Abdominal pain (peds)

This page is for pediatric patients. For adult patients, see: abdominal pain, abdominal pain in pregnancy, and/or abdominal pain (geriatrics)

Background

Bilious emesis is a surgical emergency until proven otherwise

Clinical Features

Abdominal pain
May be associated with nausea, vomiting, or diarrhea
Fever may be present in pain from infectious etiology

Differential Diagnosis

Pediatric Abdominal Pain

0–3 Months Old

Emergent
Nonemergent

3 mo–3 y old

Emergent
- Intussusception
- Testicular Torsion
- Trauma
- Volvulus
- Appendicitis
- Toxic megacolon
- Vaso-occlusive crisis
Nonemergent

3 y old–adolescence

Emergent
- Appendicitis
- DKA
- Vaso-occlusive crisis
- Toxic ingestion
- Testicular Torsion
- Ovarian Torsion
- Ectopic Pregnancy
- Trauma
- Toxic megacolon
- Inflammatory bowel disease
- Gastric ulcer disease
- Ovarian cyst
- Pregnancy
- Pancreatitis
- Cholecystitis
- Intussusception (to age 6)
Nonemergent
- Constipation
- Acute Gastroenteritis
- Nonspecific viral syndrome
- Streptococcus pharyngitis
- Urinary tract infection
- Pneumonia
- Renal Stone
- Henoch-Schonlein purpura
- Inflammatory bowel disease

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

See Also

References

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