Professional Documents
Culture Documents
Abdominal Pain in Children
Abdominal Pain in Children
Madesa Espana, MD
Pediatric EM Section
St. Josephs Regional Medical
Center
Incidence
5 % of patients presenting to the pediatric clinic
and ED (2 12 years old, <72 hours duration)
Gastroenteritis
Incidence
Incidence
Appendicitis
Abdominal pain of uncertain etiology
Intussusception
Abdominal adhesions
Gastroenteritis
Pyelonephritis
Sickle cell painful crisis
Henoch-Schonlein purpura
Associated symptoms
Fever
Vomiting
Decreased appetite
Cough
Headache
Sorethroat
Historical Data
Historical data
Associated symptoms
Vomiting
Diarrhea
Duration
Type of emesis: bile, blood
bloody
Fever
Rash
Genitourinary symptoms
Physical Examination
General appearance
Ill-appearing or toxic
Dehydrated
Shock
Vital signs
Febrile
Tachycardic
Tachypneic
Hypotensive
Physical Examination
Head/Face
Fontanels
Sunken
Bulging
Bruising/swelling
Physical Examination
Eyes
Icteric sclera
Abnormal eye movements
Sunken appearance
Periorbital swelling
Physical Examination
ENT
Mucus membranes
Moist vs dry
Lesions/ulcerations
Swelling
Bleeding
Physical Examination
ENT
Nose
Rhinorrhea
Nose bleed
Throat
Erythema
Exudates
Physical Examination
Chest/Axilla
Appearance
Tenderness
Swelling/Masses
Physical Examination
Cardiovascular
Heart sounds
Rhythm
Pulses
Edema
Physical Examination
Abdomen
Appearance
Distension
Scars
Bruises
Physical Examination
Abdomen
Palpation
Tenderness
Organomegaly
Masses
Physical Examination
Abdomen
Tenderness
Localized
Diffuse
Rebound
Rovsings sign
Guarding
Voluntary
Non-voluntary
Physical Examination
Abdomen
Rectal exam
Stool Guaic
Other findings
Psoas sign
Obturators sign
Murphys sign
Physical Examination
Pelvis/inguinal area
Males
Females
Vaginal bleeding
Speculum exam
Physical Examination
Skin
Color
Pale
jaundice
Rashes
Signs of injury/abnormal bleeding
Turgor
Peripheral circulation
Physical Examination
Neurologic examination
Mental status
Cranial nerves
Motor
Sensorory
Cerebellar
Physical examination
Psychiatric evaluation
Mental status
Depression
Anxiety
Suicidal ideation/attempt
Homicidal ideation/attempt
Hallucinations/delusions
Differential diagnosis
Infants
Gastroenteritis
Constipation
Malrotation +/- Volvulos
GERD
Infantile Colic
Intussuception
Urinary tract infection
Testicular torsion
Differential diagnosis
Children
Gastroenteritis
Constipation
Intussuception
Torsion
UTI
Kidney stones
Sickle cell crisis
DKA
Testicular torsion
Incarcerated Hernia
Pneumonia
Strep throat
Henoch-Schonlein
Purpura
Meningococcemia
Toxic ingestions
Diferrential Diagnosis
Adolescent Males
Testicular torsion
Varicocele
Pyelonephritis
Kidney stones
Gallstones
Pancreatitis
Hepatitis
Incarcerated
Hernia
Constipation
DKA
IBD
STD
GERD
Toxic ingestions
Differential diagnosis
Adolescent females
Ovarian torsion
Ruptured ovarian
cyst
PID
UTI
Gallstones
Cholecystitis
Kidney stones
DKA
Toxic ingestions
Pre-/menstrual
cramps
Complications of
pregnancy
Ectopic
Threatened AB
Missed AB
Appendicitis
Incidence
Appendicitis: evidence-based
data
Neonates:
Abdominal distension
Vomiting
Fever
Hypothermia
Respiratory distress
Appendicitis: evidence-based
data
Appendicitis: evidence-based
data
Older children
Abdominal pain
Vomiting
Fever
Anorexia
Pain with movement or cough
Localized RLQ tenderness
Diffuse/rebound tenderness
Laboratory studies
CBC, differential
ESR
C-reactive protein
Urinalysis
Poor sensitivity and specificity
Radiologic studies
Plain films
Radiologic studies
Ultrasound
Radiologic studies
CT scan
Enlarged appendiceal diameter (> 6 mm)
Appendiceal wall thickening (> 1 mm)
Periappendiceal inflammatory changes
including fat streaks, phlegmon, fluid
collection, and/or extraluminal gas
Radiologic studies
CT scan
Advantages
Establish alternative diagnoses
Differentiates between perforated
and non-perforated appendicitis
Reduces length of stay and cost
of care
Reduces perforation rate
Useful in obese, uncooperative
patients
Radiologic studies
CT scan
Disadvantages
Higher cost compared to ultrasonography
Risks associated with contrast
administration
Potential need for sedation
Exposure to ionizing radiation
False negative rate 10%
Diagnostic work-up
Laboratory data
Radiologic evaluation
Ultrasound
CT scan
Treatment of appendicitis
Surgery
Laparoscopic
Open
Conservative management
Antibiotics
IV hydration
Treatment of appendicitis
Conservative management
Treatment of appendicitis
Conservative management
Advantages
Less pain
Shorter recovery time
Avoid complications of surgery
and anesthesia
Treatment of appendicitis
Conservative management
Disadvantages
No significant complications
Thank you!
Have a great day.