Abdominal pain (peds): Difference between revisions

Latest revision as of 18:15, 7 July 2021

This page is for pediatric patients. For adult patients, see: abdominal pain, abdominal pain in pregnancy, and/or 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.

Abdominal pain
May be associated with nausea, vomiting, or diarrhea
Fever may be present in pain from infectious etiology

Differential Diagnosis

Pediatric Abdominal Pain

Evaluation

Depends on location and history

Consider:
- hCG
  - Consider ectopic pregnancy in any female of reproductive age
- Urinalysis
- CBC
- Chemistry
Possible imaging:
- Ultrasound
  - Appropriate for intussusception, ovarian/testicular torsion, gallbladder, pregnancy, appendicitis
- CT
  - May be associated with 1/1,000 lifetime risk of malignancy
- Abdominal radiography
  - 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 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).

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

References

Authors:

@@ Line 1: / Line 1: @@
-''For adult patients see [[Abdominal pain]]''
+{{Peds top}} [[abdominal pain]], [[abdominal pain in pregnancy]], and/or [[abdominal pain (geriatrics)]]
 ==Background==
 *Bilious emesis is a surgical emergency until proven otherwise
-*Most abdominal pain in children has a medical etiology rather than surgical issue.
 ==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==
@@ Line 10: / Line 14: @@
 ==Evaluation==
-*[[Urinalysis]], hCG
+''Depends on location and history''
-*CBC
+*Consider:
-*Chemistry
+**hCG
+***Consider [[ectopic pregnancy]] in any female of reproductive age
+**[[Urinalysis]]
+**CBC
+**Chemistry
 *Possible imaging:
-**[[Abd xray]]
+**[[Ultrasound]]
-***Specific, not sensitive
+***Appropriate for [[intussusception]], [[ovarian torsion|ovarian]]/[[testicular torsion]], [[gallbladder]], [[pregnancy]], [[Appendicitis (peds)|appendicitis]]
-**Ultrasound
-***Appropriate for intussusception, ovarian/testicular, GB, IUP, appy
 **CT
 ***May be associated with 1/1,000 lifetime risk of malignancy
+**[[Abdominal radiography]]
+***[[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]]).
 ==Management==
@@ Line 25: / Line 33: @@
 ==Disposition==
-*Treat underlying etiology
+*Depends on underlying etiology
-*Most patients go home.
+**If symptoms are fully resolved and the patient has a benign abdominal exam, most patients go home with return precautions
-*No un-diagnosed and continued pain should be discharged.
+**In general, unclear cases with continued pain should NOT be discharged home
 ==See Also==
@@ Line 36: / Line 44: @@
 ==References==
+<references/>
+[[Category:Pediatrics]]
-[[Category:Pediatrics]] [[Category:GI]] [[Category:Symptoms]]
+[[Category:GI]]
+[[Category:Symptoms]]