Abdominal Pain

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Abdominal Pain
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• Abdominal pain may present as a crying episode in
  infants
• May be difficult to identify, let alone to
  localize.
• Older children are able to point to the site of
  pain as well as this may facilitate localization.

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• Most of the pathological conditions present with
  localized quadrant pain, while functional pain is
  often periumbilical
• Pain presenting for the first time may, however,
  herald the onset of a recurrent pathology

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Red Flags

• Surgical abdomen ( abdominal distension,
  guarding, rigidity, absent peristalsis, lump)
• Persistent vomiting / bilious vomiting
• Dehydration / shock

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• Why ?
• Persistent vomiting may lead to dehydration.
• Bilious vomiting suggests obstruction distal to
  the Ampulla of Vater

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Red Herrings

• Torsion testes
• Basal pneumonia
• Hip joint pathology

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Causes Acute Pain Abd.

• Less common
• Appendicitis
• Intestinal obstruction
• Peritonitis
• Renal colic
• Hennoch-Schonlein Purpura

• Common
• Intestinal colic
• Dysentery
• Hepatitis
• Gastritis

Rare Pancreatitis, Biliary colic, Meckels
diverticulum, Lead poisoning, Porphyrias, Sickle
cell crisis, Herpes zoster
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Causes - Chronic

• Common
• Constipation
• Dyspepsia
• psychogenic

• Less common
• Colitis
• Recurrent appendicitis

• Rare
• Inflammatory bowel disease
• Abdominal migraine
• Systemic vasculitides

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Evaluation

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Ask

• Onset / Duration / progress / type of pain / site
  of pain / aggravating and relieving factors
• Vomiting
• Change in bowel pattern
• Fever
• Other symptoms
• Urinary symptoms, behavior disturbances

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ONSET

• Sudden onset of pain (minutes / hours) may
  suggest a colic.
• Inflammatory pain may progress gradually
  ( hours / days)
• Sudden screaming episodes in an infant indicate
  intussusception

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DURATION

• Episodes of colicky pain may last for short
  durations
• Inflammatory pain lasts longer

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PROGRESS

• Short lasting and self - limiting pain often
  indicates colic and is often recurrent
• Inflammatory pain lasts longer and usually does
  not recur

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TYPE OF PAIN

• Dull ache indicates chronic pathology
• Colicky pain is due to smooth muscle spasm in a
  hallow viscus Eg Ureteric or intestinal colic

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Site of pain

• Site of pain localized to a quadrant helps to
  focus attention to the organs situated in that
  region
• Generalized pain may be due to intestinal or
  peritoneal pathology

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Aggravating and Relieving factors

• Pain in gastritis may be related to eating
  ( Pain - food - relief cycle)
• Colicky pain may be aggravated by movement

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Look

• Sick or well
• Abdominal distension
• Tenderness
• Guarding / rigidity
• Hernial orifices
• Jaundice
• Abdominal lump

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• A child suffering from acute surgical abdomen,
  dysentery or pancreatitis looks sick
• Generalized abdominal distension is a feature of
  intestinal disease while localized distension
  suggests hepatitis or localized pathology

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• Localized tenderness denotes local inflammatory
  conditions while peritonitis and intestinal
  obstruction present with generalized tenderness.
• Absence of tenderness may suggest
  non-inflammatory pathology
• Guarding and rigidity indicate inflammation of
  the overlying peritoneum

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• Jaundice may be a marker of hepatitis. It could
  also indicate biliary obstruction or pancreatitis
  
• Abdominal lump may help localize the disease

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Acute dysentery Acute hepatitis Appendicitis Intus
susception Peritonitis H - S Purpura
Intestinal colic Acute gastritis Renal
colic/Biliary colic Meckels diverticulum Sickle
cell disease Lead poisoning Porphyria
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Chronic Abdominal Pain
Constipation Dyspepsia Functional
(Psychogenic) Parasitic infection Tumors Appendici
tis Irritable colon / colitis