Abdominal Pain in Children

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Belly pain is a very common Paediatric ED presentation, so how do we sort the plain old tummy-ache from the more serious causes?  Common conditions like gastroenteritis and constipation can mimic more significant diagnoses such as appendicitis and intussusception.

In this PEMcast we take a quick tour through the causes of abdominal pain in children.
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Outline: Abdominal Pain in Children

[CP] hello, disclaimer, introduction/background

Approach & Differentials

(with reference to McCollough & Sharieff 2006, and our own experience):

[KB] Approach to assessment

[SF] Extra-abdominal causes of belly pain:

  • Infections:
    • pharyngitis / URTI = mesenteric adenitis
    • pneumonia
    • sepsis
  • Toxins:
    • spider bite (probably not Red Back Spider)
    • ingestions eg iron
  • Metabolic:
    • HUS
    • DKA
  • Other:
    • HSP
    • abdominal migraine
    • abdominal epilepsy ??
    • functional
    • torsion testis / ovary

Tsalkidis A, Gardikis S, Cassimos D, Kambouri K, Tsalkidou E, Deftereos S, Chatzimichael A. Acute abdomen in children due to extra-abdominal causes. Pediatr Int. 2008 Jun;50(3):315-8. PubMed PMID: 18533944.

Causes of Abdominal Pain in Children

[CP] Main concern for parents and doctors is appendicitis (difficult diagnosis, medicolegal concerns, signifcant morbidity, high rate of perforation in younger children)

Other causes: (brief sketch of each):

[KB] Gastro

[SF] Constipation

[CP] Mesenteric adenitis

[KB] Functional & recurrent Abdo pain

[SF] Abdominal Migraine

[CP] Intussusception

[KB] Bowel Obstruction & incarcerated hernia

[SF] Meckel’s diverticulitis

[CP] Infants: “Colic”

(Pyloric spenosis, malrotation with midgut volvulus, NEC) – pain is not the predominant symptom

[ALL] Comments on abdo pain differentials, colic, infants & neonates

[CP] Summary, goodbye

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