Abdominal pain (peds)
Background
Remember: 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
Epidemiology
Ten most common Dx in order:
AGE (26%)
Nonspecific AP (26%)
Viral Illness (6%)
Constipation (5%)
UTI (5%)
Pharyngitis (5%)
Appy (4%)
Asthma (2%)
OM (2%)
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
- UA, Upreg
- Dehydration: electrolytes, renal fxn tests
- Vomiting without diarrhea: LFTs, lipase, toxin screen
- Fever: CBC, CRP
- Diagnostic imaging
- Role of abdominal xrays: only good if positive (ann emerg med-1992 rothrock et al)
- 50% of of patients with major disease had normal radiographs
See Also
Peds: Necrotizing Enterocolitis (NEC)
Peds: Volvulus
Peds: Pyloric Stenosis
Peds: Intussusception
Peds: Meckel's Diverticulum
Peds: Appendicitis (Peds)
Peds: Inguinal Hernia (Peds)
Source
Gausche 11/03- By Lampe
7/2/09 PANI