Abdominal pain (peds): Difference between revisions

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.

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: @@
+<languages/>
+<translate>
+</translate>
+{{PediatricPage|abdominal pain| abdominal pain in pregnancy|abdominal pain (geriatrics)}}
+<translate>
 ==Background==
-bilious emesis in a kid is a surgical emergency until proven otherwise
+*Bilious emesis is a surgical emergency until proven otherwise
+==Clinical Features==
-Visceral pain is dull & non-specific
+[[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 [[Special:MyLanguage/nausea|nausea]], [[Special:MyLanguage/vomiting|vomiting]], or [[Special:MyLanguage/diarrhea|diarrhea]]
+*[[Special:MyLanguage/Fever|Fever]] may be present in pain from infectious etiology
-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
+==Differential Diagnosis==
+</translate>
+{{Pediatric abdominal pain DDX}}
+<translate>
-==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==
+==Evaluation==
-* 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==
+''Depends on location and history''
-===Infant===
+*Consider:
-green vomit: bad sign
+**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]]).
-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===
+==Management==
-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
+*Based on diagnosis
-===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==
+==Disposition==
-# 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==
+*Depends on underlying etiology
-[[Necrotizing Enterocolitis (NEC)]]
+**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
-[[Volvulus]]
-[[Pyloric Stenosis]]
-[[Intussusception]]
+==See Also==
-[[Meckel's Diverticulum]]
+*[[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)]]
-[[Appendicitis (Peds)]]
-[[Inguinal Hernia (Peds)]]
-==Source==
+==References==
-Gausche 11/03- By Lampe
-/2/09 PANI
+<references/>
-[[Category:Peds]]
+[[Category:Pediatrics]]
 [[Category:GI]]
+[[Category:Symptoms]]
+</translate>