Emergent evaluation of the child with acute abdominal pain
- Mark I Neuman, MD, MPH
Mark I Neuman, MD, MPH
- Associate Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Richard M Ruddy, MD
Richard M Ruddy, MD
- Professor of Clinical Pediatrics
- University of Cincinnati College of Medicine
- Section Editors
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Melvin B Heyman, MD, MPH
Melvin B Heyman, MD, MPH
- Section Editor — Pediatric Gastroenterology
- Professor of Pediatrics
- University of California, San Francisco
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The emergent evaluation of children with acute abdominal pain, including a brief description of life-threatening and common causes, will be discussed here.
The evaluation and management of children with chronic abdominal pain is reviewed separately. (See "Chronic abdominal pain in children and adolescents: Approach to the evaluation" and "Functional abdominal pain in children and adolescents: Management in primary care".)
Among children, abdominal pain is a frequent, nonspecific symptom that is typically associated with self-limited conditions such as gastroenteritis, constipation, and viral illnesses. The challenge for the clinician is to identify patients with abdominal pain who may have the following:
●Serious, potentially life-threatening conditions, such as an acute abdomen from appendicitis or bowel obstruction (as can occur from volvulus, intussusception, or adhesions); acute manifestations of inflammatory bowel disease, pancreatitis, hepatitis or intra-abdominal mass.
●Extra-abdominal infections that require specific treatment (such as streptococcal pharyngitis, urinary tract infection, or pneumonia)
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- - Trauma
- - Characteristics of abdominal pain
- - Associated symptoms
- - Past medical history
- Physical examination
- - Appearance
- - Vital signs
- - Abdominal examination
- - General examination
- Ancillary studies
- - Laboratory studies
- - Imaging
- ALGORITHMIC APPROACH
- Signs of obstruction or peritoneal irritation
- Focal physical findings
- - Extraabdominal
- - Mass
- - Focal tenderness
- Colicky pain
- Nonspecific symptoms
- Adolescent females
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS