abpain pediatric uniba 19-11-12
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dr. Putra Hendra SpPDUNIBA
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Common problems occur commonlyintussusception in the infantappendicitis in the childThe differential diagnosis is age-specificIn pediatrics most belly pain is non-surgicalMost things get better by themselves. Most things, in fact, are better by morning.Bilous emesis in the infant is malrotation until proven otherwiseA high rate of negative tests is OK
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Pain (location, pattern, severity, timing)pain as the first sx suggests a surgical problemVomiting (bile, blood, projectile, timing)Bowel habits (diarrhea, constipation, blood, flatus)Genitourinary complaintsMenstrual historyTravel, diet, contact history
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Warm hands and exam roomTry to distract the child (talk about pets)A quiet, unhurried, thorough examPlan to do serial examsDo a rectal exam
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TachycardiaAlert and active/still and silentAbdominal rigidity/softnessBowel soundsPeritoneal signs (tap, jump)Signs of other infection (otitis, pharyngitis, pneumonia)Check for hernias
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Newborningested maternal blood, formula intolerance, NEC, volvulus, HirschsprungsToddleranal fissures, infectious colitis, Meckels, milk allergy, juvenile polyps, HUS, IBD2 to 6 yearsinfectious colitis, juvenile polyps, anal fissures, intussusception, Meckels, IBD, HSP6 years and olderIBD, colitis, polyps, hemorrhoids
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Newborningested maternal blood, drug induced, gastritisToddlerulcers, gastritis, esophagitis, HPS2 to 6 yearsulcers, gastritis, esophagitis, varices, FB6 years and olderulcers, gastritis, esophagitis, varices
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CBC and differentialUrinalysisX-rays (KUB, CXR)USAbdominal CTStool culturesLiver, pancreatic function tests(Rehydrate, ?antibiotics, ?analgesiscs)
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Signs of obstructionair/fluid levelsdilated loopsair in the rectum?FecalithPaucity of air in the right sideConstipation
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Vascular compromisemalrotation and volvulusincarcerated hernianonreduced intussusceptionischemic bowel obstructiontorsed gonadsPerforated viscusUncontrolled intra-abdominal bleeding
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Intestinal obstructionNon-perforated appendicitisRefractory IBDTumors
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Common in children; rare in infantsSymptoms tend to get worsePerforation rarely occurs in the first 24 hoursThe physical exam is the mainstay of diagnosisClassify as simple (acute, supparative) or complex (gangrenous, perforated)
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Can be done by inversion techniqueAbsolute indicationLadds procedureRelative indicationsHirschsprungs pullthroughOvarian cystectomyIntussusceptionAtresia repairWilms tumor excisionCDH
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Typically in the 8-24 month age groupDiagnosis is historicalintermittent severe colic episodesunexplained lethargy in a previously healthy infantContrast enema is diagnostic and often therapeuticPost-op small bowel intussusception
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Diagnosisnon-specific abdominal painchronic abdominal painfemale patientsundescended testestraumaTreatmentappendicitisMeckels diverticulumcholecystitisovarian detorsion/excisionlysis of adhesions
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Menstrual historyregularity, last period, character, dysmenorrheaPelvic/bimanual exam with culturesPregnancy test/urinalysisUSLaparoscopyDifferential diagnosismittelschmerz, PID, ovarian cyst/torsion, endometriosis, ectopic pregnancy, UTI, pyelonephritis
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Causes of Acute Abdominal Pain in Children*
GastrointestinalGastroenteritisAppendicitisMesentericlymphadenitisConstipationAbdominal traumaIntestinal obstructionPeritonitisFood poisoningPeptic ulcerMeckels diverticulumInflammatory boweldiseaseLactose intoleranceLiver, spleen, andbiliary tract disordersHepatitisCholecystitisCholelithiasisSplenic infarctionRupture of the spleenPancreatitisGenitourinary causesUrinary tract infectionUrinary calculiDysmenorrheaMittelschmerzPelvic inflammatorydiseaseThreatened abortionEctopic pregnancyOvarian/testicular torsionEndometriosis
Metabolic disordersDiabetic ketoacidosisHypoglycemiaPorphyriaAcute adrenal insufficiencyHematologic disordersSickle cell anemiaHenoch-Schnlein purpuraHemolytic uremicsyndromeDrugs and toxinsErythromycinSalicylatesLead poisoningVenoms
Pulmonary causesPneumoniaDiaphragmatic pleurisy
MiscellaneousInfantile colicFunctional painPharyngitisAngioneurotic edemaFamilial Mediterraneanfever------------------------------------------------------------------------------------------------------------ *(Am Fam Physician june 1,2003 volume 67)
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Differential Diagnosis of Acute Abdominal Pain by Predominant Age*
Birth to one yearInfantile colicGastroenteritisConstipationUrinary tract infectionIntussusceptionVolvulusIncarcerated herniaHirschsprungs disease
Two to five yearsGastroenteritisAppendicitisConstipationUrinary tract infectionIntussusceptionVolvulusTraumaPharyngitisSickle cell crisisHenoch-Schnlein purpuraMesenteric lymphadenitis Six to 11 yearsGastroenteritisAppendicitisConstipationFunctional painUrinary tract infectionTraumaPharyngitisPneumoniaSickle cell crisisHenoch-Schnlein purpuraMesenteric lymphadenitis
12 to 18 yearsAppendicitisGastroenteritisConstipationDysmenorrheaMittelschmerzPelvic inflammatory diseaseThreatened abortionEctopic pregnancyOvarian/testicular torsion----------------------------------------------------------------------------------------------------- *(Am Fam Physician june 1,2003 volume 67)