Differential diagnosis when evaluating a patient with acute abdominal pain. Chronic pain is noncyclic pelvic pain that lasts 6 months or longer which is severe enough to cause functional disability or the. Acute abdominal pain american academy of pediatrics. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. The causes of an acute abdomen are listed in this chapter. Diagnostic approach and management of acute abdominal pain article pdf available in acta medica indonesiana 444. The most common approach to the diagnosis of abdominal pain focuses on the location of the pain, with a separate grouping for causes of diffuse abdominal pain. Patients with splenic infarction typically present with fever as well as leftsided abdominal pain.
Musculoskeletal abdominal pain, in contrast to visceral abdominal pain, is sharp and localized to an area of the abdominal wall usually smaller than 2 cm. Pdf diagnostic approach and management of acute abdominal. See what you know about diagnosing abdominal pain by considering in which quadrant of the body its located. Pain localization, which requires knowledge of gut development and. Furthermore, abdominal examination of young children with abdominal pain is challenging. According to the data from turkish statistics institute in 2004, 350432 patients with peptic ulcer, gastritis, duodenitis, appendicitis, intestinal obstruction and hernia, all of whom presented with abdominal pain, were hospitalized. Sharieff, mdb apediatric emergency medicine, keck usc school of medicine, 755 woodward boulevard, pasadena, ca 91107, usa bchildrens hospital and health center, university of california, san diego, 3030 childrens way, san diego, ca 92123, usa abdominal pain and gastrointestinal. Abdominal pain is the most common reason for a visit to the emergency department ed, accounting for 8 million 7% of the 119 million ed visits in 2006. Diagnostic approach to abdominal pain in adults 92114, 9. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist. Request pdf approach to the patient with abdominal pain the gastroenterologist routinely has to deal with abdominal pain as it is one of the commonest symptoms that patients experience. Approach to imaging of pelvic pain in the female patient acute pelvic pain chronic pelvic pain dysmenorrhea acute and chronic pelvic pain definition acute pain is intense pain characterized by sudden onset. Although a common presentation, abdominal pain must be approached in a serious.
The initial assessment should attempt to determine if the patient has an acute surgical problem that requires immediate and prompt surgical intervention, or urgent medical therapy. Abdominal mass general presentation an abdominal mass in a neonate, young child, or adolescent patient is something that every pediatrician needs to be wary of as these masses can indicate malignancy. Pediatric abdominal pain is often a diagnostic dilemma. The term recurrent abdominal pain, or rap, refers mainly to the duration of painful period and frequency of pain. Those with a splenic cyst are either asymptomatic or present with dull leftsided abdominal pain in the absence of fever. Diagnostic approach and management of acute abdominal. The commonly accepted duration is at least three months in the preceding period, and over this threemonth period, there are at least three episodes of pain that are severe enough to affect the daily activities of the affected patients. A detailed history of how the pain started, how it progressed, its location, and other associated factors can often suggest a diagnosis of functional pain.
The causes of pediatric abdominal masses are extensive, ranging from benign to neoplastic, and often originating from organs within the intra abdominal cavity table. Abdominal pain is one of the most common reasons for outpatient and er visits a lot can happen in the abdomen and you need an organized approach just a few diagnoses to ponder. This is video about looking for abdominal pain caused in the abdominal wall. Differential diagnosis mapped to location of abdominal pain some conditions can cause pain in different regions, and it may be difficult to associate the disease with the location of the pain. Apart from patients history, physical examination, laboratory results, imaging through ultrasound and ct scan are often indicated to establish the definite diagnosis and treatment.
History of pain frequency and duration character of the pain. The etiology of the pain may be any of a large number of processes. Approach to abdominal pain online emergency medicine. Aug 01, 2019 pediatric abdominal pain can be caused by a diverse set of pathologies that span the entire spectrum of disease severity. Crosssectional survey investigators from childrens mercy hospital, kansas city, mo, and the university of kansas, lawrence, explored how children with abdominal pain are viewed, assessed, and treated by pediatric gastroenterologists. Foundations frameworks approach to pediatric abdominal pain author. Evaluation of abdominal pain in the emergency department hartmut gross, m. Vol 44 number 4 october 2012 diagnostic approach and management of acute abdominal pain 347 is a common early complaint of acute abdominal. Approach to pediatric abdominal pain general presentation background abdominal pain in a child is one of the most common presentations with both trivial and lifethreatening etiologies, ranging from functional pain to acute appendicitis. Although clinically challenging, with the correct approach, managing the child with functional. Approach to pediatric abdominal pain learn pediatrics. Pain may also be reported in the left side of the chest or the left shoulder. I have chosen this topic due to common presentation of pediatric patients in emergency and out patient department.
