds)|Inguinal Hernia (Peds)]]


== 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
==References==


7/2/09 PANI
<references/>


[[Category:Peds]] [[Category:GI]]
[[Category:Pediatrics]]
[[Category:GI]]
[[Category:Symptoms]]
</translate>

Latest revision as of 21:29, 17 January 2026


This page is for pediatric patients. For adult patients, see: abdominal pain,abdominal pain in pregnancy, and abdominal pain (geriatrics)



Background

  • Bilious emesis is a surgical emergency until proven otherwise


Clinical Features

Side-by-side comparison of quadrants and regions.
Chart of commonly reported referred pain sites.


Differential Diagnosis

Pediatric Abdominal Pain

0–3 Months Old

3 mo–3 y old

3 y old–adolescence


Evaluation

Depends on location and history


Management

  • Based on diagnosis


Disposition

  • Depends on underlying etiology
    • If symptoms are fully resolved and the patient has a benign abdominal exam, most patients go home with return precautions
    • In general, unclear cases with continued pain should NOT be discharged home


See Also


References

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