dr. Putra Hendra SpPDUNIBA

Common problems occur commonlyintussusception in the infantappendicitis in the childThe differential diagnosis is age-specificIn pediatrics most belly pain is non-surgicalMost things get better by themselves. Most things, in fact, are better by morning.Bilous emesis in the infant is malrotation until proven otherwiseA high rate of negative tests is OK

Pain (location, pattern, severity, timing)pain as the first sx suggests a surgical problemVomiting (bile, blood, projectile, timing)Bowel habits (diarrhea, constipation, blood, flatus)Genitourinary complaintsMenstrual historyTravel, diet, contact history

Warm hands and exam roomTry to distract the child (talk about pets)A quiet, unhurried, thorough examPlan to do serial examsDo a rectal exam

TachycardiaAlert and active/still and silentAbdominal rigidity/softnessBowel soundsPeritoneal signs (tap, jump)Signs of other infection (otitis, pharyngitis, pneumonia)Check for hernias

Newborningested maternal blood, formula intolerance, NEC, volvulus, HirschsprungsToddleranal fissures, infectious colitis, Meckels, milk allergy, juvenile polyps, HUS, IBD2 to 6 yearsinfectious colitis, juvenile polyps, anal fissures, intussusception, Meckels, IBD, HSP6 years and olderIBD, colitis, polyps, hemorrhoids

Newborningested maternal blood, drug induced, gastritisToddlerulcers, gastritis, esophagitis, HPS2 to 6 yearsulcers, gastritis, esophagitis, varices, FB6 years and olderulcers, gastritis, esophagitis, varices

CBC and differentialUrinalysisX-rays (KUB, CXR)USAbdominal CTStool culturesLiver, pancreatic function tests(Rehydrate, ?antibiotics, ?analgesiscs)

Signs of obstructionair/fluid levelsdilated loopsair in the rectum?FecalithPaucity of air in the right sideConstipation

Vascular compromisemalrotation and volvulusincarcerated hernianonreduced intussusceptionischemic bowel obstructiontorsed gonadsPerforated viscusUncontrolled intra-abdominal bleeding

Intestinal obstructionNon-perforated appendicitisRefractory IBDTumors

Common in children; rare in infantsSymptoms tend to get worsePerforation rarely occurs in the first 24 hoursThe physical exam is the mainstay of diagnosisClassify as simple (acute, supparative) or complex (gangrenous, perforated)

Can be done by inversion techniqueAbsolute indicationLadds procedureRelative indicationsHirschsprungs pullthroughOvarian cystectomyIntussusceptionAtresia repairWilms tumor excisionCDH

Typically in the 8-24 month age groupDiagnosis is historicalintermittent severe colic episodesunexplained lethargy in a previously healthy infantContrast enema is diagnostic and often therapeuticPost-op small bowel intussusception

Diagnosisnon-specific abdominal painchronic abdominal painfemale patientsundescended testestraumaTreatmentappendicitisMeckels diverticulumcholecystitisovarian detorsion/excisionlysis of adhesions

Menstrual historyregularity, last period, character, dysmenorrheaPelvic/bimanual exam with culturesPregnancy test/urinalysisUSLaparoscopyDifferential diagnosismittelschmerz, PID, ovarian cyst/torsion, endometriosis, ectopic pregnancy, UTI, pyelonephritis

Causes of Acute Abdominal Pain in Children*

GastrointestinalGastroenteritisAppendicitisMesentericlymphadenitisConstipationAbdominal traumaIntestinal obstructionPeritonitisFood poisoningPeptic ulcerMeckels diverticulumInflammatory boweldiseaseLactose intoleranceLiver, spleen, andbiliary tract disordersHepatitisCholecystitisCholelithiasisSplenic infarctionRupture of the spleenPancreatitisGenitourinary causesUrinary tract infectionUrinary calculiDysmenorrheaMittelschmerzPelvic inflammatorydiseaseThreatened abortionEctopic pregnancyOvarian/testicular torsionEndometriosis

Metabolic disordersDiabetic ketoacidosisHypoglycemiaPorphyriaAcute adrenal insufficiencyHematologic disordersSickle cell anemiaHenoch-Schnlein purpuraHemolytic uremicsyndromeDrugs and toxinsErythromycinSalicylatesLead poisoningVenoms

Pulmonary causesPneumoniaDiaphragmatic pleurisy

MiscellaneousInfantile colicFunctional painPharyngitisAngioneurotic edemaFamilial Mediterraneanfever------------------------------------------------------------------------------------------------------------ *(Am Fam Physician june 1,2003 volume 67)

Differential Diagnosis of Acute Abdominal Pain by Predominant Age*

Birth to one yearInfantile colicGastroenteritisConstipationUrinary tract infectionIntussusceptionVolvulusIncarcerated herniaHirschsprungs disease

Two to five yearsGastroenteritisAppendicitisConstipationUrinary tract infectionIntussusceptionVolvulusTraumaPharyngitisSickle cell crisisHenoch-Schnlein purpuraMesenteric lymphadenitis Six to 11 yearsGastroenteritisAppendicitisConstipationFunctional painUrinary tract infectionTraumaPharyngitisPneumoniaSickle cell crisisHenoch-Schnlein purpuraMesenteric lymphadenitis

12 to 18 yearsAppendicitisGastroenteritisConstipationDysmenorrheaMittelschmerzPelvic inflammatory diseaseThreatened abortionEctopic pregnancyOvarian/testicular torsion----------------------------------------------------------------------------------------------------- *(Am Fam Physician june 1,2003 volume 67)