The backbone for the diagnosis of cawp centers around the carnetts test. Since the book first appeared, it has remained the classic treatise on the initial approach to abdominal pain. Foundations frameworks approach to pediatric abdominal pain. Approach to abdominal pain department of emergency medicine. Most gastrointestinal manifestations of cf present with regional abdominal pain. Evaluation of acute abdominal pain in adults sarah l. The most common causes of acute abdomen are appendicitis. Pdf approach to patient with abdominal pain mucahit. In the majority of cases in adults, the diagnosis of acute abdominal pain can be established on clinical grounds without resort to extensive investigation. Abdominal masses are often incidentally discovered by a parent while bathing the child, palpated unexpectedly on routine physical examination, or detected on abdominal imaging. It is a common problem and, although the vast majority of these episodes are benign and selflimiting, persistent abdominal pain may signify an underlying pathology requiring urgent intervention. Acute abdominal pain has an onset over minutes but can persist for days.
Pain in the abdomen is the single most important symptom of an acute abdominal pathologic process. A systematic approach for the assessment and diagnosis. Stair, md acute abdominal pain approximately 510% of ed visits 5 million visits annually most common diagnosis is. Evaluating abdominal pain requires an approach that relies on the. The evaluation of the child or adolescent with chronic abdominal pain will be discussed here. Emergency medicine bord approach to abdominal pain. An integrative approach to abdominal pain in children. The most common causes of acute abdomen are appendicitis, biliary colic, cholecystitis, diverticulitis, bowel obstruction, visceral perforation, pancreatitis. It is the symptom that brings the patient to his physician. Acute abdominal pain is usually a selflimiting, benign condition that is commonly caused by.
Because of multiple organ systems, varied pathology from life threatening to benign, and differences in presentation related to sex and age, identifying a final diagnosis is a challenge. The workup of patients with chronic abdominal pain can be extremely challenging as clinicians are responsible for determining whether the patient can be observed or treated symptomatically or this abdominal pain heralds a more systemic disease. Maneesha agarwal, md and kristen grabow moore, md, med. Types of pain visceral pain dull,poorly localised in midline epigastrium, periumblical, or hypogastrium because afferent fibres transmit to both sides of spinal cord. Fortunately, studies of the accuracy of history and physical examination for the more serious causes of abdominal pain eg, acute appendicitis. Recurrent abdominal pain rap is common in children, and affects about 10%20% of schoolgoing children. A positive carnetts sign has a diagnostic accuracy of 97% for abdominal wall pain. An approach to lower abdominal pain dr kay karlsson causes of abdominal pain commonest causes my approach a few unusual cases diverticulitis and current management.
The underlying etiology of abdominal pain can be distention, contraction, compression, and torsion of abdominal contents with other pathological reasons. Abdominal pain can be classified into acute or chronic ranging from benign, selflimiting condition to life threatening conditions. An integrative approach to abdominal pain in children matthew hand do director, pediatric nephrology and integrative medicine new hampshires hospital for children. Diagnostic approach and management of acute abdominal pain. Disclosures nothing to disclose thanks to mark integlia md, our peds gi.
It has a large number of possible causes and so a structured approach is required. Acute abdominal pain can be classified according to its location and nature, history, or associated signs table 1. Pdf diagnostic approach and management of acute abdominal pain. The location of pain is a useful starting point and will guide further evaluation. Dividing the abdomen based on the location of pain and tenderness can aid in the development of a dif ferential diagnosis fig. Abdominal emergencies of hospital visits may include surgical and nonsurgical emergencies. Aug 15, 2012 clinical approach to a patient with abdominal pain slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Acute abdominal pain represents the cardinal symptom of a large number of intra abdominal pathologies. An integrative approach to abdominal pain in children matthew hand do director, pediatric nephrology and integrative medicine new hampshires hospital for children elliot hospital system. Acute abdominal pain in adults approach to the patient.
