Acute Abdominal Pain in Children

萬芳家醫科實習報告 組別 7

2003/07/31 – 2003/08/08姓名 施富傑

Pain

Visceral painParietal painReferred pain

Visceral pain

Visceral pain fibers: Bilateral,unmyelinated, enter the spinal cord at multiple area

Visceral pain: dull, poor localized

Parietal pain

Parietal pain fiber: myelinated , enter specific dorsal root ganglia

Parietal pain: sharp, intense, discrete, localized

Referred pain

Referred pain:the disease organ and remote area share the central pathways

Cause of Acute Abdominal Pain in Children

Gastroinstestinal causesLive, spleen, and biliary tract disordersGenitourinary causesMetabolic disordersHematologic disordersDrug and toxinsPulmonary causes

Clinical Evaluation

HistoryPhysical examinationInvestigationManagement

History

AgePain historyPrecipitating or Relieving factorRecent traumaAssociated symptomsGynecologic historyPast historyFamily history

Physical examination

General appearanceVital signsAbdominal examinationRectal and pelvic examinationAssociated signs

Investigation

Blood cell countUrinalysisPlain-film abdominal radiographsUltrasonographyCT

ManagementIndications for surgical consultations in Children with Acute abdominal PainSevere or increasing abdominal pain with progressive signs of deteriorationBile-stained or feculentInvoluntary abdominal guarding/rigidityRebound abdominal tendernessMarked abdominal distention with diffuse tympanySignificant abdominal traumaSuspected surgical cause for the painAbdominal pain without an obvious etiology