1. ACUTE ABDOMEN
Department of Paediatrics
Pt. J. L. N. Hospital & Research centre
Bhilai
Dr. SUBODH KUMAR SAHA
2. TYPES OF ABDOMINAL PAIN
Visceral Pain - Dull
poorly localised,
usually periumbilical
Parietal pain - sharp,
intense,
discrete
Referred pain - same features as parietal
pain
3. Site of pain
Foregut structures epigastrium
(oesophagus & stomach)
Midgut structures periumbilical
(small intestine)
Hind gut structure lower abdomen
(large intestine & rectum)
15. Differential Diagnosis of Acute
Abdominal Pain by Predominant Age
Birth to one year
Infantile colic
Gastroenteritis
Constipation
Urinary tract infection
Intussusception
Volvulus
Incarcerated hernia
Hirschsprung's disease
16. Two to five years
Gastroenteritis
Appendicitis
Constipation
Urinary tract infection
Intussusception
17. Two to five years
Volvulus
Trauma
Pharyngitis
Sickle cell crisis
Henoch-Schönlein purpura
Mesenteric lymphadenitis (adenovirus)
18. Six to 11 years
Gastroenteritis
Appendicitis
Constipation
Functional pain
Urinary tract infection
19. Six to 11 years
Trauma
Pharyngitis
Pneumonia
Sickle cell crisis
Henoch-Schönlein purpura
Mesenteric lymphadenitis
20. 12 to 18 years
Appendicitis
Gastroenteritis
Constipation
Dysmenorrhea
Mittelschmerz
Pelvic inflammatory disease
Threatened abortion
Ectopic pregnancy
Ovarian/testicular torsion
21. Evaluation of Acute Abdominal
Pain in Children
Pain History
Recent Trauma
Precipitating or Relieving Factors
Associated Symptoms Vomiting,
Diarrhea
Urinary frequency,
Dysuria,
Polyuria & polydipsia
Henoch - Schönlein purpura - Joint pain, rash, and
smoke-colored urine suggest
22. Gynecologic History.
History of sexual activity and contraception
Amenorrhea
Use of an IUD suggest - PID
Sudden onset of midcycle pain of short
duration suggests - mittelschmerz
30. Investigations
HB URINE X RAY Abd.
TLC PUS CELLS USG
DLC RBCS CT SCAN
ESR
SICKLING
PS
31. Indications for Surgical
Consultations in Children
Severe or increasing abdominal pain with
progressive signs of deterioration
Bile-stained or feculent vomitus
Involuntary abdominal guarding/rigidity
Rebound abdominal tenderness
32. Indications for Surgical
Consultations in Children
Marked abdominal distension with diffuse
tympany.
Signs of acute fluid or blood loss
Significant abdominal trauma
Suspected surgical cause for the pain
Abdominal pain without an obvious etiology
37. Treatment
Reduction with air enema
Reduction with saline enema
Reduction with radiocontrast
material
38. Functional abdominal pain
Abdominal pain that cannot be
explained by structural, physiological or
pathological abnormality.
39. Functional abdominal pain includes several
different types of chronic abdominal pain
recurrent abdominal pain
three or more bouts of abdominal pain (belly ache) in
children 4-16 years old over a three-month period severe
enough to interfere with his/her activities.
located around the umbilicus
functional dyspepsia,
upper abdominal pain
nausea, vomiting,
irritable bowel syndrome (IBS).
pain relieved by motion
change in stool frequency
change in stool consistency
42. Absence of red flag signs
Fever
Wt. loss
Poor growth
Joint pain
Mouth ulcer
Unusual rashes
Loss of appetite
Hemetemesis
Melena
Night time awakening due to pain or diarrhoea
52. Physical examination
Shows normal weight gain
Differential diagnosis
Overfeeding
Underfeeding
Milk Allergy
Early introduction of foods
GERD
No burping after feeds
53. MANAGEMENT
SIMETHICONE
Reduces the surface tension of bubbles
over intestinal surface.
Anticholinergic drugs
dicyclomine/ dicycloverine
relax muscles in the wall of the gut
side effects : drowsiness. Apnoea
diarrhoea constipation seizures
55. Abdominal crisis sickle cell
anemia
Belongs to a perticular community
H/o blood transfusion,joint pain
May be associated with jaundice
Anemia
56. Abdominal crisis in SCA
Sequestration crisis
Sudden enlargement of spleen
Shock
Pallor
Treatment: Blood transfusion
