Pediatric acute abdominal pain
Things that you want to keep in mind, acute
abdominal pain
We’ll be focusing upon the following
Acute gastroenteritis being the most common
We’ve talked about rotavirus as being the
– the virus being very common
We also talked about salmonella, Campylobacter jejuni so and so forth
Let’s start talking about ages here once
again
Acute abdominal pain
Less than two years of age: trauma, intussusception, incarcerated hernia
What does that mean?
This was an inguinal hernia which went through
the inguinal canal
It became – What became?
The intestine became strangulated
It became incarcerated
What are you worried about in acute abdominal
pain?
Rupture, peritonitis and death
Volvulus, urinary tract infection
Less than two years of age
2 to 5: African-American boy, sickle cell
anemia
What does that mean to you?
This means that there is vaso-occlusive crisis
especially when this African-American boy is playing
There’s sickling of the RBC, therefore
decreased blood supply to the, maybe perhaps
the mesentery
Welcome to acute abdominal pain with sickle
cell anemia
Even amazingly — look at this, this is no
joke
Lower lobe pneumonia, more common
than you would think in clinical practice
This is a child and you're thinking, “Dr.
Raj, is that a mistake?
You’re saying pneumonia causing acute abdominal
pain?”
When the lungs are in the chest, remember this is a child
so therefore, lower lobe pneumonia
which is right above the diaphragm
is going to be very close to his abdomen
and in a child between ages of two to five
years of age, in fact
is a very common cause of acute abdominal pain
And the x-ray here may or may not even show
changes in a child
So it behaves atypical
Keep that in mind
Big time
Urinary tract infection here as well
Older children, so now we’re getting into
eight years, ten years, eleven years and such
and we have appendicitis
Mittelschmerz, ectopic pregnancy
and pelvic inflammatory disease Many of these are actually very much in a female
Mittelschmerz means — Remember
in the middle of the menstrual cycle is
when the egg egg is being released from the ovary
Picture that
The follicles rupturing from the ovary, there
goes the egg
Who’s going to catch it?
“I got, I got it.”
Who’s the mitt?
Who’s the catcher?
The fallopian tube and the fimbriae
And during that time when the follicle ruptures
you might get a little bit of blood in the peritoneum
That will cause acute abdominal pain in a
female
Welcome to mittelschmerz
And we have ectopic pregnancy
Think about ectopic pregnancy
As the egg which has not been fertilized instead of being planted in the uterus
in that female may get then obviously trapped in the fallopian tube
Acute abdominal pain
and PID being one of the most common causes of ectopic pregnancy
Use common sense, use the information that we’ve accumulated
accumulated, accumulated
and go with the ages here and make the correct
diagnosis
Age becomes, as you can see here, incredibly important for differentials
Diagnosis, all etiologies
GI, reproductive, renal, all of that area
Consider CBC to help you figure out
Urine analysis becomes important
Pregnancy test
Maybe it’s pancreatitis, right?
Pancreatitis
Cystic fibrosis, pancreatitis, abdominal pain
Liver function tests, chest x-ray, abdominal x-ray, CT scan
depending as to what your cause is

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