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Abdominal Pain (Pediatric) (Gynaecological: Menometrorrhagia /…
Abdominal Pain (Pediatric)
Renal
:
Flank pain / dysuria / cloudy and foul-smelling urine / haematuria / anuria
Obstructive
Acute Retention of Urine:
suprapubic pain,
palpable bladder, and anuria
Urolithiasis:
Colicky pain radiates from flank to groin, Groans and rolls in pain,
Infection/Inflammation
Urinary Tract Infection:
Dysuria, frequency,
urgency. Might have fever. Pre-existing Hypospadias
Gastrointestinal
:
Diarrhea / Constipation / vomiting / hematemesis / coffee-ground emesis / haematochezia / melena
Upper GIT
Gastric
Infection/Inflammation
Gastritis and Ulceration:
Mild dyspepsia (epigastric pain & bloating), anemia, loss of weight, recent onset
or rapid progression of symptoms, malena or
hematemesis, and dysphagia
GERD
:
Epigastric or retrosternal discomfort, exacerbated by lying flat,
with sour taste in mouth
Obstructive
Pyloric Stenosis:
RHC / Epigastric Pain. Post-postprandial non-bilious vomiting.Palpable mass in RHC / epigastric
Non-organic causes
Abdominal Migraine:
abdominal pain in addition to headaches, Midline pain a/w vomiting and facial pallor. FHx of Migraine
Pancreas
Pancreatitis
:
Epigastric pain radiating to back. Relieved on bending forward. Frequent vomiting and Nausea. Grey's Turner or Cullen's signs may be observed (emergency). RF: CF
Pancreatic Infarct:
RF: sickle-cell disease
Lower GIT
Non-organic causes
Irritable Bowel Syndrome
:
Pain worse before defecation and better after. Explosive, loose and mucus-stool. a/w abdominal bloating, feeling of incomplete defecation. Constipation. Worse under stress. FHx of IBS
Obstructive
Intussusception:
EMERGENCY!!
Sudden, Severe Colicky Pain, Pallor (round the mouth), Lethargy, Bilious vomiting, LOA, Palpable mass in abdomen, Redcurrent jelly stool, Abdominal distention, Shock
Intestinal Obstruction
:
pain, distension, nausea/vomiting, and lack of passage of stool
or flatus
High-pitch or absence of bowel sound
Hirschsprung Disease:
Colicky pain, vomiting, abdominal distention
Chronic Constipation:
Colicky Pain RF: Spina bifida, Hirschsprung disease
Infection/Inflammation
IBD
Generalised abdominal pain, bloody diarrhoea,
and weight loss. Clubbing and Cachetic. May have erythema nodosum, oral lesions or perianal skin tags. Puberty delayed, growth failure
FHx: IBD
Appendicitis:
LOA, Vomiting.
Pain begins initially as a generalised pain but migrates to RIF, Pain worse on flexing hips / walking / coughing. Tenderness and guarding at Mcburney's Point on palpation
Other differential: Merkel Diverticulum
Gastroenteritis
:
Milder pain; diarrhoea, nausea and
vomiting predominate over pain. May have fever. Dry mucous membrane, sunken fontanelle, Prolonged capillary refill, reduced tissue turgor, decreased urine output, cold extremities
Hepatobiliary
:
RHC pain / Jaundice / steatorrhea / pale-coloured stool / tea-coloured urine
Hepatitis:
RHC pain, fever, Nausea/vomiting.
Jaundice, hepatomegaly
Cholangitis:
RHC pain, fever, jaundice. RF: CF
Gynaecological
:
Menometrorrhagia / Menorrhagia / Metrorrhagia / Menstrual clots
Pelvic Inflammatory Disease
Torsion of Fallopian tube
Primary Dysmenorrhea
Ectopic Pregnancy
Red Flags
:
High fever / LOW / Altered Mental Status / Respiratory distress / Dehydration / Severe Colicky pain / pallor / Grey's Turner or Cullen's Sign / Rebound tenderness, Guarding on palpation / Melena / Haematemesis / pulsatile mass
Extra-abdominal
Testicular Torsion
Inguinal hernia
Lower Lobe Pneumonia
AMI
Unlocalised
:
W/O localising symptoms
Diabetic Ketoacidosis
:
RF: T1DM
Trauma
Vasculature
Abdominal Aortic Auerysm