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Abdominal Pain
Pediatrics
34
Medical
Pre-School
12/05/2011

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Term
how can acute abdominal pain be approached?
Definition
the likelihood of disease (age); complaints and other associated symptoms; physical examination; laboratory tests and imaging studies
Term
pain receptors in the abdomen
Definition
visceral and mucosal receptors
Term
visceral receptors
Definition
on serosal surfaces within the mesentery
respond to mechanical and chemical stimuli
Term
mucosal receptors
Definition
respond to chemical stimuli
Term
Types of pain
Definition
visceral, referred and localized pain
Term
visceral pain
Definition
poorly localized in the midline
Term
referred pain
Definition
in the viscera originating from a site distant from the affected organ
Term
localized pain
Definition
parietal peritoneum becomes inflamed
Term
what are the associated symptoms of abdominal pain?
Definition
constipation - bowel obstruction
fever, anorexia - appedicitis
surgical emergency - fever, protracted vomiting, syncope, or presyncope, and GI bleed
Term
physical examination for abdominal pain
Definition
inspection (jaundice, distention, evidence of bleeding or bruising)
auscultation (bowel sounds, bruits)
palation (masses or organomegaly, hernias, guarding, rebound tenderness)
percussion
special testing
general appearance
Term
physical examination cont'd
Definition
murphy's sign -chlesystitis
mcburney's point - appendicitis
psoas sign - appendiciis
obturators sign - appendicitis
Term
common signs of appendicitis
Definition
RLQ pain on palpation
low grade fever
localized tenderness to percussion
guarding
psoas sign (extension of right thigh)
obturator sign (nternal rotation of right thigh)
rovsing's sign - pain in RLQ with palpation of LLQ
Dunphy's sign - pain with coughing
McBurney's point
Term
Lab tests: CBC, Amylase and lipase, UA
Definition
CBC - infeciton or blood loss
Amylase and lipase - suspect pancreatitis
UA - hematuria, dysuria or back pain
Term
Imaging studies based on quadrants
Definition
RUQ - ultrasound
LUQ - CT
RLQ - CT with IV contrast
LLQ - CT with oral and IV contrast
suprapubic - ultrasound
plain films to detect free air, bowel obstruction
Term
RUQ symptoms
Definition
pulmonary symptoms - PE or pneumonia
Urinary symptoms - UA positive -UTI or pyelonephritis
Colic - hepatobiliary or nephrolithiasis
Term
RLQ pain
Definition
fever or pain that moves from periumbilical to RLQ - peritonitis or appendicitis - CT with IV contrast
no fever or movement of pain -assess psoas sign, rigidity, rebound, guarding or pain on right side of rectum
Term
LLQ abdominal pain
Definition
fever or diverticular disease; assess for abdominal distention, tenderness and rectal bleeding
CT with oral and IV contrast
Term
LUQ pain
Definition
variety of clinical conditions
if history suggests esophageal or gastric pathology - endoscopy or upper GI series
older patinets - CT to image pancreas, spleen, kidneys, intestines, and vasculature
Term
plain films of the abdomen
Definition
more readily available and less expensive
free air - perforated viscus
abnormal calcifications - gallstones kidney stones, appendicholiths
Term
women with abdominal pain
Definition
ectopic pregnancy, ovarian cysts, uterine fibroids, pelvic inflammatory disease, tubo-ovarian abcesses, endometriosis
Term
appendicitis
Definition
fever, leukocytosis, localize pain to the RLQ
Term
cholycystitis
Definition
RUQ pain associated with fever and leukocytosis; older patients are more likely to prsent with generalized pain, decreased bowel sounds, a mass, rigidity, longer duration of pain
Term
acute pancreatitis
Definition
midepigastric pain, decreased bowel sounds, nausea, emesis, pain radiating to back; advanced age has 20-30% mortality rate; general population has 8-10%
Term
peptic ulcer disease and perforation
Definition
midepigastric pain, nausea, emesis, fever, pain worse with eating or anorexia; 16% of older patinets complain of abdominal pain
Term
diverticular disease
Definition
fever, leukocytosis, LLQ pain, incidence increases with age; 10-30% with diverticular disease will have diverticulitis or painful disease
Term
small bowel obstruction
Definition
generalized abdominal pain, decreased bowel sounds, distended abdomen, fever, leukocytosis
most commonly caused by adhesions from previous surgeries (50-70%)
gallstone ileus - rare cause; more common in women
Term
Large bowel obstruction
Definition
malignancy is most common cause
Term
abdominal aortic aneurysm
Definition
infrarenal and extend to iliac
highest risk older men who use tobacco, have hypertension, or peripheral vascular disease and family history of abdominal aortic aneurysm
Term
acute mesenteric ischemia
Definition
uncommon but fatal in older patients
superior mesenteric artery - more commonly affected
severe, poorly localized pain out of proportion to physical findings
Term
abdominal pain in children you should look at
Definition
age, pain history, recent trauma, precipitating or relieving factors, associated symptoms, gynecologic history, past health, family history (cystic fibrosis)
Term
children with acute abdominal pain
Definition
nausea, vomiting, fever, anorexia, change in activity level, abdominal distention, rash, diarrhea, constipation
Term
common causes of pediatric acute abdominal pain
Definition
colic, constipation, gasteroenteritis, streptococcal pharyngitis, UTI, pneumonia, viral illness
Term
indications for surgical consult in children with acute abdominal pain
Definition
severe or increased abdominal pain with signs of deterioration
bile stained or feculent vomit
involuntary abdominal distention
signs of acute fluids or blood loss
significant abdominal trauma
suspected surgical cause
abdominal pain without obvious etiology
Term
life threatening causes of abdominal pain in children and adolescents
Definition
trauma, appendicitis, intussusception, malrotation of midgut volvulus, incarcerated inguinal hernia, adhesions, necrotizing enterocolitis, peptic ulcer disease, ruptured ovarian cyst or ovarian torsion, ectopic pregnancy, PID, foreign body ingestion, hemolytic uremia syndrome, diabetic ketoacidosis, primary bacterial peritonitis
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