Acute abdominal pain in adolescents approach to the patient. Abdominal pain is a common reason for referral to a gastroenterologist. Approach to the patient with abdominal pain request pdf. Because acute, severe abdominal pain is still a common problem whose misdiagnosis can result in quick death, each generation of beginning physicians is faced with the. Abdominal pain in children university of new mexico. Apley and naish, who documented rap in children in the middle of last century, noted that in the vast majority of cases, no organic causes could be. This quiz will provide you with sample patient scenarios. A more complete differential diagnosis of abdominal pain and its pathophysiology is discussed separately. Evaluation of acute abdominal pain in adults american.
Recurrent abdominal pain rap, defined by apley as a minimum of three episodes of pain occurring over three months or more,1 is the most common chronic pain reported by school aged children and. Approach to acute abdominal pain emergency medicine clinics. The differential diagnosis of abdominal pain is extensive making a concise approach sometimes difficult. Evaluating abdominal pain requires an approach that relies on the likelihood of disease, patient history, physical examination, laboratory tests, and imaging studies. The relationship between abdominal pain regions and specific diseases. An approach to the patient with chronic undiagnosed. Christopher cheung approach to pediatric abdominal. Christopher cheung approach to pediatric abdominal pain. Evaluation of abdominal pain in the emergency department. Pdf the incidence of acute abdominal pain ranges between 510% of all visits at emergency department. Abdominal pain in individuals with cf is challenging for the patient as well as the physician, as the differential diagnosis can be complex. If you continue browsing the site, you agree to the use of cookies on this website.
Abdominal xr is common, but has low specificity and sensitivity for most etiologies of pain. A stick and a burn our approach to abdominal wall pain. An approach to the patient with chronic undiagnosed abdominal. Approach to pediatric abdominal pain slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Evaluation and management of acute abdominal pain in the. Abdominal pain in children maureen mccollough, md, mpha,t, ghazala q. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Who guidelines for management of chronic pain in adults. The stanford medicine 25 program for bedside medicine at the stanford school of medicine aims to promote the culture of. Approach to acute abdomen authorstream presentation. Pdf approach to patient with abdominal pain mucahit emet. This twopart series will discuss a brief pathophysiology of abdominal pain and an approach to the initial history and physical exam in a pediatric ed patient population. The evaluation of the child or adolescent with chronic abdominal pain requires an understanding of the pathogenesis of abdominal pain, the most common causes of abdominal pain in children and adolescents, and the typical patterns of presentation. Prevalence and diagnosis challenges between 10 and 25 percent of schoolage children have had abdominal pain within the last three months that has interfered with activities.
Approach to acute abdominal pain gastrointestinal emergencies. The incidence of acute abdominal pain ranges between 510% of all visits at emergency department. Jul 21, 20 part 1 using history elements part 2 using physical exam to approach abdo pain part 3 using lab tests and imaging tests to approach abdo pain part 4 putting it toget. In functional pain, growth is good and the physical exam is normal. Pediatric gastroenterologists approach to chronic abdominal pain. The acute abdomen is defined as a sudden onset of severe abdominal pain of less than 24 hours duration. Another 15% experience pain, but do not go to the doctor for it. Many of these causes will be benign and selflimited, while others are medical urgencies or even surgical emergencies. Heikkinen m, pikkarainen p, eskelinen m, julkunen r. While proceeding the pediatric abdominal pain, we have to know some basics of it.
Additionally, the history may be limited and a good physical exam can be difficult. Apr 01, 2008 acute abdominal pain can represent a spectrum of conditions from benign and selflimited disease to surgical emergencies. Two other factors that need to be considered up front with abdominal pain include sex and age. This chapter deals with the investigations and assessment of a patient presenting with acute abdominal pain. Evaluation of abdominal pain in children approach bmj.
Gps ability to diagnose dyspepsia based only on physical examination and patient history. Approach to chronic abdominal pain in cystic fibrosis. An acute exacerbation of chronic abdominal pain should not be described as acute abdominal pain. Abdominal pain is the most common reason for a visit to the emergency depart ment accounting for 8 million 7% of the 119 million emergency department ed. Approach to abdominal pain 1 risk stratify be very careful with elderly, immunocompromised, and diabetic patients. A free powerpoint ppt presentation displayed as a flash slide show on id. For example, right lower quadrant pain strongly suggests appendicitis. Practice guidelines for primary care of acute abdomen 2015. Apr 28, 2015 todays topic of my presentation is approach to pediatric abdominal pain. Abdominal trauma should be considered when abdominal pain is out or proportion to physical exam findings.