Approach To Abd Pain

APPROACH TO PEDIATRIC
ABDOMINAL PAIN
DR GOKAH
GIDEON
GHANA POLIC
HOSPITAL
Overview
 Introduction
 History
 Physical Examination
 Investigations
 Supplementary information
General Presentation
Background
• Abdominal pain in a child is one of the most common presentations with both trivial
and
life threatening etiologies, ranging from functional pain to acute appendicitis.
• The majority of pediatric abdominal complaints are relatively benign (e.g. constipation),
but it is important to pick up on the cardinal signs that might suggest a more
serious underlying disease.
• Diagnosing abdominal pain in children is also a challenging task. Conditions vary
amongst age groups ( i.e. volvulus in neonates, intussusception in toddlers) and trying
to thoroughly evaluate a child in pain can make the process all the more challenging.
BASIC ANATOMY AND PHYSIOLOGY
• When taking a history and examining a child with abdominal pain, consider all
the organs in the abdominal area.
• Pathologies of the lower lung (i.e. pneumonia) can often be interpreted as
abdominal pain; similarly, genitourinary pathology (i.e. testicular torsion) can be
as well.
• A sharp stabbing pain may suggest somatic involvement – this type
of sensation is usually well localized; while dull, non-specific, throbbing
pain suggests visceral involvement that is difficult to localize.
• Remember, the differential diagnosis of a child varies
depending on their age group.
PRESENTATION AND EMERGENT
CONSIDERATIONS
• Acute pain lasts several hours to days while chronic pain can last from days to weeks to
months. In a child presenting with abdominal pain, it is important to identify any
emergent concerns and reach a timely diagnosis.
Red flag signs include:
• · Bilious vomiting
• · Bloody stool or emesis
• · Night time waking with abdominal pain
• · Hemodynamic instability
• · Weight loss
Questions to
Ask?
HISTORY
Mnemonics PQRSTAAA:
o Place/Location: identify the specific location of the pain, have child use
one finger to locate her pain.
o Quality: pain can be a sharp stabbing pain (i.e. trauma) or diffuse,
poorly, localized pain (i.e. chronic or visceral pain)
o Radiation: pain can radiate from its point of origin in any direction
o Severity: degree of pain on a scale of 10
HISTORY: Continued
o Timing/Onset: onset of the pain, duration of pain, course during the day, does it
wake them at night, and the frequency of episodes
o Alleviating Factors: anything that reduces the pain – body position, movements
(or lack thereof), medications.
o Aggravating Factors: anything that increases the pain – body
position, movements, relation to food intake.
o Associated Symptoms: can include hematemesis, vomiting, nausea,
hematochezia, melena, diarrhea, fever, and weight loss
HISTORY: Continued
 Ask about bowel movement patterns and stool quality (size, hard/soft, odour).
 Ask about ingestion of toxin or foreign object; accidental or non-accidental trauma
 Ask about dietary history: in young children, too much milk can lead to
constipation.
 Ask about past medical history and medical
comorbidities. Cystic fibrosis predisposes to gallstones.
Spina bifida/cerebral palsy/developmental delay
predisposes to constipation.
Sickle cell disease predisposes to splenic auto-infarction.
Recurrent respiratory tract infections suggest mesenteric
HISTORY: Continued
 Ask about sexual history – screen for STI
• Females: don’t forget about menstrual cycles (regularity, amount of
bleeding,
relation to abdominal pain)
 Ask about family medical history, especially inflammatory bowel disease.
 Ask about travel history, social and psychiatric (potential stressors) history.
Physical Exam and
Investigations
PHYSICAL EXAM:
• ABCs; vitals; and growth parameters (is there evidence of failure to thrive).
• Inspection: look for contour, symmetry, pulsations, peristalsis, vascular
irregularities,
skin markings, wall protrusions (hernias), any signs of trauma (Ie.
bruising, swelling),
and abdominal distension
• Palpation: assess tenderness with light and deep palpation, assess for guarding
and rebound tenderness, palpate for liver, spleen, kidney and abdominal masses
(including fecal mass).
PHYSICAL EXAM: continued
• Percussion: assess general tone (tympanic vs non-tympanic), percuss for liver
span
and spleen tip, assess for ascites (find edge of percussion tone change).
• Auscultation: auscultate before palpation in the abdominal exam, listen for

bowel sounds, abdominal bruits, pressure of the stethoscope also tests for
tenderness
• Digital rectal exam: first exam the anus for fissures and skin tags, then assess
for
tone, stool, and blood.
Key
points:
1. Determine if abdominal pain is acute or
chronic
2. Is the abdomen acute/surgical or benign
3. Are red flags present

Approach To Abd Pain

Uploaded by

Copyright:

Available Formats

Approach To Abd Pain

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Approach To Abd Pain

Uploaded by

Copyright:

Available Formats

APPROACH TO PEDIATRIC

• Auscultation: auscultate before palpation in the abdominal exam, listen for

You might also like