Download - Pediatric abdominal pain
The Approach and the differential
Praneel KumarBundaberg Hospital Emergency Department
● Sneak a peak – wealth of information simply by observing the child from the door way
● Detailed history – parents and kids are poor historian
● Fear of 'stethoscope' and white coat● Unique presentation
• Child's level – kneel or sit near the child as opposed to standing over the child
• Distract with toys• Use parent-- let mum do the abdominal
exam• Peritoneal signs – bounce the baby • Take off diaper• Rectal exam – only if indicated -generally
not helpful
● Remember Extra- abdominal cause – full examination
● VITAL SIGNS ARE VITAL -Don't memorize – have a reference card
● Importance of observation – in Dem or in the ward
● Most kids are going home● Kids live longer to face the
consequences of radiation● Surgical disease turn bad quickly
● In terms of the age of the child● Surgical Emergencies of
Abdopelvic/non surgical GI disease and Extra-abdominal
● 1/3 kids -appendix ruptures before operation
● Classical presentation of appendicitis is seen less often in peads compared to adults – eg loss of appetite
● WBC-- neither sensitive nor specific
● Pain meds or anti emetic do not delay diagnosis
● Rectal exam- not helpful
● Ultrasound -- Investigation of choice
● 2nd most common cause of abdominal emergency
● 3months to 6years ( peak – 5-9 months of age )
● 90% are ileocolic and idiopathic in nature
● Red current jelly stool and palpable mass – not common
● Fecal occult blood positive more common -rectal exam to test fecal occult blood
● Ultrasound -investigation of choice
● Infant with bilious vomiting – volvulus until proven otherwise
● Abdomen usually soft and non tender until strangulation of the bowel has developed – distended and tender
● Investigation of choice –xray and ultrasound
● Time is bowel
● Take the diaper off – most common is inguinal hernia
● Get the surgeons involve early
● Acute Gastroenteritis● Constipation● Functional abdominal pain or non
specific abdominal pain
Which of 2 diagnosis are found on emergency discharge records most frequently for missed pediatric abdominal catastrophies in court cases??
● 1.Gastroenteritis● 2. Constipation
● Pneumonia● Group A beta hemolytic streptococal
pharyngitis
● Recheck and document exam before discharge
● Good discharge instruction are key-- movie analogy
● Follow up –revisit or phone follow up