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Acute abdominal pain (causes (acute appendicitis (anorexia, central pain…
Acute abdominal pain
causes
inflammatory bowel disease
blood/mucous in stools
FHx diarrhoea
weight loss and poor growth
acute appendicitis
anorexia
central pain localising to RIF
peritonism in RIF
tachycardia
MOST COMMON
henoch-schonlein purpura
purpuric rash on legs
joint pain
UTI
dysuria, frequency
bedwetting
back pain
vomitting
evidence of infection on urinanalysis or microscopy
Mesenteric adenitis
recent viral infection
no peritonism
pain can mimic appendicitis
COMMON
constipation
hard or infrequent stool
mass in LIF
faecal loading on xray
intestinal obstruction
bile-stained vomitting
abdominal distension
consider a volvulus
intussusception
intermittent, screaming colic
shock/pallor
'red current jelly' stool
3-24 months old
diabetes
diabetic ketoacidosis
lower lobe pneumonia
signs of pneumonia
referred abdo pain
peptic ulcer
pain at night
relief with milk
helicobacter pylori
renal calculi
hydronephrosis
gastroenteritis
vomitting and diarrhoea
investigations
FBC
leucocytosis in acute appendicitis and UTI
urine dipstick
nitrite +ve in UTI
haematuria w HSP
urine microscopy and culture
pyuria and presence of organisms indicate infection
AXR
dilated bowel loops = intestinal obstruction
abnormal gas pattern = intussusception
faecal loading = constipation
Abdo USS
exclude renal tract abnormality
barium enema
intussusception
CRP/ESR
may be elevated in infection and IBD
examination
vital signs
inspection
palpation
superficial
deep
peritonism
lymphadenopathy
percussion
observation
auscultation
history
pain in young children may present w intermittent unexplained screening
pallor and screaming are suggestive of intussusception
older children may point to the pain
blood in stool
IBD
intussusception
henoch-scholein purpura
some types of gastroenteritis
important to ask about associated symptoms
vomitting and diarrhoeaa
recent viral infection
joint or urinary symptoms
loss of appetite