1. ACUTE ABDOMEN Department of PaediatricsPt. J. L. N. Hospital & Research centre Bhilai Dr. SUBODH KUMAR SAHA

2. TYPES OF ABDOMINAL PAINVisceral Pain - Dullpoorly localised,usually periumbilicalParietal pain - sharp,intense,discreteReferred pain - same features as parietalpain 3. Site of painForegut structures epigastrium(oesophagus & stomach)Midgut structuresperiumbilical(small intestine)Hind gut structure lower abdomen(large intestine & rectum) 4. Gastrointestinal causesGastroenteritisAppendicitisMesenteric lymphadenitisConstipationAbdominal trauma 5. Gastrointestinal causesIntestinal obstructionPeritonitisFood poisoningPeptic ulcerMeckels diverticulumInflammatory bowel diseaseLactose intolerance 6. Liver, spleen & biliary tractdisordersHepatitisCholecystitisCholelithiasisSplenic infarctionRupture of the spleenPancreatitis 7. Genitourinary causesUrinary calculiDysmenorrheaMittelschmerzPelvic inflammatory disease 8. Genitourinary causesThreatened abortionUrinary tract infectionEctopic pregnancyOvarian/testicular torsionEndometriosisHematocolpos 9. Metabolic disordersDiabetic ketoacidosisHypoglycemiaPorphyriaAcute adrenal insufficiency 10. Hematologic disordersSickle cell anemiaHenoch-Schnlein purpuraHemolytic uremic syndrome 11. Drugs and toxinsErythromycinSalicylatesLead poisoningVenoms 12. Pulmonary causesPneumoniaDiaphragmatic pleurisy 13. MiscellaneousInfantile colicFunctional painPharyngitisAngioneurotic edemaFamilial Mediterranean Fever 14. Familial mediterranian feverGene responsible is 17p13.3Self limited brief episodes of feverPolyserositisAmyloidosisSkin rash,myelgiaSpenomegalyPathogenesis : increased TNF,IL-6,IL8Treatment : cholchicine 15. Differential Diagnosis of AcuteAbdominal Pain by Predominant Age Birth to one yearInfantile colicGastroenteritisConstipationUrinary tract infectionIntussusceptionVolvulusIncarcerated herniaHirschsprungs disease 16. Two to five yearsGastroenteritisAppendicitisConstipationUrinary tract infectionIntussusception 17. Two to five yearsVolvulusTraumaPharyngitisSickle cell crisisHenoch-Schnlein purpuraMesenteric lymphadenitis (adenovirus) 18. Six to 11 yearsGastroenteritisAppendicitisConstipationFunctional painUrinary tract infection 19. Six to 11 yearsTraumaPharyngitisPneumoniaSickle cell crisisHenoch-Schnlein purpuraMesenteric lymphadenitis 20. 12 to 18 yearsAppendicitisGastroenteritisConstipationDysmenorrheaMittelschmerzPelvic inflammatory diseaseThreatened abortionEctopic pregnancyOvarian/testicular torsion 21. Evaluation of Acute AbdominalPain in ChildrenPain HistoryRecent TraumaPrecipitating or Relieving FactorsAssociated Symptoms Vomiting,DiarrheaUrinary frequency,Dysuria,Polyuria & polydipsiaHenoch - Schnlein purpura - Joint pain, rash, andsmoke-colored urine suggest 22. Gynecologic History.History of sexual activity and contraceptionAmenorrheaUse of an IUD suggest - PIDSudden onset of midcycle pain of shortduration suggests - mittelschmerz 23. Past historyA history of surgeryH/0 hospitalizationA history of similar pain 24. Drug UseIronErythromycin 25. Family HistorySickle cell anemiaCystic fibrosis 26. PHYSICAL EXAMINATIONGeneral AppearanceVital Signs. Tachycardia Hypotension Fever Inflammation HypertensionHUS & HSPKussmauls Diabetic ketoacidosis.respirationPostmenarcheal Ectopic pregnancygirl is in shock 27. Abdominal Examination.Breathing patternInspectionPalpationPercussionAuscultation 28. Rectal & Pelvic ExaminationTendernessPresence of massVaginal discharge,atresia, imperforate hymen 29. Associated SignsPallor& jaundiceSCAPurpura&arthritis HSPCullens & Gray turner Internal hemorrhagesignJaundiceliver diseasePositive Murphys Acute cholecystitissign 30. Investigations HB URINE X RAY Abd. TLCPUS CELLS USG DLCRBCSCT SCAN ESR SICKLING PS 31. Indications for Surgical Consultations in ChildrenSevere or increasing abdominal pain withprogressive signs of deteriorationBile-stained or feculent vomitusInvoluntary abdominal guarding/rigidityRebound abdominal tenderness 32. Indications for Surgical Consultations in ChildrenMarked abdominal distension with diffusetympany.Signs of acute fluid or blood lossSignificant abdominal traumaSuspected surgical cause for the painAbdominal pain without an obvious etiology 33. ManagementTreatment should be directed at the underlying cause. 