Acute Abdominal Pain Acute Abdominal Pain

Dr. Ashok Jaisingani Dr. Ashok Jaisingani

Introduction Introduction

►Between one-third to one-half of the child Between one-third to one-half of the child admitted hospital for acute abdominal admitted hospital for acute abdominal pain have non-specific abdominal pain.pain have non-specific abdominal pain.

►Another one-third have acute Another one-third have acute appendicitis. appendicitis.

►Other relatively benign condition also Other relatively benign condition also cause abdominal pain such as cause abdominal pain such as constipation, urinary tract infection constipation, urinary tract infection account for most of remain. account for most of remain.

Work-up Of child with Acute Work-up Of child with Acute Abdominal Pain Abdominal Pain

► A careful history and examination and active A careful history and examination and active observation are paramount. observation are paramount.

► Routine test include urine analysis, microscopy and Routine test include urine analysis, microscopy and culture. culture.

► Frequently helpful tests such as abdominal Frequently helpful tests such as abdominal ultrasound scan can diagnose pelvic, UTI and GIT ultrasound scan can diagnose pelvic, UTI and GIT pathology. pathology.

► Occasionally helpful a plain supine radiograph Occasionally helpful a plain supine radiograph particularly in preschool child with pain and particularly in preschool child with pain and vomiting, urea and electrolytes and CBC. vomiting, urea and electrolytes and CBC.

► Selective specific investigation are blood culture, Selective specific investigation are blood culture, stool culture, plasma amylase and diagnostic stool culture, plasma amylase and diagnostic laparoscopy. laparoscopy.

Acute Non – Specific Abdominal Acute Non – Specific Abdominal Pain Pain

► Pain is poorly localized, not aggravated by Pain is poorly localized, not aggravated by movement and rarely accompanied by guarding. movement and rarely accompanied by guarding.

► Site and severity of maximum tenderness often Site and severity of maximum tenderness often vary during the course of repeated examination. vary during the course of repeated examination.

► Symptoms are usually self limiting within 24h. Symptoms are usually self limiting within 24h. ► The etiology of non-specific pain in children is The etiology of non-specific pain in children is

obscure but viral infection and transitient obscure but viral infection and transitient intussusception are account for some cases. intussusception are account for some cases.

► Mesenteric adenitis a viral infection causing Mesenteric adenitis a viral infection causing widespreadwidespread1- Reactive lymphadenopathy 1- Reactive lymphadenopathy 2- Fever 2- Fever 3- Diffuse Abdominal Pain. 3- Diffuse Abdominal Pain.

Other Causes Of Acute Other Causes Of Acute Abdominal Pain Abdominal Pain

► Intestinal Obstruction Intestinal Obstruction ► Constipation Constipation ► Urinary Tract Infection Urinary Tract Infection ► GastroenteritisGastroenteritis► Tropical Disease Tropical Disease ► There are numerous rare cause of abdominal pain in There are numerous rare cause of abdominal pain in

children are children are 1- Henoch-schonlen purpura 1- Henoch-schonlen purpura 2- Sickle Cell Disease 2- Sickle Cell Disease 3- Primary peritonitis, acute pancreatitis and biliary 3- Primary peritonitis, acute pancreatitis and biliary colic colic 4- Testicular torsion and gynecological pathology 4- Testicular torsion and gynecological pathology 5- Urinary stone disease. 5- Urinary stone disease.

Intestinal Obstruction Intestinal Obstruction

► Intestinal obstruction in children Intestinal obstruction in children caused by caused by

► Intussusception Intussusception ► Inguinal Hernia Inguinal Hernia ►Adhesion Adhesion ►Meckel’s diverticulum Meckel’s diverticulum

Constipation Constipation

►The passage of hard or infrequent stool.The passage of hard or infrequent stool.►Constipation is more often cause acute Constipation is more often cause acute

abdominal pain when it is secondary to abdominal pain when it is secondary to 1- Anal Fissure 1- Anal Fissure 2- Hirschsprung’s Disease 2- Hirschsprung’s Disease 3- Anorectal malformation 3- Anorectal malformation 4- Neuropathic bowl. 4- Neuropathic bowl.

►Rectal examination and plain abdominal Rectal examination and plain abdominal radiography may helpful in severe radiography may helpful in severe cases. cases.

Urinary Tract Infection Urinary Tract Infection

► UTI is an uncommon cause of abdominal pain. UTI is an uncommon cause of abdominal pain. ► Urinary symptoms vomiting and fever tend to Urinary symptoms vomiting and fever tend to

be predominant. be predominant. ►Definitive infection can be confirmed by Definitive infection can be confirmed by

urinalysis, microscopy and culture. urinalysis, microscopy and culture. ► Sterile pyuria may accompany acute Sterile pyuria may accompany acute

appendicitis appendicitis ► Child with pelviuretic junction obstruction Child with pelviuretic junction obstruction

present with acute or recurrent abdominal present with acute or recurrent abdominal pain with no urinary symptoms. pain with no urinary symptoms.

Gastroenteritis Gastroenteritis

► It may cause colicky abdominal pain. It may cause colicky abdominal pain. ►Onset of pain before the diarrhea and Onset of pain before the diarrhea and

presence of lower abdominal presence of lower abdominal tenderness should raise suspicion of tenderness should raise suspicion of appendicitis. appendicitis.

►Pelvic tenderness on rectal Pelvic tenderness on rectal examination may be useful pointer to examination may be useful pointer to appendicitis. appendicitis.

Tropical Diseases Tropical Diseases

►Tropical Diseases causing acute Tropical Diseases causing acute abdominal pain are abdominal pain are 1- Ascariasis1- Ascariasis2- Typhoid 2- Typhoid 3- Amoebiasis 3- Amoebiasis