Acute abdominal pain in children

History: 1. 2. 3. 4.

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Age of onset Pain hx: location, timing of onset, character, severity, duration, and radiation of pain Recent trauma Precipitating / relieving factors; Parietal pain is aggravated by movement. Relief of pain after a bowel movement suggests a colonic source, and relief after vomiting suggests a source in the more proximal bowel. Associated symptoms; a. Bilious vomiting bowel obstruction b. Diarrhea gasteroenteritis, food poisoning c. Bloody diarrhea IBD, infectious enterocolitis d. Current jelly stool intussucpetion e. Failure to pass flatus or feces intestinal obstruction Urinary frequency, dysuria, urgency, malodorous urine UTI g. Purulent vaginal discharge salpingitis h. Cough, SOB, chest pain thoracic source i. Polyuria, polydypsia DM j. Joint pain, rash, smoke colored urine Henoch SP Gynecologic hx Past medical hx surgical Drug hx Famoily hx

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6. 7. 8. 9. PE

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3. 4. Ix 1. 2. 3. 4. 5. 6.

General appearance- children with visceral pain tend to writhe during waves of peristalsis, while children with peritonitis remain quite still and resist movement Vital signs - Tachycardia and hypotension suggest hypovolemia. Hypertension may be associated with Henoch-Schnlein purpura or hemolytic uremic syndrome. Kussmauls respiration indicates diabetic ketoacidosis. Abdominal examination Rectal and pelvic examination FBC UFEME Pregnancy test CXR Abdominal X-ray CT scan