34. INTUSSUCEPTION90% < 2 years of ageMore commen in malesAssociated with URIDiarrhoearotavirus vaccinehematoma(HSP)Hemangiomalymphoma 35. symptoms Pain abdomen of sudden onset Vomiting Sausage shaped mass Normal in between pain Blood stained finger on PR examination 36. InvestigationsBa enema: Thin streak of Ba in intussuce-ptumUSG: Target lesion in transverse plane 37. Treatment Reduction with air enema Reduction with saline enema Reduction with radiocontrast material 38. Functional abdominal painAbdominal pain that cannot beexplained by structural, physiological orpathological abnormality. 39. Functional abdominal pain includes severaldifferent types of chronic abdominal painrecurrent abdominal painthree or more bouts of abdominal pain (belly ache) inchildren 4-16 years old over a three-month period severeenough to interfere with his/her activities.located around the umbilicus functional dyspepsia, upper abdominal pain nausea, vomiting, irritable bowel syndrome (IBS). pain relieved by motion change in stool frequency change in stool consistency 40. DIFFERENTIAL DIAGNOSIS OF CHRONICABDOMINAL PAINCONSTIPATIONACID REFLUXLACTOSE INTOLERANCECHRONS DISEASEULCERATIVE COLITISPARASITIC INFESTATIONHEPATITISPANCREATITISUTIAPPENDICITISINTESTINAL INFECTION 41. ImplicationsInterference with school attendanceDepressionAnxietyEmotional disturbances 42. Absence of red flag signsFeverWt. lossPoor growthJoint painMouth ulcerUnusual rashesLoss of appetiteHemetemesisMelenaNight time awakening due to pain or diarrhoea 43. DiagnosisNormal physical examinationsAbsence of abnormal pathological testsAbsence of red flag signs 44. Goals of managementProvide quality life through Support Education Medication Better coping skills 45. ManagementStick to the diagnosisAvoid unnecessary invasive testsAntispasmodicsLow dose tricyclic antidepressentsAvoid carbonated drinksPsychological treatment : behavioural therapyrelaxation exerciseshypnosis 46. physician Normal lifeschool parents 47. Colic Excessive paroxysmal crying Most often in evening hours Healthy baby Difficult to console Equal frequency in male & female 48. Wessels criteriaCry lasting > 3 hrsOccuring> 3 daysfor > 3 weeks 49. EtiologyIncreased level of motilin lactalbumin 5 HIAAPsychological stressDrugs during pregnancy 50. Frequency10 to 30 % Infants worldwideSex : Equal frequencyAge : 2 wks to 4 months 51. HistoryDiagnosis of exclusionEvening hoursPeaks at 6 weeksHigh pitched cryExclude other causes : hair in eye strangulated hernia ottitis sepsis 52. Physical examinationShows normal weight gainDifferential diagnosisOverfeedingUnderfeedingMilk AllergyEarly introduction of foodsGERDNo burping after feeds 53. MANAGEMENTSIMETHICONEReduces the surface tension of bubblesover intestinal surface.Anticholinergic drugs dicyclomine/ dicycloverine relax muscles in the wall of the gut side effects : drowsiness.Apnoea diarrhoea constipation seizures 54. MANAGEMENTDietary managementElimination ofcows milk eggs wheat nut productsHerbal teaCar ride simulatorsReduced stimulationFocussed parent counselling 55. Abdominal crisis sickle cellanemia Belongs to a perticular community H/o blood transfusion,joint pain May be associated with jaundice Anemia 56. Abdominal crisis in SCASequestration crisis Sudden enlargement of spleen Shock Pallor Treatment: Blood transfusion 57. vaso occlusive crisisLiver : microinfarctKidney: microscopic hematuriagross hematuriaproteinuriaSpleen: infarct 58. Treatment of VOCBlood transfusion low HbIV fluidesdehydrationNSAID AcetaminophenibuprofenneproxenOpioidesmorphine 59. NONSURGICAL CAUSES OFABDOMINAL PAINPULMONARY Lobar pneumoniapleurisypulmonary embolismCardiac myocarditispericarditisCCFMetabolic Diabetes mellitusacute adrenal insufficiencyacute intermittent porphyriaPoisonsDrugs 60. NONSURGICAL CAUSES OFABDOMINAL PAIN Pancreatitis Cholecystitis Sickle cell crisis Familial mediterrenian fever Hereditory angioneurotic oedema 61. NONSURGICAL CAUSES OF ABDOMINALPAINPyelonephritisUTIAbdominal migrainAbdominal epilepsyFunctional abdominal pain 62. INTUSSUCEPTION 63. INTUSSUCEPTION 64. INTUSSUSCEPTION 65. CROHNS DISEASE 66. INTUSSUCEPTION 67. MALROTATION 68. URETERAL CALCULUS 69. APPENDICITIS USG 70. APPENDICITIS WITHOUT PERFORATION 71. APPENDICITIS WITH PERFORATION 72. JEJUNAL ATRESIA 73. ATRESIA JEJUNUM 74. HIRSCHPRUNGS D/S 75. HIRSCHSPRUNGS 76. DUPLICATION CYST 77. DUPLICATION CYST 78. ROUND WORM 79. TORSION OVARY 80. ASCARIS 81. Pelvic inflammatory disease Endometritis Tubo ovarian abscess Salpingitis Pelvic peritonitis 82. PIDLowner abdominal painAbnormal vaginal dischargeAdnexal temdernessPainful cervical movementDysmenorrhoea 83. Causes of PID N. gonorrhoeae C.trachomatis B hemolytic streptococci Peptostreptococus E.coli Gardnerella Mycoplasma hominis 84. THANK YOU